Extended Depth Of Focus Intraocular Lens Research Articles

Comparative visual outcomes of EDOF intraocular lens with FLACS vs conventional phacoemulsification.

To investigate the visual quality after femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS) with the implantation of an extended depth-of-focus (EDOF) intraocular lens (IOL) TECNIS Symfony. Eye Center, the Second Affiliated Hospital of Zhejiang University, Zhejiang, China. Prospective cohort study. Patients were given the option to choose FLACS or CPS and were implanted with a TECNIS Symfony. Main outcome measures were postoperative examinations that included defocus curves, contrast sensitivity (CS), optic path difference aberrometry scan, anterior segment photography, and questionnaires. 261 patients (261 eyes) were enrolled. The circularity index of FLACS was more precise than that of CPS ( P = .001). FLACS demonstrated a significantly lower IOL decentration ( P = .011) and IOL tilt ( P = .009). FLACS presented a significantly lower total aberration ( P < .001), higher-order aberrations (HOAs) ( P = .001), coma ( P = .001), and spherical aberration ( P < .001). With IOL decentration of more than 0.40 mm, total internal aberration ( P = .023) and HOAs ( P = .045) were significantly deteriorated. As for defocus curve, FLACS was better at -1.00 diopter ( P < .01). The FLACS group achieved higher CS at 6 to 18 cycles per degree under glare condition ( P < .05). With regard to photic phenomena, the FLACS group received better outcomes ( P < .05). With the implantation of an EDOF IOL, FLACS could precisely control the shape and size of the capsulotomy and induce a significantly better-centered IOL, leading to higher visual performance compared with CPS.

Comparison of clinical outcomes of trifocal intraocular lens (AT LISA, Eyecryl SERT trifocal) versus extended depth of focus intraocular lens (Eyhance, Eyecryl SERT EDOF)

To compare four different types of intra ocular lenses (IOLs), namely, AT LISA, Eyecryl SERT trifocal, Eyhance, Eyecryl SERT extended depth of focus (EDOF) with respect to their clinical outcomes. This is a retrospective comparative study in which patients who underwent surgery and one of the four types of IOL were implanted. Postoperative evaluation was recorded at one month, postoperatively. The monocular uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) (6 m), uncorrected intermediate visual acuity (UIVA) (60 cm), distance-corrected intermediate visual acuity (CIVA), uncorrected near visual acuity (UNVA) (40 cm), and corrected near visual acuity (CNVA) were assessed postoperatively on post operative day 30, for all four IOL groups. Defocus curve and contrast sensitivity were also compared. With regards to UDVA and CDVA, P value was not statistically significant. (P = 0.534 and 0.421, respectively). EDOF group of IOLs had statistically significant better UIVA and CIVA than trifocal IOL group. (P < 0.001, 0.012, <0.001) and EDOF group had statistically significant worse P value pertaining to UNVA and CNVA (P < 0.001, 0.070, <0.001, 0.190). Pertaining to contrast sensitivity, EDOF group had better contrast sensitivity than Trifocal IOL group (P < 0.001). All four IOLs compared in this study had good comparable distant visual acuity. Near visual acuity was better with AT LISA and Eyecryl SERT trifocal IOL while intermediate vision was better with Eyhance and Eyecryl SERT EDOF IOL. Contrast sensitivity was better in EDOF IOLs than in both trifocal IOLs.

Comparison of Bilateral Reading Performance Among Two Presbyopia-Correcting Intraocular Lenses.

To evaluate and compare the performance of a trifocal diffractive intraocular lens (IOL) and a lens combining a bifocal diffractive profile and extended depth of focus (EDOF) profile. This non-randomized, prospective comparative study included 42 patients (84 eyes) undergoing lens surgery with implantation of either the FineVision HP trifocal IOL (PhysIOL) or TECNIS Synergy bifocal EDOF IOL (Johnson and Johnson Surgical Vision). There were 21 patients (42 eyes) in each group. The primary outcome was reading speed at high contrast and luminance. Secondary outcomes were reading speed at lower contrasts and luminances, visual acuity at all distances (distance, intermediate, and near) with and without correction, and quality of vision. The reading speed at high contrast (100%) and high luminance (100%) was better in the Synergy group (P = .01). This difference between the two IOLs seemed to be preserved at lower contrasts and luminances. There was no statistically significant difference between visual acuities except for monocular uncorrected intermediate visual acuity (P = .046) in favor of the FineVision HP IOL. The mean spherical equivalents in the FineVision HP and Synergy groups were 0.14 ± 0.64 and 0.10 ± 0.33 diopters without significant difference between these means (P = .78). The defocus curve was more dome-shaped for the Synergy IOL. The evaluation of visual symptoms was comparable in both groups. The glare halo (Halometry test; Aston University) was smaller in the FineVision HP group (P = .03). The Synergy IOL appears to provide better reading speed and is less sensitive to refractive error. Both lenses provided excellent distance, intermediate, and near vision. [J Refract Surg. 2022;38(7):428-434.].

