EDOF IOLs Research Articles

Objective measurement of intraocular lenses using the VirtIOL device

Purpose. The primary goal of this study was to evaluate the resolution of three different intraocular lenses using the VirtIOL device. The secondary objective was to determine the contrast achieved by these lenses. Material and Methods. An in-vitro assessment of three intraocular lenses (including a single vision IOL, a trifocal IOL and an EDOF IOL) was performed using the VirtIOL device. The key feature of this apparatus is a table-mounted device that allows the user to look through an IOL along the optical axis at a target at any distance. An industrial camera “UI-3040CP-C-HQ Rev.2 (AB02491)” (Co. Navitar, USA) was mounted on the chin rest of the VirtIOL. The USAF 1951 test chart was presented at the following distances: 6 m, 1 m and 0.4 m. The IOLs were each mounted in a model eye. The resolution capability, expressed as line pair per mm [lp/mm] and contrast values were measured under photopic conditions at a system aperture of 3 mm. The measurement of the contrast values was repeated ten times with each lens at each distance. Results. All IOLs (monofocal/trifocal/EDOF) achieved a resolution of 0.445 lp/mm at a distance of 6 m, as well as 1.00 / 2.82 / 2.52 lp/mm at 1 m. The measurement of resolution at the distance of 0.4 m resulted in 1.00 / 3.56 / 1.12 lp/mm. At various test distances, the following mean contrast values and standard deviations were obtained: 236 ± 8.1 / 115 ± 2.5 / 123 ± 3.9 (p < 0.001) at 6 m, 96 ± 0.8 / 75 ± 0.7 / 81 ± 0.7 (p < 0.001) at 1 m and 36 ± 0/ 42 ± 0.7 / 36 ± 0.4 (p < 0.001) at 0.4 m. Conclusion. The VirtIOL device in combination with the measuring camera used provides a basis for objective measurements of IOLs. The resolution capability of the three IOLs increases with decreasing distance, whereas the contrast values decrease. This study confirms the usefulness of the setup and provides a basis for further evaluations of intraocular lenses with the VirtIOL device. Keywords intraocular lenses, VirtIOL, virtual implantation, resolution capability, contrast

Mix-­and­-match Implantation of Multifocal and Extended Depth of Focus IOLs

Purpose: Analysis of results of combined implantation of non­diffractive IOL with extended depth of focus and multifocal IOL.Materials and methods. The study included 40 patients (80 eyes) after cataract phacoemulsification or clear lens removal with a mean follow­up of 15.4 ± 1.2 (12–22) months. Women accounted for 60 % (n = 24) and men for 40 % (n = 16). 20 patients (40 eyes) with bilateral AcrySof IQ Vivity implantation formed the minimonovision group (group I), and 20 patients (40 eyes) with AcrySof IQ Vivity implantation in the dominant eye (n = 20) and Acrysof IQ Panoptix implantation in the non­dominant eye (n = 20) formed the group of mix­-and­-match implantation (group II).Results. At the maximum follow­up period of 3 months, UCNVA in group I was 0.61 ± 0.14, in group II — 0.82 ± 0.09 (p = 0.048), BCNVA — 0.66 ± 0.17 and 0.92 ± 0.14, respectively (p = 0.039). No significant differences were found between groups comparing UCIVA, BCIVA, UCDVA and BCDVA (p > 0.1), but slightly higher values were determined in patients after bilateral implantation of Acrysof IQ Vivity IOLs. In group I, 2 patients (10 %) had glare and 2 (10 %) had halo. Patients did not complain about difficulties in driving in the darkness. In 9 cases out of 20 (45 %) patients required spectacle correction for reading. In group II, adverse optical phenomena were identified in 7 patients (35 %), of which 4 patients (20 %) had glare and 3 (15 %) had halo. None of the patients required spectacle correction for reading. In both groups, 95 % of cases (19 patients) rated the surgical outcome as “excellent” and 5 % (1 patient) as “good”. Conclusion. For the first time in Russia, the results of combined (mix­-and­match) implantation of EDOF and trifocal IOLs in comparison with bilateral IOL implantation in presbyopic patients were analyzed. The advantage of combined implantation for achieving better near visual acuity and comparable incidence of adverse optical phenomena was shown.

