Extended Depth Of Focus Intraocular Lens Research Articles

Retinal image quality through an operating microscope with wavefront shaping extended depth of focus intraocular lens in model eye

PURPOSETo compare the quality of images of gratings placed in a model eye viewed through an extended depth of focus (EDoF) intraocular lens (IOL) to that of diffractive bifocal IOL or monofocal IOL. DESIGNExperimental laboratory investigation. METHODSNon-diffractive wavefront shaping EDoF (CNAET0, Alcon laboratories), echelette-designed EDoF (ZXR00V, Johnson & Johnson Vision), diffractive bifocal IOL with low power addition (SV25T, Alcon Laboratories), or monofocal IOL (CNA0T0, Alcon laboratories) was placed in a fluid-filled model eye. A USAF Resolution Grating Target was glued to the posterior surface of the model eye and viewed through a flat or a wide-angle contact lens. The contrast of the gratings viewed through the EDoF or multifocal IOLs was compared to that through the monofocal IOL. A wavefront analyzer was used to measure the spherical power of the central 4.5 mm optics of the EDoF, multifocal, and monofocal IOLs. The distribution of the dioptric power and the dioptric power map were compared. RESULTSThe gratings observed through the flat contact lens with the CNAET0, ZXR00V, or SV25T were slightly blurred when viewed through the multifocal optics. The blurred area was in the circumferential area of the CNAET0, the central area of SV25T, and the peripheral area of ZXR00V. The mean contrast was 0.258±0.020 for CNAET0, 0.227±0.025 for ZXR00V, and 0.221±0.020 for SV25T for the 16.0 cyc/mm grating. The contrast was significantly lower for ZXR00V (P=0.004) and SV25T (P=0.004) than the 0.303±0.015 for CNA0T0 but the differences were not significant. For the wide-angle contact lens, the contrast for CNAET0 was 0.182±0.009, for ZXR00V was 0.162±0.011, and for SV25T was 0.163±0.007 for the 16.0 cyc/mm grating, and none was significantly different from the 0.188±0.012 for CNA0T0. The dioptric variations of the CNAET0 indicated a ring-shaped area of higher power corresponding to the circumferential blurred zone observed through the flat contact lens. CONCLUSIONThe wavefront shaping and echelette-designed EDoF-IOLs reduce the contrast of the grating more than the monofocal IOL when viewed through the flat contact lens. The degree of reduction depended on the design of the extended-focus optics. The difference was less through the wide-angle contact lens.

In vitro optical assessment of three types of non-diffractive extended depth-of-focus intraocular lenses

Objective: To evaluate the in vitro optical performance of three types of non-diffractive extended depth-of-focus (EDoF) intraocular lenses (IOLs). Methods: Experimental study. Three Vivity IOLs, three Eyhance IOLs, and three ES60 IOLs were included. The professional optical bench OptiSpheric® IOL PRO 2 and an ISO-2 corneal model were applied. The through-focus modulation transfer function (MTF) and predicted visual acuity (logarithm of the minimum angle of resolution) of different spatial frequencies and different focuses under apertures of 3.0 mm and 4.5 mm were recorded. The aspheric monofocal (Tecnis ZCB00), diffractive EDoF (Tecnis Symfony), and trifocus (STF1) IOLs, as well as the lowest visual requirement criteria of EDoF IOLs of American Academy of Ophthalmology served as assessment controls. Results: For the 3.0-mm aperture, the peak value of the MTF was highest with ZCB00, followed by Eyhance, ES60, Vivity, Symfony, and STF1. All experimental non-diffractive EDoF IOLs had two MTF peaks, and the distance between both peaks was longest with Vivity (1.76 D), followed by ES60 (1.43 D) and Eyhance (1.36 D). Among the control IOLs, Symfony had two MTF peaks, and the peak MTF of the intermediate focus was highest. STF1 had three MTF peaks, and the peak MTF of the near focus was highest. For the 4.5-mm aperture, the ranking of the MTF peak of the six types of IOLs was the same as that for the 3.0-mm aperture. Vivity had an increased MTF peak of the distance focus, but a decreased intermediate focus MTF peak, while the MTF peaks of the distance, intermediate, and near focuses in the other IOLs decreased, compared to those for the 3.0-mm aperture. The predicted visual acuity of the distance focus of the three types of non-diffractive EDoF IOLs was all better than 0.0. The predicted visual acuity of the intermediate focus of the Vivity IOL and the ES60 IOL was 0.11 and 0.05 better than that of the Eyhance IOL, respectively. Based on the predicted visual acuity of 0.2, Vivity and ES60 had a depth of focus of at least 0.50 D exceeding ZCB00, while Eyhance had a depth of focus of 0.40 D exceeding ZCB00. Conclusion: In the experiments in vitro, the three types of non-diffractive EDoF IOLs exhibited varying degrees of intermediate to near focus optical performance while maintaining distance focus optical performance. The Eyhance IOL showed better distance focus optical performance than ES60 and Vivity IOL. The Vivity IOL and the ES60 IOL showed better depth of focus extensions than the Eyhance IOL and met the lowest visual requirement criteria of EDoF IOLs of American Academy of Ophthalmology.