Academy IRIS® Registry Analysis of Incidence of Laser Capsulotomy Due to Posterior Capsule Opacification After Intraocular Lens Implantation.

PurposeAcademy IRIS® (Intelligent Research in Sight) Registry was used to determine the incidence of postoperative neodymium-doped yttrium aluminum garnet laser capsulotomy (Nd:YAG) and time to posterior capsular opacification (PCO) diagnosis based on intraocular lens (IOL) type and brand.MethodsThis retrospective analysis included eyes implanted with 1 of 2 IOL brands, with ≥365 days of follow-up available in the IRIS Registry, and ≥2 visits within 180 days of surgery. Analyses included Nd:YAG incidence due to PCO within 1 year after surgery by IOL type and brand, mean time to PCO diagnosis, and mean time to Nd:YAG.ResultsOf 89,947 eyes after cataract surgery, 24,834 (28%) had PCO diagnosis within 365 days, and 9262 (10%) underwent Nd:YAG; 4.1% of 57,523 eyes with monofocal and 21.2% of 32,424 eyes with diffractive multifocal (MF) or diffractive extended depth of focus (EDOF) IOLs had Nd:YAG. Nd:YAG was 3.2 times more likely in eyes with diffractive MF or diffractive EDOF IOLs versus monofocal. For monofocal IOLs, 3.2% of eyes with AcrySof® and 8.1% of eyes with Tecnis® had Nd:YAG (P<0.0001). For diffractive MF or diffractive EDOF IOLs, 13.0% of eyes with AcrySof and 21.7% of eyes with Tecnis had Nd:YAG (P<0.0001). Nd:YAG risk was 2.4 times higher in eyes with Tecnis versus AcrySof IOLs. Overall, mean time to PCO diagnosis and Nd:YAG was 150.7 and 180.7 days. Mean time to PCO for monofocal versus diffractive MF or diffractive EDOF IOLs was 165.3 versus 139.7 days (P<0.0001). Mean time to Nd:YAG for monofocal versus diffractive MF or diffractive EDOF IOLs was 196.4 versus 175.3 days (P<0.05).ConclusionReal-world data for AcrySof and Tecnis IOLs revealed lower Nd:YAG rates and longer time to PCO diagnosis and Nd:YAG after monofocal versus diffractive multifocal or diffractive EDOF implantation. Nd:YAG rates were significantly lower with AcrySof versus Tecnis IOLs.

Evaluation of a Novel Non-Diffractive Extended Depth of Focus Intraocular Lens – First Results from a Prospective Study

Purpose To evaluate a novel hydrophobic, non-diffractive, extended depth of focus (EDOF) intraocular lens (IOL) design in comparison to two monofocal aspheric lenses. Methods Inclusion criteria for this prospective, monocentric cohort study were opacification of the crystalline lens and patients’ wishes for surgery. In the case of the EDOF IOL, patients asked for a presbyopia correction. All patients received surgery on both eyes. Corrected and uncorrected distance visual acuity (CDVA, UCDVA), uncorrected and distance corrected intermediate visual acuity (UIVA, DCIVA) and defocus curves (all monocular and binocular) were compared three months postoperatively. Results Fifty-six eyes were implanted with an EDOF IOL (LuxSmartTM, Bausch & Lomb GmbH, Berlin, Germany), 50 eyes with a monofocal aspheric IOL: 32 eyes with a clear IOL (Polylens® AS 61, Polytech Domilens, Roßdorf, Germany), 16 eyes with a yellow IOL (iSert® 251, Hoya Surgical Optics GmbH, Frankfurt, Germany). Three months postoperatively, UCDVA was comparable with the EDOF IOL, versus the monofocal IOL (P > 0.9). Binocular DCIVA in the EDOF IOL was significantly higher than in the monofocal IOL (P = 0.001). Monocular DCIVA better than 20/23 Snellen was achieved in 10% with the monofocal IOL and in 68% (P < 0.0001) with the EDOF IOL. Defocus curves showed a depth of focus at 20/23 Snellen of 1.6 vs. 0.83 diopters (D) in the EDOF IOL, vs. the monofocal IOL. No patient reported halos or starbursts in non-standardized questioning. Conclusion This non-diffractive EDOF IOL provided comparably high UCDVA and significantly higher DCIVA than the mono-focal lenses, causing only mild optical phenomena.