Возможности использования интраокулярной коррекции со сложной оптикой у пациентов с эпимакулярным фиброзом

Еpimacular fibrosis (EMF) occupies one of the leading positions in the structure of retinal surgical diseases. Vitreoretinal surgeons often face the necessity to perform combined surgical intervention in patients with native lens. Multifocal IOLs and IOLs with complex optics are strongly contraindicated for implantation in patients with macular pathology. However, not so long ago the ophthalmologic world was presented with an innovative method of presbyopia correction using EDOF IOLs (Extended depth-of-focus). Purpose. To study the use of intraocular correction with complex optics in patients with epimacular fibrosis. Material and methods. 14 patients of different genders with clinically significant EMF and initial cataract were included in the study. Patients underwent combined surgery including phacoemulsification (PEK) with implantation of EDOF IOL (Synthesis+ (Cutting Edge), France) and subsequent standard vitrectomy surgery. All patients underwent standard ophthalmologic examination before surgery and one month after surgical treatment. Results and discussion. We found that the distance vision after one month had a significant increase. Determination of IEP at the middle distance also recorded an increase. We recorded a statistically significant increase in the RPE at close distance visometry, which is probably explained by the elimination of central opacity of the own crystalline lens, preventing the ability of clear focusing of vision in the presence of presbyopic refraction. Keywords: epimacular fibrosis, facovitrectomy, EDOF, presbyopia, cataract, IOL

The BVI ISOPURE® 123 intraocular lens: a new hydrophobic preloaded extended monofocal IOL with intermediate vision correction.

PubMed, Web of Science, Scopus, and Google Scholar searches were conducted for published research articles featuring the ISOPURE 123 IOL. Excellent uncorrected and corrected binocular distance visual acuity of at least 20/25 can be achieved; uncorrected binocular intermediate vision of 20/25 or better in 81% and 50% at 80 cm and 66 cm, respectively, and 42% binocular near vision of 20/40 or better can be achieved. The defocus curve showed good visual acuity at far and intermediate distances with a depth of focus value of 1.50 D. Photic phenomena are minimal compared to other EDOF IOLs. Excellent contrast sensitivity was maintained compared to a standard monofocal IOL. Studies show that this isofocal optic design IOL provides excellent visual performance for far vision and functional intermediate vision with an increased range of vision with few photic phenomena. This lens is an effective option for providing functional intermediate vision and correcting aphakia.

Outcomes of extended depth of focus intraocular lenses implantation

This article compares the outcomes of implantation of two EDOF IOLs in patients with presbyopia and/or cataract. The prospective study included 60 patients (81 eyes) after implantation of EDOF IOL Tecnis Symfony (32 patients, 45 eyes; group 1) or EDOF IOL AcrySof IQ Vivity (28 patients, 36 eyes; group 2). The mean follow-up period was 3.9±1.3 months. All groups showed a significant (p<0.05) increase in uncorrected near visual acuity (UCNVA), intermediate visual acuity (UCIVA), and distance visual acuity (UCDVA) at the maximum follow-up time compared to preoperative values. In group 1, the best corrected near visual acuity (BCNVA) increased from 0.61±0.10 to 0.82±0.16 at the maximum follow-up time, and in group 2 - from 0.58±0.08 to 0.67±0.12 (p>0.05). Both groups showed a significant increase in best corrected intermediate and distance visual acuity (BCIVA and BCDVA) at the maximum follow-up time. The increase in the indicator compared to the preoperative period was not significant in both groups (p>0.05). The frequency of side optical phenomena was low in both groups. No significant differences were found between the groups (p>0.05). This study presents a comparative analysis of the results of implantation of two different EDOF IOLs. Both lenses were comparable in most of the studied parameters, including providing good distance and intermediate vision, functional near vision, as well as a low frequency of side optical phenomena. In all cases the patients were satisfied with the results of the surgical intervention.