Comparatively analysing the postoperative optical performance of different intraocular lenses: a prospective observational study

BackgroundPostoperative performance, including best corrected distance visual acuity (BCDVA) and optical metrics (from the OQAS and iTrace devices), was compared among 4 different intraocular lenses (IOLs).MethodsThis prospective observational study included 104 eyes from 104 subjects who underwent cataract surgery combined with implantation of 4 different IOLs: monofocal (Mon) IOLs, segmental refractive (SegRef) IOLs, diffractive (Dif) IOLs and extended depth of focus (EDoF) IOLs. Postoperative BCDVA and optical metrics were collected at the 6th month. The OQAS optical metrics included the objective scattering index (OSI), Strehl ratio (SR), modulation transfer function (MTF) cut-off frequency, and predicted visual acuity (PVA); the iTrace optical metrics included blur/double vision, glare/halo, starburst, mixed focus, night myopia, and night hyperopia.ResultsThere was no significant difference in BCDVA among the 4 groups (P = 0.059; power = 70.3%). Differences were observed in all OQAS optical metrics among the groups (all P < 0.001). Overall, Mon IOLs and EDoF IOLs exhibited better performance than Dif IOLs and SegRef IOLs. Starburst was the only iTrace optical metric that differed among the groups (P < 0.001): SegRef IOLs caused more starbursts than Mon IOLs (P = 0.001), Dif IOLs (P = 0.006) and EDoF IOLs (P < 0.001). Spearman rank correlation analysis was used to determine the relationships among the iTrace optical metrics, OQAS optical metrics and BCDVA: starburst was negatively correlated with BCDVA, PVA at contrasts of 100% and 20%, OSI, and MTF cut-off frequency (all P ≤ 0.001); mixed focus was positively correlated with BCDVA, PVA at contrasts of 100% and 20%, OSI, and MTF cut-off frequency (all P ≤ 0.001).ConclusionsPostoperative BCDVA and optical metrics varied among the different IOLs, which should be taken into account in the selection and management of IOLs for cataract patients.Trial registrationThis study was approved by the First Affiliated Hospital of Guangzhou Medical University Ethical Review Board (No. 50 2022).

Systematic bibliometric analysis of research hotspots and trends on the application of premium IOLs in the past 2 decades.

To analysis of research hotspots and trends on the application of premium intraocular lens (PIOLs) in the past 2 decades. The literature search was performed on the Web of Science and included PIOLs studies published between January 2000 and December 2022. The retrieved literature was collated and analyzed by R-tool's Bibliometrix package, CitNetExplorer, CiteSpace and other software. A total of 1801 articles about PIOLs were obtained, most of which were published in Spain and the United States. The organization that published the most articles was the University of Valencia in Spain. Alió JL, and Montés-Micó R, from Spain were the most influential authors in this field. The Journal of Cataract and Refractive Surgery and Journal of Refractive Surgery were the core journals for this field; the top 10 cited articles mainly focus on postoperative satisfaction with multifocal intraocular lens (IOLs) and postoperative results of toric IOLs. Through the keyword analysis, we found that trifocal IOLs, astigmatism and extended depth of focus (EDoF) IOLs are the most discussed topics at present, and the importance of astigmatism and the clinical application of the new generation of PIOLs are the emerging research trends. Bibliometric analysis can effectively help to identify multilevel concerns in PIOLs research and the prevailing research trends in the realm of PIOLs encompass the adoption of EDoF IOLs, trifocal IOLs, and their respective Toric models.

Comparative efficacy and safety of all kinds of intraocular lenses in presbyopia-correcting cataract surgery: a systematic review and meta-analysis.