Comparison of visual outcomes after two types of mix-and-match implanted trifocal extended-depth-of-focus and trifocal intraocular lenses

To compare visual outcomes between two types of mix-and-match implanted trifocal extended-depth-of-focus (EDoF) and trifocal intraocular lenses (IOLs). A total of 212 eyes of 106 subjects with mix-and-match implanted FineVision Triumf and FineVision HP IOLs (Triumf-HP group) and 212 eyes of 106 subjects with mix-and-match implanted Zeiss AT LARA and AT LISA IOLs (AT LARA-LISA group) were enrolled in this retrospective case-control study. Uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), and binocular distance-corrected defocus curves were measured between 6 and 10weeks after cataract surgery. There was no significant difference in UDVA among the four IOLs. UNVA was the best in eyes with the FineVision HP IOL (0.04 ± 0.06 logMAR), followed by eyes with the AT LISA IOL (0.07 ± 0.07 logMAR), the FineVision Triumf IOL (0.09 ± 0.09 logMAR), and the AT LARA IOL (0.11 ± 0.08 logMAR), respectively. The AT LARA-LISA group had better visual acuity than the Triumf-HP group between - 1.00 D and - 1.50 D of defocus, and the Triumf-HP group had better visual acuity than the AT LARA-LISA group between - 3.00 D and - 4.00 D of defocus. Mix-and-match implantation of trifocal EDoF and trifocal IOLs provided good visual outcomes in far, intermediate, and near distances. The mix-and-match implantation of Triumf-HP IOLs led to better visual outcomes in near vision, while that of the AT LARA-LISA IOLs led to better visual outcomes in intermediate vision.

In vitro optical performance of multifocal and extended depth-of-focus intraocular lenses in spherical aberration conditions.

To evaluate and compare the optical performances of 4 different types of intraocular lenses (IOLs) in various spherical aberration (SA) conditions. POSTECH, Pohang, South Korea. In vitro laboratory study. A custom optical bench system with adaptive optics was used. A monofocal IOL, a bifocal IOL, a trifocal IOL, and an extended depth-of-focus (EDoF) IOL from Zeiss were evaluated by measuring through-focus modulation transfer function (MTF) as a function of vergence. MTF changes with SA from -0.1 to +0.1 with 0.05 μm step size were analyzed and compared. In aberration-free conditions, the 4 IOLs showed different MTF curves consistent with their designs. In SA conditions, all the IOLs showed MTF value decreases and the decrease rates at the far focus varied from 28% to 38% per 0.1 μm SAs. The trifocal IOL had low MTF values at the intermediate focus in the noise level with ±0.1 μm SAs. All tested IOLs showed MTF decreases with SA in different levels. The trifocal and EDoF IOLs were the most and least sensitive to SA among the evaluated IOLs. The study results might be useful in the selection of IOLs for cataract patients with SA.

Prediction accuracy of no-history intraocular lens formulas for a diffractive extended depth-of-focus intraocular lens after myopic corneal refractive surgery.