A Case of Bilateral Implantation of Diffraction IOL with Extended Depth of Focus in a Patient with a History of Keratorefractive Excimer Laser Surgery

A clinical case of bilateral implantation of EDOF IOL in a patient after LASIK is presented. The standards for assessing visual acuity at an intermediate distance are indicated. A modified version of the test table for the intermediate distance is presented. The obtained functional result corresponds to theoretical ideas about the potential of IOL with a prolonged focus. When calculating the IOL after LASIK, a sufficient degree of accuracy was provided by the formulas Haigis-L, Barrett True-K. The use of data on the total refractive power of the cornea is promising.

Lucidis 124m Edof Iol; Experience from Two Tertiary Care Centers and Quality of Life Study

Purpose: To determine visual outcomes and post-operative complications after Lucidis 124M EDOF IOL implantation after phacoemulsification and to see the effect of these lenses on Quality of life of the patients. Study Design: Mixed study design (Quasi Experimentaland qualitative analysis). Place and Duration of Study: WAPDA Teaching Hospital and Acuity Eye Centre, Lahore, from November 2017 to October 2022. Methods: Hundred eyes of seventy five patients underwent Lucidis EDOF IOL implantation after phacoemulsification using 2.75 mm clear posterior corneal incisions. Criteria used to document visual outcomes were uncorrected and corrected distance and near vision measurements. Quality of life (QoL) was assessed by interviewing the patients at least 6 months postoperatively using google forms. Results: Hundred eyes of 75 patients were enrolled. There were 39 (52%) males and 36 (48%) females. Mean age was 1.48 ± 0.50 years. Meanbaseline un-corrected visual acuity (UCVA) was 2.83 ± 1.48. Eighty two percent eyes had corrected vision of 6/6 and 75 eyes achieved N.6 for near. Fifty patients out of 75 responded to the questionnaire regarding QoL. Sixteen percent patients had glare, 85% reported no difficulties during night driving and 68% had no problem in watching TV without glasses. Sixty eight percent did not experience any itching, watering, or discomfort and 90% responded that their QoL had improved. None of the patients had lens deposits, discoloration or decentration. One had endophthalmitis. Conclusion: Lucidis EDOF IOL are safe and effective lenses in terms of visual outcomes and spectacle independence resulting in better quality of life.

EDOF intraocular lens design: shift in image plane vs object vergence

BackgroundTo compare 2 different design scenarios of EDOF-IOLs inserted in the Liou-Brennan schematic model eye using raytracing simulation as a function of pupil size.MethodsTwo EDOF IOL designs were created and optimized for the Liou-Brennan schematic model eye using Zemax ray tracing software. Each lens was optimized to achieve a maximum Strehl ratio for intermediate and far vision. In the first scenario, the object was located at infinity (O1), and the image plane was positioned at far focus (I1) and intermediate focus (I2) to emulate far and intermediate distance vision, respectively. In the second scenario, the image plane was fixed at I1 according to the first scenario. The object plane was set to infinity (O1) for far-distance vision and then shifted closer to the eye (O2) to reproduce the corresponding intermediate vision. The performance of both IOLs was simulated for the following 3 test conditions as a function of pupil size: a) O1 to I1, b) O1 to I2, and c) O2 to I1. To evaluate the imaging performance, we used the Strehl ratio, the root-mean-square (rms) of the spot radius, and the spherical aberration of the wavefront for various pupil sizes.ResultsEvaluating the imaging performance of the IOLs shows that the imaging performance of the IOLs is essentially identical for object/image at O1/I1. Designed IOLs perform dissimilarly to each other in near-vision scenarios, and the simulations confirm that there is a slight difference in their optical performance.ConclusionOur simulation study recommends considering the difference between object shift and image plane shift in design and test conditions to achieve more accurate pseudoaccommodation after cataract surgery.

Optical Quality and Higher Order Aberrations of Refractive Extended Depth of Focus Intraocular Lenses.