To assess the efficacy and safety of various intraocular lenses (IOLs), including standard monofocal, bifocal, trifocal, extended depth of focus (EDOF), and enhanced monofocal IOLs, post-cataract surgery through a network meta-analysis. A systematic search of PubMed, Cochrane Library, and Web of Science was conducted to identify relevant studies from the past 5 years. Parameters such as binocular visual acuities, spectacle independence, contrast sensitivity (CS), and optical quality were used to evaluate efficacy and safety. Data from the selected studies were analyzed using Review Manager 5.4 and STATA 17.0 software. Twenty-eight Randomized Controlled Trials (RCTs) comprising 2465 subjects were included. Trifocal IOLs exhibited superior uncorrected near visual acuity (UNVA) compared to monofocal IOLs (MD: -0.35; 95% CI: -0.48, -0.22). Both trifocal (AcrySof IQ PanOptix IOLs group MD: -0.13; 95% CI: -0.21, -0.06) and EDOF IOLs (MD: -0.13; 95% CI: -0.17, -0.09) showed better uncorrected intermediate visual acuity (UIVA) than monofocal IOLs. Trifocal IOLs ranked highest in spectacle independence at various distances (AT LISAtri 839MP group: SUCRA 97.5% for distance, 80.7% for intermediate; AcrySof IQ PanOptix group: SUCRA 83.0% for near). For cataract patients who want to treat presbyopia, trifocal IOLs demonstrated better visual acuity and spectacle independence at near distances. Different types of trifocal IOL characteristics differ. EDOF and enhanced monofocal IOLs have improved visual quality at intermediate distances.Therefore, It is very important to select the appropriate IOLs based on the lens characteristics and patient needs.

Optical and clinical simulated performance of a new refractive extended depth of focus intraocular lens.

The purpose of this study is to evaluate the optical and expected clinical performance of a new refractive Extended Depth of Focus (EDF) intraocular lens (IOL) designed to maintain a monofocal-like dysphotopsia profile. Simulated visual acuity (sVA) with varying defocus was calculated using the area under the Modulation Transfer Function measured in an average eye model and from computer simulations in eye models with corneal higher-order aberrations. Tolerance to defocus was evaluated using computer simulations of the uncorrected distance sVA under defocus. To evaluate the dysphotopsia profile, halo pictures obtained using an IOL-telescope, as well as simulated images in a realistic eye model under defocus were assessed. The results of the refractive EDF were compared to those of a diffractive EDF of the same platform. The refractive EDF IOL provides similar range of vision to the diffractive EDF IOL with the same distance, and similar intermediate and near sVA. The refractive EDF IOL provides the same tolerance to hyperopia as the diffractive EDF but more tolerance to myopia. Halo pictures and simulations showed that the refractive EDF provides comparable dysphotopsia profile to the monofocal IOL and better than the diffractive EDF. The results of this preclinical study in clinically relevant conditions show that the new refractive EDF IOL is expected to provide similar range of vision to the diffractive IOL of the same platform and higher tolerance to refractive errors. The refractive EDF provides a dysphotopsia profile that is better than the diffractive EDF and comparable to that of the monofocal IOL, also in the presence of residual refractive errors.

Tolerance to refractive error with a new extended depth of focus intraocular lens

PurposeTo evaluate the tolerance to refractive errors of a new purely refractive extended depth of focus (EDF) intraocular lens (IOL) using preclinical and clinical metrics.MethodsPreclinical evaluation included computer simulations of visual acuity (sVA) and dysphotopsia profile of different IOL designs (refractive EDF, diffractive EDF, multifocal, standard, and enhanced monofocals) using an appropriate eye model with and without ±0.50 D defocus and/or +0.75 D of astigmatism. Patients bilaterally implanted with a refractive EDF (Model ZEN00V) or an enhanced monofocal (Model ICB00) IOL from a prospective, randomized study were included. At the 6-month postoperative visit, uncorrected and corrected distance vision (UDVA and CDVA), visual symptoms, satisfaction and dependency on glasses were evaluated in a subgroup of patients with absolute residual refractive error of >0.25 D in one or both eyes.ResultsIn the presence of defocus and astigmatism, sVA was comparable for all except the multifocal IOL design. The refractive EDF was more tolerant to myopic outcomes and maintained a monofocal-like dysphotopsia profile with defocus. Binocular logMAR UDVA was −0.03 ± 0.08 for ZEN00V and −0.02 ± 0.11 for ICB00. 100% ZEN00V and 97% ICB00 patients did not need glasses and were satisfied with their distance vision. Monocular CDVA, contrast sensitivity and visual symptoms were also similar between both groups.ConclusionsThe clinical outcomes of the refractive EDF IOL demonstrated high quality distance vision and dysphotopsia comparable to a monofocal IOL, even in the presence of refractive error, thus matching the design expectations of the EDF IOL.