To compare the accuracy of intraocular lens (IOL) calculation methods for extended depth-of-focus (EDoF) IOLs in eyes with a history of myopic laser-assisted in situ keratomileusis (LASIK)/photorefractive keratectomy (PRK) surgery lacking historical data. Changsha Aier Eye Hospital, Changsha, and Wuhan Aier Eye Hospital, Wuhan, China. Retrospective case series. Patients with axial lengths (ALs) ≥25.0 mm and a history of myopic LASIK/PRK surgery who underwent cataract surgery with implantation of EDoF IOLs were enrolled. A comparison was performed of the accuracy of 10 IOL methods lacking historical data, including Barrett True-K no history (Barrett TKNH), Haigis-L, Shammas, and Potvin-Hill formulas and average, minimum, and maximum IOL power on the ASCRS online postrefractive IOL calculator; Seitz/Speicher/Savini (Triple-S) formula; and Schuster/Schanzlin-Thomas-Purcell (SToP) formulas based on Holladay 1 and SRK/T formulas. IOL power was calculated with the abovementioned methods in 2 groups according to AL (Group 1: 25.0 mm ≤ AL < 28.0 mm and Group 2: AL ≥ 28.0 mm). 64 eyes were included. Excellent outcomes were achieved with the minimum, Barrett TKNH, SToP (SRK/T), and Triple-S formulas in the whole sample and subgroups, which led to similar median absolute error, mean absolute error, and the percentage of eyes with a prediction error within ±0.5 diopters (D). In the whole sample, the Haigis-L and maximum formulas had a significantly higher absolute error than minimum, SToP (SRK/T), and Barrett TKNH formulas. The maximum formula also had a significantly lower percentage of eyes within ±0.5 D than the Barrett TKNH, and SToP (SRK/T) formulas (15.6% vs 50% and 51.5%, all P < .05 with Bonferroni adjustment). Predicting the EDoF IOL power in postmyopic refractive eyes by no-history IOL formulas remains challenging. The Barrett TKNH, Triple-S, minimum, and SToP (SRK/T) formulas achieved the best accuracy when AL ≥ 25.0 mm, while the Barrett TKNH and SToP (SRK/T) formulas were recommended when AL ≥ 28.0 mm.

Comparative Analysis of the Clinical Outcomes of Mix-and-Match Implantation of an Extended Depth-of-Focus and a Diffractive Bifocal Intraocular Lens.

To evaluate and compare the clinical outcomes of the extended depth-of-focus intraocular lens (EDOF-IOL) and the diffractive bifocal IOL. Fifty-six eyes of 28 patients underwent cataract surgery with implantation of an EDOF-IOL (TECNIS Symfony, ZXR00) in their dominant eye and a diffractive bifocal IOL (+3.25 D add TECNIS ZLB00) in their nondominant eye. Monocular and binocular uncorrected distance, intermediate and near visual acuity, defocus curves, contrast sensitivity, patient satisfaction score (0-5), and spectacle dependence at near vision were evaluated at 3 months after the surgery. Postoperative binocular uncorrected distant visual acuity was 0.009±0.031 logMAR, uncorrected intermediate visual acuity was 0.090±0.158 logMAR, and uncorrected near visual acuity was 0.099±0.068 logMAR. The monocular defocus curve demonstrated better performance at intermediate distance in eyes with an EDOF-IOL and better performance at near distance in eyes with a diffractive bifocal IOL. An EDOF-IOL exhibited better outcomes in contrast sensitivity compared with a diffractive bifocal IOL. Three patients (10.7%) required glasses for near vision. Mix-and-match implantation of a diffractive bifocal IOL with an EDOF-IOL provides an excellent range of vision, and high levels of contrast sensitivity and patient satisfaction.

Influence of angle alpha on visual quality after implantation of extended depth of focus intraocular lenses

BackgroundTo assess postoperative changes in angle alpha, and to evaluate the postoperative visual quality of patients with different angle alpha values after implantation of extended depth of focus (EDOF) intraocular lenses (IOLs).MethodsSeventy-nine eyes of 79 patients who had phacoemulsification with EDOF IOLs implantation were enrolled. A cut-off value of 0.3 mm, 0.4 mm, and 0.5 mm in preoperative angle alpha was chosen to divide eyes into groups. Distance, intermediate, and near visual acuities, modulation transfer function (MTF), and aberrations were recorded during a 6-month follow-up. A patient questionnaire was completed.ResultsThere were no significant differences in angle alpha postoperatively compared to preoperatively. No significant differences were found in visual acuity and MTF between all groups. With 5 mm pupil diameter, there were significant differences of higher-order aberrations and spherical aberration in ocular aberration and internal aberration between angle alpha<0.4 mm and angle alpha≥0.4 mm. Additionally, significant differences of coma were also added in cut-off value of 0.5 mm. When the value of angle alpha is 0.4 mm or higher, there were significant differences in the score of halos and glare.ConclusionsAngle alpha did not affect visual acuity, but the value of 0.4 mm or higher in angle alpha affected the visual quality under scotopic conditions and occurrence of halos and glare. For patients with 0.4 mm or higher in angle alpha, the choice to implant a EDOF IOL should be carefully considered.