To compare the optical quality and higher order aberrations of four different refractive extended depth of focus intraocular lens (EDOF IOL) models (Lentis Comfort [Teleon Surgical BV], MiniWell (SIFI), LuxSmart [Bausch & Lomb], and AcrySof IQ Vivity [Alcon Laboratories, Inc]) and a monofocal IOL (Tecnis ZCB00; Johnson & Johnson Surgical Vision, Inc). An optical metrology instrument (OptiSpheric IOL PRO2; Trioptics GmbH) was used to study image quality metrics of the different IOLs. The modulation transfer function (MTF) was measured at pupil sizes 1 to 5 mm in 1-mm steps. Area under the MTF and simulated visual acuity were calculated for different pupil diameters. Wavefront aberrations were measured with the SHS Ophthalmic device (Optocraft GmbH), which features a Hartmann-Shack sensor. All EDOF lenses yielded a simulated far visual acuity of 0.00 logMAR (20/20 Snellen) or better. At the 0.20 logMAR visual acuity level, the EDOF IOLs showed an increased depth of focus of at least 0.75 diopters compared to the monofocal IOL. Pupil dependency was more pronounced with the MiniWell, LuxSmart, and Vivity, whereas the Lentis showed a more consistent behavior at different apertures. The wavefront measurement revealed increased central aberrations for the MiniWell, LuxSmart, and Vivity IOL compared to the monofocal control. All EDOF IOLs demonstrated increased depth of focus while maintaining good simulated visual acuity at the far focus. Pupil dependency differed between the IOL models. The wavefront analysis revealed the complex design of the different EDOF IOLs with several zones with varying aberrations. [J Refract Surg. 2023;39(10):668-674.].

Опыт применения интраокулярных линз с углубленным фокусом у пациентов, оперированных по поводу отслойки сетчатки

There is currently insufficient evidence in the literature on the implantation of a deep focus IOL in patients with retinal detachment during cataract surgery or second-stage cataract surgery. In the course of the study, it was found that visual acuity at distance and near in patients operated on for retinal detachment, cataracts with implantation of intraocular lenses with deep focus is lower than visual acuity at the same distances in patients operated on for cataracts with EDOF IOL implantation, and the degree of satisfaction and the presence of optical phenomena are almost identical. Keywords: retinal detachment, deep focus IOL.

Наш опыт имплантации ИОЛ AcrySof IQ Vivity®. Предварительные результаты

AcrySof IQ PanOptix® multifocal IOLs provide patients with far, near and intermediate vision. But this type of IOL is characterized by various undesirable optical phenomena and a decrease in contrast sensitivity. A new type of IOL with an extended depth of focus, like the AcrySof IQ Vivity ® overcomes these disadvantages and should also give patients freedom from the use of glasses. Aim. The aim of our study was to analyze the results of implantation of the AcrySof IQ Vivity ® IOL with extended depth of focus up to 6 months after surgery аnd also to compare the studied parameters with those after implantation of the AcrySof IQ PanOptix ® IOL. Methods. The study group included 20 eyes (13 patients) with an implanted AcrySof IQ Vivity® IOL. Patients were examined for distance UCVA and BCVA, and, for a period of 6 months, UCVA for near (40 cm) and for intermediate distance (60 cm) were additionally studied. Patients' satisfaction was determined using the VF-14 questionnaire. Presence of undesirable optical phenomena was also determined. Spatial contrast sensitivity was determined under photopic and mesopic conditions. The comparison group of AcrySof IQ PanOptix ® is taken from a study by our colleagues (108 eyes of 71 patients). Comparison was carried out according to the specified parameters. Results. 6 months after IOL implantation, UCVA and BCVA in both groups was comparably high (in the study group AcrySof IQ Vivity ® UCVA 0.95±0.29; BCVA 1.06±0.1; in the comparison group AcrySof IQ PanOptix® – UCVA 0.93±0.18, BCVA 1.0±0.04). UCVA for near in the study group was 0.41±0.16; in the comparison group 0.85±0.22. UCVA for intermediate distance 0.52±0.17; in the comparison group 0.84±0.24. Satisfaction on the VF-14 scale: 83.0±6.5 points in the AcrySof IQ Vivity ® group, 97.9±1.2 points in the AcrySof IQ PanOptix ® group. In the study group, only one patient complained of glare, in the comparison group, such complaints were significantly more frequent. Spatial contrast sensitivity was superior in the AcrySof IQ Vivity ® group at all frequencies both under photopic and mesopic conditions. Conclusion. At a period of 6 months after phacoemulsification with implantation of the AcrySof IQ Vivity ® IOL, it is possible to achieve high distance visual acuity, as well as with the implantation of the AcrySof IQ PanOptix ® IOL. However, near visual acuity is significantly lower, which required the use of glasses by patients. Visual acuity at an intermediate distance is more comparable. In the AcrySof IQ Vivity® group, spatial contrast sensitivity is higher and the rate of optical adverse events is much lower. Key words: phaco emulsification; trifocal IOL; EDOF IOL; Vivity; PanOptix; contrast sensitivity

Visual Function after Implantation of Diffractive Extended Depth-of-Focus Intraocular Lenses in Eyes with Primary Open-Angle Glaucoma.