Quality of vision clinical outcomes for a new fully-refractive extended depth of focus Intraocular Lens.

To evaluate the visual performance of a purely refractive extended depth of focus (EDF) intraocular lens (IOL). A prospective, multi-center, randomized, subject/evaluator-masked study. Subjects were bilaterally implanted with the EDF test (Model ZEN00V, N = 60) or an enhanced monofocal control (Model ICB00, N = 57) IOL. Monocular corrected distance (CDVA), intermediate (DCIVA), near acuities (DCNVA) and patient reported visual symptoms were evaluated at the 6-month visit. Monocular mesopic contrast sensitivity (CS) and depth of focus (DOF) testing were assessed at 3 months. CDVA (Mean ± SD) was -0.06 ± 0.08 for test and -0.05 ± 0.08 logMAR for control groups. DCIVA was 0.13 ± 0.08 for test and 0.18 ± 0.14 logMAR for control groups (p = 0.0127). DCNVA was 0.37 ± 0.10 for test and 0.43 ± 0.16 logMAR for control groups (p = 0.0137). Test lens was statistically superior for intermediate and near. Overall, 91.7% (halos), 95.0% (starbursts) and 95.0% (glare) of test lens patients reported that they did not experience, were not bothered, or were slightly bothered by specific visual symptoms, compared to 98.2%, 100% and 96.5% in the control group. The DOF range over which monocular visual acuity was 0.20 logMAR or better was -1.6 D for the test lens. Mesopic CS was comparable between both groups, falling within 0.11 log units for all measured cycles per degree with and without glare. The EDF IOL demonstrated extended range of vision and statistically superior intermediate and near performance compared to the monofocal IOL. Distance visual acuity, contrast sensitivity and dysphotopsia profile were similar to the monofocal IOL.

Patient-Reported Outcome Measures (PROMs) with Refractive and Diffractive Extended Depth of Focus (EDOF) Intraocular Lenses.

Extended depth of focus intraocular lenses (EDOF-IOLs) provide unaided far- and mid-range vision. Refractive IOLs, in contrast to diffractive designs, are associated with a lower depth of focus and absence of dysphotopsia. The aim of this study was to assess spectacle independence for far-range, mid-range, and near-vision activities in patients after implantation of refractive or diffractive EDOF-IOLs using patient-reported outcome measures (PROMs) in a real-world setting. In 2021 and 2022, all patients in a single center referred for bilateral cataract surgery were assigned to 7 experienced cataract surgeons who either bilaterally implanted only a diffractive EDOF-IOL (Carl Zeiss Meditec AG, AT LARA Jena, Germany, three surgeons) or refractive EDOF-IOL (Johnson & Johnson Vision Inc., Tecnis Eyhance Irvine, California, USA, four surgeons) at the surgeon's discretion, with the aim of bilateral emmetropia. Six months after both cataract surgeries, all patients were contacted by telephone and asked to report their outcomes using a structured questionnaire investigating their spectacle usage for various daily activities and their experience with night glare or halos. Inclusion criteria were a normal postoperative visual potential based on the preoperative examination and completion of the questionnaire regarding postoperative visual experience. Of the patients, 514 underwent bilateral cataract surgery aiming for bilateral emmetropia with the implantation of EDOF-IOLs (422 with Tecnis Eyhance and 92 with AT LARA). A complete questionnaire was obtained from 472 (92%) patients, who were included in the study (393 vs. 79). Comparing Tecnis Eyhance with AT LARA IOL, 54 vs. 57% patients were able to perform most of their daily activities without spectacles, 9 vs. 19% reported not being dependent on spectacles at all, 25 vs. 29% reported using their smartphones without spectacles, 15 vs. 49% patients reported experiencing glares or halos at night, and 1 vs.15% with driving disturbance. Overall, 95 vs. 93% patients described themselves as "satisfied" or "highly satisfied" with their IOL. With both types of EDOF-IOLs, the majority of patients could perform most of their daily activities without spectacles, except reading, and were highly satisfied with their IOLs. Patients with diffractive Zeiss AT LARA EDOF-IOLs were more likely to accomplish unaided near-range visual tasks; however, they were also at a higher risk of experiencing glares or halos at night.