Nondiffractive wavefront-shaping extended depth-of-focus intraocular lens: visual performance and patient-reported outcomes.

To evaluate visual performance and patient-reported outcomes after bilateral implantation of a new nondiffractive wavefront-shaping extended depth-of-focus (EDoF) intraocular lens (IOL). Department of Ophthalmology, Goethe University, Frankfurt, Germany. Prospective, single-arm, single-center study. Patient population: 16 patients (32 eyes) who received bilateral implantation of a nondiffractive wavefront-shaping EDoF IOL (AcrySof IQ Vivity) were included. Target refraction in both eyes was emmetropia. Observation procedure: Monocular and binocular uncorrected (UCVA) and distance-corrected (DCVA) visual acuity (VA), refractive outcome, defocus curve, and contrast sensitivity (CS) were evaluated 3 months after surgery with a questionnaire on optical phenomena and spectacle independence. Main outcome measure: 3-month postoperative monocular and binocular UCVA and CDVA (logMAR), defocus curve, CS, and quality of vision (QoV) questionnaire results. 16 patients with 32 eyes were included. Mean spherical equivalent was -0.16 ± 0.37 diopters (D) 3 months postoperatively. Binocular uncorrected distance VA at distance, intermediate, and near was 0.01 ± 0.05 logMAR at 4 m, 0.05 ± 0.05 logMAR at 80 cm, 0.07 ± 0.06 logMAR at 66 cm, and 0.25 ± 0.11 logMAR at 40 cm, respectively. Despite some minor optical phenomena, 88% of patients would choose the same lens. 63% of patients reported no optical phenomena at all. CS was 1.25 ± 0.41 logCS (photopic), 0.96 ± 0.24 logCS (mesopic), and 0.93 ± 0.24 (mesopic + glare). This nondiffractive wavefront-shaping EDoF IOL provides good VA at far and intermediate distance and functional near VA. It showed good QoV and CS and high spectacle independence for distance and intermediate vision with significantly less optical phenomena than with other EDoF or multifocal IOLs.

Visual outcomes of a new nondiffractive extended depth-of-focus intraocular lens targeted for minimonovision: 3-month results of a prospective cohort study.

To evaluate visual outcomes, spectacle independence, and optical phenomena after bilateral implantation of a nondiffractive extended depth-of-focus (EDoF) intraocular lens (IOL) targeted for minimonovision. University Eye Clinic Maastricht, the Netherlands. Prospective case series. Patients with age-related cataract were bilaterally implanted with a nondiffractive EDoF IOL (Alcon AcrySof IQ Vivity), targeted for minimonovision. Outcome measures were the uncorrected distance visual acuity (UDVA), corrected distance visual acuity, uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), distance corrected intermediate visual acuity, distance corrected near visual acuity, refractive outcomes, defocus curves, spectacle independence, photic phenomena, and Catquest-9SF questionnaire. 44 eyes of 22 patients were included. The mean binocular UDVA, UIVA, and UNVA were -0.07 (±0.10), 0.04 (±0.09), and 0.23 (±0.12) logMAR, respectively. The percentage of eyes within ±1.0 diopters (D) and ±0.5 D of target was 100% and 95% for the dominant eye and 100% and 86% for the nondominant eye, respectively. The binocular defocus curve was better than 0.10 logMAR over a range from -2.0 D to +0.5 D. The percentage of patients who reported not or rarely using spectacles for distance, intermediate, and near viewing distance was 96%, 68%, and 38%, respectively. The percentage of patients who experienced no halos, glare, or starbursts were 91%, 91%, and 100%, respectively. The Catquest-9SF showed a high patient satisfaction for daily life activities. Bilateral AcrySof IQ Vivity IOL implantation targeted for minimonovision provided good visual acuity results for far and intermediate with functional near vision, high level of patient satisfaction and spectacle independence, and a monofocal disturbance profile.