The aim of this prospective study was to compare the visual functions of extended depth-of-focus intraocular lenses (EDOF IOLs) and monofocal IOLs in eyes with mild to moderate primary open-angle glaucoma (POAG). Cataractous eyes with POAG controlled using medical treatments, no central visual field defects, and mean deviation (MD) values of -10dB or better on the 30-2 test grid of the Swedish Interactive Threshold Algorithm standard program were included. Twenty-two eyes of 22 patients received EDOF IOLs (ZXR00V and ZXV150-375; J&J), whereas 24 eyes of 24 patients received monofocal IOLs (ZCB00V and ZCV150-375; J&J). MD values, corrected distance visual acuity (CDVA), and photopic contrast sensitivity were measured at 3months after surgery. Noninferiority of CDVA and contrast sensitivity in eyes with EDOF IOLs to eyes with monofocal IOLs were examined. The postoperative mean MDs of eyes with EDOF and monofocal IOLs were -2.76dB and -4.21dB with no significant difference. The CDVA of eyes with EDOF IOLs was noninferior to that of eyes with monofocal IOLs (P = 0.02). There were no inferiority in contrast sensitivity at any spatial frequency (P < 0.001). The visual function of EDOF IOLs in eyes with mild-to-moderate POAG was not inferior to that of monofocal IOLs. Registered in the Japan Registry for Clinical Research (identifier: jRCTs032200218).

Clinical prospective intra-individual comparison after mix-and-match implantation of a monofocal EDOF and a diffractive trifocal IOL.

To assess intra-individually visual acuity (VA) and subjective outcome after mix-and-match implantation of a monofocal EDOF IOL and a diffractive trifocal IOL. The monofocal EDOF Isopure IOL was implanted in the dominant eye and the trifocal FineVision HP IOL in the non-dominant eye. Postoperative evaluation included VA at various distances, contrast acuity, monocular defocus curves, decentration and tilt, wavefront aberrometry, VF-7 questionnaire and a halo and glare simulator. 50 eyes of 25 subjects were enroled. The trifocal IOL performed better at monocular DCNVA (p < 0.01) and at defocus levels of -1.5D to -4.0D (p < 0.01), the monofocal EDOF IOL was better at -0.5D (p = 0.013). No differences in monocular BCDVA, DCIVA, contrast acuity, decentration or tilt were observed (p > 0.05). Wavefront analysis revealed lower HOAs in the trifocal group at 5 mm (p < 0.01) and no difference (p = 0.107) at 3 mm pupil aperture. The monofocal EDOF IOL displayed increased negative SA at 5 mm (p < 0.01) and 3 mm (p < 0.01) pupil diameter. Low values of optical phenomena and satisfying results of the VF-7 questionnaire were obtained. Excellent visual performance and low rates of optical phenomena were achieved after mix-and-match implantation of the monofocal EDOF Isopure IOL and the trifocal FineVision HP IOL. Trifocal IOL implantation in the non-dominant eye may decrease optical disturbing phenomena. Similar results were observed for monocular distance, intermediate and contrast VA. The trifocal IOL provided better monocular near VA. Decentration and tilt and HOAs were low.

The tolerance of refractive errors of extended depth of focus intraocular lens in patients with previous corneal refractive surgery.