Comparison of modal and zonal wavefront measurements of refractive extended depth of focus intraocular lenses.

Extended depth-of-focus (EDoF) intraocular lenses (IOLs) are typically evaluated using commercially available aberrometers. Given the intricate optical design of these IOLs, employing an appropriate wavefront reconstruction method with a sufficient sampling resolution of the aberrometer is crucial. A high-resolution Shack-Hartmann wavefront sensor was developed by magnifying the pupil aperture by a factor of five onto a lenslet array (pitch: 133 µm) and utilizing a full-frame CMOS sensor (24 by 36 mm), resulting in a 26.6 µm sampling resolution. Zonal wavefront reconstruction was used and compared with Zernike-based modal wavefront reconstruction to retain detailed local slope irregularities. Four refractive EDoF IOLs with a power of 20D were examined, and the wavefront difference between the zonal and modal methods, expressed as the root mean squared error (RMSE), remained significant for two of the IOLs up to the 16th-order Zernike spherical aberrations (SAs). Conversely, a negligibly small RMSE was observed for the other two IOLs, as long as the Zernike SAs were higher than the 6th order. The raytracing simulation results from the zonal wavefronts exhibited a stronger correlation with the results of recent optical bench studies than those from the modal wavefronts. The study suggests that certain recent refractive EDoF IOLs possess a complex optical profile that cannot be adequately characterized by limited orders of SAs.

The effect of trifocal and extended-depth-of-focus intraocular lenses on optical coherence tomography parameters.

Optical properties of commonly used multifocal and extended-depth-of-focus (EDOF) intraocular lenses (IOLs) can induce artifacts or changes in optical coherence tomography (OCT) measurements. Our purpose was to investigate the possible effects of different IOLs on peripapillary and macular OCT parameters. The preoperative and postoperative third-month peripapillary OCT and ganglion cell analysis (GCA) parameters of patients having monofocal (Alcon IQ), multifocal (PanOptix), or EDOF (Vivity) IOL implanted during cataract surgery were compared. Sixty-four eyes of 64 patients were included (21 monofocal, 24 multifocal, and 19 EDOF). Although all OCT image qualities increased postoperatively, only GCA image quality changes in the monofocal and multifocal groups reached statistical significance. Most peripapillary retinal nerve fiber layer (RNFL) and GCA parameters were similar preoperatively and postoperatively. The superior RNFL thickness in the monofocal group and the temporal RNFL thickness in the EDOF group were higher postoperatively ( P = 0.04 and P = 0.02, respectively). Most GCA and RNFL value changes between preoperative and postoperative measurements were similar between groups. In the parameters that changed, postoperative values were higher in the monofocal group ( P = 0.02 for minimum ganglion cell layer and inner plexiform layer, P = 0.04 for average RNFL). Trifocal and EDOF IOLs do not seem to have a negative effect on OCT parameters.

Clinical performance after implantation of the Symfony extended depth of focus intraocular lens in the dominant eye and the Synergy presbyopia correcting intraocular lens in the non-dominant eye.

To evaluate subjective and objective outcomes after combined implantation of an extended depth of focus (EDOF) intraocular lens (IOL) and a combined technology multifocal lens (CT-IOL). Two clinical practices in the USA. Prospective, unmasked, multi-center, non-randomized bilateral eye study. Patients interested in reducing their dependence on spectacles were implanted with an EDOF IOL in the dominant eye and a CT-IOL in the non-dominant eye. Refractive and visual acuity data at various distances (4 m, 66 cm, 40 cm, 33 cm) were collected 3 months post-surgery, along with the distance-corrected binocular defocus curve and responses to questionnaires related to spectacle independence, visual disturbances, and overall visual function. Data from 37 subjects were analyzed. The distance corrected binocular defocus curve showed a mean VA better than 0.1 logMAR (20/25) at all vergences from +1.00 D to -2.50 D. Thirty-six subjects (97%) had an uncorrected binocular VA of 0.3 logMAR or better, at all test distances. Seventy percent of subjects (26/37) reported never wearing glasses at any distance and 84% (31/37) were "completely" or "mostly" satisfied with their overall vision after surgery. Halos were the disturbance reported most frequently, and reported as most bothersome, with difficulty driving at night the most common visual function issue. Difficulty reading was the next most reported issue. Overall eyesight was rated as "excellent" or "good" by 92% (34/37) of subjects. This combined EDOF/CT-IOL approach was well tolerated by subjects and provided some potential benefits relative to bilateral implantation of either lens.