To evaluate the tolerance for refractive errors and visual outcomes of extended depth of focus intraocular lens (EDOF IOLs) in patients with previous corneal refractive surgery for myopia. Patients from Aier Eye Hospital of Wuhan University with previous myopia excimer laser correction underwent cataract surgery and implantation of an EDOF IOL. The follow-up period was three months. The uncorrected distance, intermediate, and near visual acuities (UDVA, UIVA, UNVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), defocus curve, optical quality, including modulation transfer functions (MTF) and Strehl ratio (SR), National Eye Institute Visual Functioning Questionnaire-14 for Chinese people (VF-14-CN), spectacle independence, and dysphotopsia were assessed. At the final visit, UDVA, CDVA, UIVA, and UNVA (LogMAR) were 0.06 ± 0.09, 0.01 ± 0.06, 0.11 ± 0.08, 0.20 ± 0.10, respectively. The mean spherical equivalent (SE) was - 0.57 ± 0.58D, sphere and cylinder were - 0.24 ± 0.60D, - 0.70 ± 0.58D respectively. No statistical difference in UDVA between eyes with SE in ± 0.50 D and in ± 1.0 D (p > 0.05). Corneal astigmatism > 1.00D has no significant effect on postoperative visual acuity (p > 0.05). The defocus curve showed that visual acuity could reach 0.2 in the refractive range of + 0.50D ~ - 1.50D. SR and MTF values were all higher than before the surgery. In bilateral implantation patients, the VF-14-CN questionnaire score and visual quality were quite excellent. The EDOF IOL have a certain tolerance for refractive errors and corneal astigmatism, and it's recommended for patients with prior myopia excimer laser surgery to achieve satisfactory visual performance.

Patient reported outcomes after implementation of an enhanced depth of focus intraocular lens with low postoperative myopia

BackgroundEnhanced depth-of- focus intraocular lenses (EDOF IOL) have filled the gap between monofocal and multifocal intraocular implants with optical qualities of monofocal lenses and usually minor dysphotopsias typical for multifocal lenses. The purpose of this study was to evaluate visual outcomes after bilateral implantation of a new EDOF IOL in patients with requirements for perfect near and intermediate vision. MethodsThe study included 15 patients (29 eyes as one was amblyopic) with bilateral implantation of LUXSMART EDOF IOL (Bausch & Lomb) with a targeted myopia (between –0.25 and –0.50D) in both eyes. Monocular corrected and uncorrected visual acuity for far, intermediate and near as well as refractive outcomes were evaluated at 1, 3, 6 and 12 months after the surgery. Additionally, binocular visual acuity, contrast sensitivity and defocus curve were measured at the final follow-up visit. At 12 months’ visit patients completed a questionnaire evaluating patient satisfaction, spectacle independence and presence of dysphotopsias. ResultsBinocular uncorrected visual acuities at 12 month’s visit were 0.13 ​± ​0.16, 0.06 ​± ​0.08, 0.07 ​± ​0.09 and 0.15 ​± ​0.09 logMAR for far distance, 80 ​cm, 66 ​cm and 40 ​cm respectively. Corrected binocular visual acuities at 12 months were 0.00 ​± ​0.00, 0.05 ​± ​0.07, 0.05 ​± ​0.06, 0.13 ​± ​0.16 respectively for distance, 80 ​cm, 66 ​cm and 40 ​cm. Automated refraction spherical equivalent at 12 months’ visit stood at –0.70 ​± ​0.48D, which was 0.46D less than calculated biometric target, however spherical equivalent of subjective refraction at 12 months equaled –0.49 ​± ​0.46D, which was closer to preoperative biometric target. Defocus curve had gentle shape without peaks typical for monofocal IOLs. Binocular contrast sensitivity results were superior to average results for that age group and equaled 1.78 ​± ​0.16 logMAR without correction and 1.81 ​± ​0.13 logMAR with correction. Spectacle independence for near and intermediate distances was achieved in all patients and for far distance in 73.3% of patients. Burdensome dysphotopsias were not reported in any case. ConclusionsEDOF IOLs targeted bilaterally at low myopia can provide excellent near and intermediate visual acuity and independence of any optical correction in majority of cases. This approach can be used in selected patients who are focused on stationary activities.

Accuracy of Nine Formulas to Calculate the Powers of an Extended Depth-of-Focus IOL Using Two SS-OCT Biometers

To evaluate the accuracy of nine formulas to calculate the power of a new extended depth-of-focus intraocular lens (EDOF IOL), the AcrySof IQ Vivity (Alcon Laboratories, Inc), using measurements from two optical biometers, the IOLMaster 700 (Carl Zeiss Meditec AG) and Anterion (Heidelberg Engineering GmbH). After constant optimization, the accuracy of these formulas was analyzed in 101 eyes: Barrett Universal II, EVO 2.0, Haigis, Hoffer Q, Holladay 1, Kane, Olsen, RBF 3.0, and SRK/T. Both standard and total keratometry from the IOLMaster 700 and standard keratometry from the Anterion were used for each formula. Constant optimization provided slightly different values for the A-constant, which ranged between 118.99 and 119.16, depending on the formula and the optical biometer. According to the heteroscedastic test, within each keratometry modality the standard deviation of the SRK/T was significantly higher compared to that of the Holladay 1, Kane, Olsen, and RBF 3.0 formulas. The SRK/T formula provided less accurate results also when the absolute prediction errors were compared by Friedman test. According to McNemar's test with Holm corrections, statistically significant differences were found within each keratometry modality between the percentage of eyes with a prediction error within ±0.25 diopters obtained with the Olsen formula compared to the Holladay 1 and Hoffer Q formulas. Constant optimization remains a mandatory step to achieve the best outcomes with the new EDOF IOL: the same constant should not be used for all formulas and for both optical biometers. Different statistical tests revealed that older IOL formulas have lower accuracy compared to newer formulas. [J Refract Surg. 2023;39(3):158-164.].

Clinical Retinal Image Quality of a Non-diffractive Wavefront-Shaping Extended Depth of Focus (Vivity) Intraocular Lens.

To evaluate clinical retinal optical image quality following implantation of an extended depth of focus intraocular lens (EDOF IOL) (Vivity; Alcon Laboratories, Inc), and to compare it with a monofocal and a trifocal IOL. This prospective, comparative, case-control study included 88 eyes implanted with: (1) 19 monofocal IOLs (AcrySof SA60AT; Alcon Laboratories, Inc); (2) 38 EDOF IOLs (AcrySof IQ Vivity); and (3) 31 trifocal IOLs (AT LISA tri 839MP; Carl Zeiss Meditec AG). Total root mean square, ocular lower (LOA) and higher (HOA) order aberrations, point spread function (PSF) Strehl ratio (PSF with LOA), and PSF Strehl ratio excluding LOA (PSF without LOA) were analyzed using a Pyramidal WaveFront-based sensor aberrometer Osiris (Costruzione Strumenti Oftalmici) at two different pupil sizes (3 and 4 mm). The trifocal IOL showed the highest PSF without LOA at both pupil sizes (0.52 ± 0.12 and 0.31 ± 0.07, respectively), followed by the AcrySof SA60AT (0.39 ± 0.10 and 0.27 ± 0.07) and AcrySof IQ Vivity (0.34 ± 0.11 and 0.24 ± 0.09) (P < .001). The AcrySof IQ Vivity and monofocal IOLs were comparable (P > .05). Despite the comparable postoperative low spherical equivalent among the IOL groups, the AT LISA tri 839MP retinal image quality (PSF with LOA) was the most severely affected by such residual refractive errors (dropped to 0.26 ± 0.06 at 3 mm; P < .001) compared to the monofocal AcrySof SA60AT (0.24 ± 0.07 at 3 mm) and EDOF Acrysof IQ Vivity (0.23 ± 0.06 at 3 mm) groups. The PSF with LOA was comparable (P > .05) among the three groups at both the 3-and 4-mm pupil size. Although trifocal IOLs provided significantly better retinal image quality if influence of LOA is excluded, they also demonstrated to be the most sensitive to residual refractive errors. Both the EDOF Acrysof IQ Vivity and mono-focal AcrySof SA60AT IOLs showed a comparable retinal image quality, and they are also comparable with trifocal IOLs when considering the clinically real PSF (PSF with LOA). [J Refract Surg. 2023;39(2):103-110.].

Presbyopia correction with a new Extended Depth of Focus Intraocular Lens.