Visual performance and photic disturbances with diffractive and nondiffractive EDOF intraocular lenses using mini-monovision: randomized trial.

To compare visual performance and photic visual disturbances of patients implanted with 2 different extended depth-of-focus (EDOF) intraocular lenses (IOLs) using mini-monovision. Ambulatory surgical center at the University of São Paulo in Ribeirão Preto, Brazil. Prospective, examiner-masked, randomized clinical trial. Patients were assigned to either a bilateral Symfony (SYM) or Vivity (VIV) IOL group, with 1 eye targeted for myopia (-0.75 diopter [D]). Defocus curve, contrast sensitivity (Pelli-Robson), Patient-Reported Spectacle Independence Questionnaire, and Quality of Vision questionnaire were recorded at 3 months postoperatively. A total of 126 patients finished the follow-up: group SYM: n = 60 and group VIV: n = 66. Regarding near visual acuity, 80% of patients in the SYM group and 84% of patients in the VIV group achieved J2 or better on the near-planned eye ( P = .3840). No significant differences were found between groups for distance visual acuity, defocus profiles, PRISC, contrast sensitivity, or reading speed ( P > .05). Notably, significant between-group differences were observed for bothersome visual disturbances ( P = .0235), with 45% of patients in the SYM group with a score of 0 for bothersome disturbances compared with 66% in the VIV group. Mini-monovision using these EDOF IOLs was well-tolerated in the patient cohort. No significant differences were found for visual performance tests between the VIV and SYM groups. However, the data suggest that Vivity IOL is associated with a lower probability of bothersome visual disturbances compared with Symfony IOL.

Extended depth of focus versus trifocal for intraocular lens implantation: An updated systematic review and meta‐analysis

Aims/Purpose: To compare the extended depth of focus (EDOF) versus trifocal intraocular lenses (IOLs) in patients undergoing IOL implantation.Methods: An electronic search was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines to include studies comparing EDOF versus trifocal IOLs. Refraction and visual acuity were primary outcomes. Secondary outcomes included defocus curves, intraocular aberrations, contrast sensitivity (CS), quality of vision (QoV) questionnaire score, haloes and glare, spectacle independence and patient satisfaction.Results: A total of 22 studies enrolling 2200 eyes were identified. Trifocal IOL showed a significant improvement in sphere (mean difference [MD] = −0.23; p = 0.001) and spherical equivalence (MD = −0.11, p = 0.0001) compared to EDOF IOL. No difference was observed in cylinder (MD = −0.03, p = 0.25) or astigmatism. Trifocal IOL had superior near visual acuity outcomes, namely uncorrected near visual acuity (MD = 0.12, p &lt; 0.00001) and distance‐corrected near visual acuity (MD = 0.12, p = 0.002). Post‐operative corrected distance visual acuity (MD = −0.01, p = 0.01) was significantly improved for the EDOF group, although no difference was noted in post‐operative uncorrected distance visual acuity (MD = 0.00, p = 0.84), uncorrected intermediate visual acuity (MD = 0.01, p = 0.68) or distance‐corrected intermediate visual acuity (MD = −0.01, p = 0.39). Defocus curve favoured trifocal IOLs at near vision and EDOF IOLs at intermediate vision. Ocular aberration, CS, haloes (odds ratio = 0.64, p = 0.10), glare and patient satisfaction were not statistically significant between the groups. The trifocal IOL was associated with an improved QoV questionnaire score (MD = 1.24, p = 0.03) and spectacle independence (odds ratio = 0.26, p = 0.02).Conclusions: Trifocal IOLs improved uncorrected near visual acuity compared to EDOF IOLs. Uncorrected distance and intermediate visual acuity, halos and glare were not statistically different between both groups.

Using adaptive optics to optimize the spherical aberration of eyes implanted with EDOF and enhanced monofocal intraocular lenses.

To assess the effect of change in ocular spherical aberration (SA) with adaptive optics on visual acuity (VA) at different defocus after implantation of extended depth-of-focus (EDOF) and enhanced monofocal intraocular lenses (IOLs). Narayana Nethralaya Eye Hospital, Bangalore, India. Prospective, longitudinal, observational. 80 eyes (40 patients) that had cataract surgery were included in the study. 40 eyes were implanted with Eyhance EDOF IOLs and the remaining with Vivity EDOF IOLs. Baseline ocular aberrations were measured with a visual adaptive optics aberrometer, then the optimal SA was determined by increasing it in steps of -0.01 μm up to -0.1 μm until the maximum improvement in near distance VA was observed for a given eye. Then the defocus curve for each eye was measured after modifying the ocular SA by magnitude equal to optimal SA. Most of the eyes accepted a negative induced SA of -0.05 μm (Eyhance group: 67.6%; Vivity group, 45.2%). In the Eyhance group (dominant eyes), VA improved at -2 diopters (D) ( P < .02) only and degraded at 0 D, +0.5 D, and +1 D defocus ( P < .05). In the Vivity group, the VA remained unchanged at all defocus ( P > .05). In the Eyhance group (nondominant eyes), VA improved at -3.5 D defocus only and degraded at +1.5 D and +2 D defocus ( P < .05). In the Vivity group, VA improved at -2.5 D defocus ( P < .05) only. A negative induced SA of -0.05 μm in implanted eyes was optimal for a slight improvement in distance-corrected near and intermediate VA without any significant decrease in baseline distance-corrected VA.

Effect of spherical aberration on visual acuity and depth of focus in pseudophakic eyes.

To assess the performance of 4 intraocular lenses (IOLs) in various spherical aberration (SA) conditions, using the VAO adaptive optics simulator. Cullen Eye Institute, Baylor College of Medicine, Houston, Texas. Prospective case series. Distance-corrected visual acuities at distance (CDVA), intermediate (DCIVA), and near (DCNVA) were measured in 42 dilated pseudophakic eyes at baseline and with ocular SA ranging from -0.4 to +0.4 μm in increments of 0.2 μm (6.0-mm pupil). 4 IOL types were assessed: monofocal IOLs with zero-SA, enhanced-monofocal, extended depth-of-focus (EDOF), and continuous range-of-vision. Compared with SA = 0 μm, significant changes (all P < .05) were: (1) zero-SA monofocal IOLs' DCNVA at high contrast improved by 0.13 logMAR with SA = -0.4 μm and worsened by 0.09 and 0.10 logMAR with SA = +0.2 and +0.4 μm, respectively. DCNVA at low contrast worsened by 0.09 logMAR with SA = +0.4 μm; and (2) with SA = -0.4 μm, the enhanced monofocal IOL lost 0.06 logMAR of CDVA at high contrast and gained 0.09 logMAR of DCNVA at low contrast. There were no significant changes from SA = 0 μm for EDOF and continuous range-of-vision IOLs. Zero-SA and EDOF IOLs were the most and least sensitive to SA modulation, respectively. In perfect optical systems where all the optical elements are aligned, induction of targeted amounts of negative SA improved the depth of focus of some IOL types. No benefit was found with positive SA.

Comparative Analysis of Tolerance to Experimentally Induced Astigmatism with Three Types of Multifocal Intraocular Lenses.

The effect of residual astigmatism and its axis on distance and near visual acuities (VAs) with multifocal intraocular lenses (IOLs) has not been studied extensively. This study compared the tolerance to experimentally induced residual astigmatism among bifocal, trifocal, and extended depth-of-focus (EDOF) IOLs. This retrospective, comparative study included 70 eyes of 70 patients implanted with bifocal, trifocal, or EDOF IOLs. Distance and near VAs were assessed with experimentally induced astigmatism by placing positive cylindrical lenses in increments of 0.50 diopters to 2.00 diopters at 90° and 180° axes over the best distance correction. Both distance and near VAs worsened with increasing magnitudes of experimentally induced astigmatism except in the EDOF group, in which the near VA remained within a clinically acceptable limit, ie, within one line from the best corrected VA under all ranges of experimentally induced astigmatism. Furthermore, the EDOF group showed the highest astigmatic threshold for losing VA lines following experimental astigmatic induction at both distance and near. The distance VA was generally better at with-the-rule (WTR) than against-the-rule (ATR) astigmatism for all three IOL groups. On the other hand, the near VA was generally better at WTR than ATR astigmatism in the bifocal group, comparable between WTR and ATR astigmatism in the trifocal group, and generally better at ATR than WTR astigmatism in the EDOF group. The EDOF IOL demonstrated the highest tolerance to experimentally induced astigmatism at both distance and near. VA was generally less affected by WTR astigmatism than ATR astigmatism, especially at distance. We proposed the residual astigmatism thresholds for clinically acceptable VA reduction in all three IOL groups.