Extended depth of focus intraocular lenses (EDoF IOLs) offer an expanded number of modalities for simultaneous cataract and presbyopia treatment. The objective of the current study was to assess clinical outcomes with a new mono-EDoF intraocular lens and to analyze the effect of different parameters on postoperative results. The inclusion criteria were defined as uneventful cataract surgery, no history of concomitant ocular disease, implantation of ZOE Primus-HD lens. Parameters from IOL Master 500 were analyzed. The main outcome measures were postoperative uncorrected distance (UDVA) and intermediate (UIVA) visual acuity. The study included 39 eyes of 37 patients (15 males and 22 females) with a mean age of 73.59±7.71. Postoperatively, the UDVA improved to 0.84±0.16 (p<0.001) and UIVA was 0.86±0.14. There was no correlation between K1, K2 and IOL power with both postoperative UDVA and IDVA. Moreover, there was no statistically significant difference between UDVA and UIVA between patients with mean K value over or under 44.0D (p=0.204 and p=0.817, respectively). The results of a multinomial logistic regression analysis for the predictive value of the factors K1, K2 and IOL power demonstrated no statistical significance, except for UIVA with a significant influence of IOL power (p=0.024) in patients with less than 0.9 Snellen visual acuity. The implantation of the new mono-EDoF ZOE Primus-HD lens led to improvement in both UDVA and UIVA. Patients with keratometry values less than 44.0D could still benefit from the mono-EDoF lenses. Further studies including wavefront aberrometry are needed to study the interaction between corneal aberrations and EDoF IOLs. Abbreviations: IOL = Intraocular lens, UDVA = Uncorrected distance visual acuity, UIVA = Uncorrected intermediate visual acuity, D = Diopters, EDoF = Enhanced Depth of Focus, MF IOL = Multifocal intraocular lens, AUC = area under the curve.

Результаты имплантации и особенности расчета ИОЛ с расширенной глубиной фокуса vivity dft015: первый опыт

Purpose. To evaluate the results of implantation of the Vivity IOL in patients with cataract and refractive lensectomy. Material and methods. The study included 25 patients (42 eyes) who underwent phacoemulsification or refractive lens exchange with Vivity IOL implantation. The mean age of the patients was 56.4 ± 11.75 years. The results were evaluated 1 month after the surgery. Postoperative visual acuity was measured monocularly at a distance and at an intermediate. The IOL was calculated using three formulas: Kane, Hill-RBF, EVO. The mean absolute (MAE) and median (MedAE) calculation errors were calculated. Results. One month after the surgery patients with lens exchange and cataracts distance and intermediate visual acuity was 0.88 ± 0.17 and 0.76 ± 0.12, 0.91 ± 0.23 and 0.81 ± 0.11 respectively. The mean absolute error according to the formulas ranged from 0.31 to 0.33 D. Pairwise comparison of the calculation accuracy revealed no significant differences (p &gt; 0.05). Conclusion. The new non-diffractive EDOF IOL Vivity DFT015 demonstrated high visual functions at long and medium distances, as well as high calculation accuracy using three modern calculators. Keywords: phacoemulsification, IOL with extended depth of focus, cataract.

Through-Focus Response of Extended Depth of Focus Intraocular Lenses.

To investigate extended depth of focus intraocular lenses (EDOF IOLs), intended to extend the depth of field after cataract surgery in a comparative study at the optical bench. An optical bench with either green or white light was used for this study. The artificial cornea used exhibited a spherical aberration of 0.2 µm. Examinations of the following lenses with a pupil opening of 3 and 4.5 mm were carried out: AcrySof IQ Vivity (Alcon Laboratories, Inc), Isopure (PhysIOL), Tecnis Eyhance (Johnson & Johnson), Vivinex Impress (Hoya Surgical Optics), and xact (Santen). Using green light and a pupil aperture of 3 mm, the AcrySof IQ Vivity showed the highest light energy for the intermediate area, whereas the Isopure and Vivinex Impress provided the highest energy for distance vision. Under the same examination conditions with a pupil opening of 4.5 mm, all lenses showed a low light distribution for the intermediate range. Regarding light distribution for distance, the Tecnis Eyhance had the highest light intensity. Using white light, the curves became much wider and more similar to each other. The five EDOF lenses investigated differ mainly by their different weighting of energy between the far and intermediate ranges. [J Refract Surg. 2022;38(8):497-501.].