Positive dysphotopsia after implantation of an EDOF intraocular lens

Introduction: This report describes a case of positive dysphotopsia (PD) after refractive lens exchange (RLE) with implantation of an extended depth-of-focus (EDOF) intraocular lens (IOL). Patient and Clinical Findings: A healthy 48-year-old man underwent RLE with bilateral implantation of a nontoric EDOF IOL and suffered from monocular triplopia in both eyes. The visual acuity was suboptimal with an uncorrected distance visual acuity of 20/25 in the right eye and 20/30 in the left eye. Diagnosis, Intervention and Outcomes: Slitlamp examination showed well-centered implanted IOLs, without capsular distension syndrome. Bilateral IOL exchange was performed with an aspheric monofocal IOL with a 7.0 mm optic diameter, which diminished the PD complaints. Conclusions: This case report describes disturbing PD after bilateral implantation of an EDOF IOL. Exchange of these EDOF IOLs with a larger optical diameter monofocal IOL resulted in resolution of symptoms.

My Experience of Extended Depth of Focus Intraocular Lens Implantation

Aim: This research was conducted to determine whether or not a recently formulated intraocular lens (IOL) with an extended depth of focus (EDOF) successfully treats cataracts. Different Techniques: After performing phacoemulsification cataract surgery on a total of 36 eyes belonging to 25 patients ranging in age from 51 to 82, the LUCIDIS EDOF IOL, which was produced by SAV-IOL SA and is situated at Route des Falaises 74 in Neuchatel, Switzerland, was successfully implanted. The patients' ages ranged from 51 to 82. SAV-IOL SA, located at 74 Route des Falaises in Neuchatel, Switzerland, served as the location for the surgical procedure. Switzerland is home to the city in question. During the course of the three-month follow-up period, the patients' uncorrected near vision (UNVA), distance-corrected near vision (DCNVA), uncorrected and corrected distance vision (UDVA and CDVA), monocular defocus curves, and refractive outcomes were evaluated. Result: "The postoperative mean values for UDVA, UNVA, and DCNVA were 0.10 \(\pm\) 0.19, 0.16 \(\pm\) 0.24, and 0.39 \(\pm\) 0.38, respectively. The average distance-corrected visual acuity was over 0.30 between +1.02 and 1.52 D defocus. After cataract surgery, the Synthesis + EDOF IOL provides functional far, intermediate, and close vision. A micro-monovision method might boost this new IOL's near-visual performance. Clinical investigations should confirm this pilot study's findings.

Clinical outcomes with a novel extended depth of focus intraocular lens Tecnis Symfony

Relevance. Some of the most current intraocular lenses (IOL) are lenses with an extended depth of focus. Lenses of this type allow you to reduce dependence on glasses by distributing light energy to long-range and focus at medium distance, without losing the quality of vision. Studies that analyze the results of implantation of this type of lens are few. Purpose: to evaluate the clinical outcomes of extended depth of focus (EDOF) intraocular lens (IOL) implantation. Materials and methods. Prospective randomized study enrolled 61 patients of 79 eyes (18 to 86 years) undergone uncomplicated phacoemulsifi cation with EDOF IOL Tecnis Symfony (USA) implantation. The study was conducted from November 2020 through November 2022. Uncorrected near visual acuity (UNVA); corrected near visual acuity (CNVA) and uncorrected and corrected distance visual acuity (UDVA and CDVA), monocular defocus curve and refractive outcomes were evaluated during a 3-month period. When calculating the IOL, the target spherical equivalent was –0.35 ± 0.11 D. Results. In the postoperative period 3 months, visual acuity were 0.7 or better in 82.4% UCDVA, 100% CDVA and 50% UCNVA. 3 months after surgery, UDVA and UNVA at 40 cm averaged 0.85 ± 0.15 and 0.69 ± 0.18, respectively. CDVA and CNVA at 40 cm was 0.98 ± 0.04 and 0.8 ± 0.14, respectively. A total of 85.7% of eyes achieved postoperative visual acuity about 0.5 for the range of defocus levels between +1.00 and −1.50 D. Conclusions. Cataract surgery with Tecnis Symfony EDOF IOL implantation provide functional levels of visual acuity in distance, intermediate zones. The near visual performance with this IOL might be signifi cantly enhanced using a micro-monovision approach