Visual performance of a new Extended Depth of Focus (EDOF) intraocular lens: Preliminary results

To evaluate visual outcomes at 3 months after bilateral implantation of a new EDOF intraocular lens in a routine cataract population. Prospective evaluation of 12 patients (24 eyes) implanted bilaterally with an EDOF intraocular lens (IOL) with emmetropia as the target. Visual acuity at distance, intermediate (70cm) and near (40cm) with and without distance correction, refractive error, monocular photopic defocus curve and contrast sensitivity curve with best corrected distance refraction were measured. Subjective outcomes in terms of visual function, spectacle independence, lighting independence, dysphotopsia and overall satisfaction were assessed at three months. The mean age of the patients was 68.33 years±10.30. The mean IOL power was 21.5±2.44D. Three months after surgery, the mean decimal uncorrected distance (UCDVA), intermediate (UCIVA) and near (UCNVA) visual acuities were 0.10, 0.09 and 0.23 logMAR respectively. The monocular defocus curve with distance correction showed 1.75D of depth of field with an acuity better than 0.3 logMAR. Patient satisfaction was high, with a low occurrence of dysphotopsia. The A-constant should be optimized for better predictability. The EDOF IOL showed satisfactory visual performance after cataract surgery, with high patient satisfaction and a low occurrence of visual disturbances. It resulted in good distance and intermediate vision, but might require spectacles for small print at a near distance.

Polychromatic through-focus image quality in a wavefront-shaping presbyopia correcting intraocular lens

ABSTRACT Objectives To compute the polychromatic through-focus image quality in eyes implanted with a new extended depth of focus (EDOF) intraocular lens (IOL). Methods Eight eyes of four patients who underwent implantation with the AcrySof IQ Vivity EDOF IOL were analyzed. Wavefront aberrations were measured. The optical metric for the polychromatic through-focus image quality used was the Visual Strehl ratio computed in the spatial domain (VSX). Eight eyes implanted with a monofocal IOL were also examined. Results The normalized VSX values change with vergence for both group of IOLs. However, the depth-of-focus (DoF) for the Vivity IOL was about 0.75, 1.00, and 1.25 D larger than the monofocal IOL, for 0.1, 0.2, and 0.3 logMAR visual acuities. The DoF computed from the polychromatic through-focus image quality for the Vivity IOL was about 2.50D, being this value 1.25D wider than the monofocal one. The DoF obtained from the defocus curve was about 2.25 D for eyes implanted with the Vivity IOL. Conclusions Polychromatic through-focus image quality analysis agrees with the clinical outcomes indicating that this methodology may be useful to estimate the DoF and the expected quality of vision in patients implanted with lenses from wavefront aberration measurement. This approach shows the increased DoF of the EDOF lens compared to a monofocal.

Outcomes of bilateral implantation of trifocal and extended depth of focus IOLs

Comparative analysis of the results of trifocal and EDOF IOL implantation in patients with presbyopia and/or cataract. This prospective study included 72 patients (144 eyes) after bilateral implantation of either Tecnis Symfony EDOF IOL (18 patients, 36 eyes; group I) or AcrySof PanOptix trifocal IOL (54 patients, 108 eyes; group II). In 18 patients out of 72 (25%) the implantation involved mini-monovision, i.e. the calculation of the IOL power on the nondominant eye was performed at -0.5 D. The average follow-up period for the patients was 7.1±1.2 months. There was a significant (p<0.05) increase in uncorrected near visual acuity (UCNVA), uncorrected intermediate visual acuity (UCIVA) and uncorrected distance visual acuity (UCDVA) at the maximum follow-up time compared to the preoperative indices in all groups. Group II was characterized by slightly better UCNVA dynamics (0.85±0.13 versus 0.2±0.04 before surgery, as comparted to 0.78±0.11 versus 0.19±0.06 before surgery in group I), but differences were not statistically significant (p>0.05). Statistically significant differences (p=0.046) were observed when comparing best corrected near vision acuity (BCNVA) in groups I and II (0.79±0.05 and 0.98±0.08, respectively) at 6 months compared to the preoperative period (0.62±0.09 and 0.6±0.11, respectively). Trifocal IOL implantation was associated with acceptable near and far vision correction and a higher frequency of adverse optical phenomena, while implantation of the EDOF IOL was associated with slightly better correction of intermediate vision and a significantly lower incidence of halo and glare. Patients were satisfied with the outcomes of surgery in all cases.

Clinical outcomes of a monofocal intraocular lens with enhanced intermediate function compared with an extended depth-of-focus intraocular lens.

To compare clinical outcomes of a new monofocal intraocular lens (IOL) with enhanced intermediate function and an extended depth-of-focus (EDoF) IOL. Asan Medical Center, Seoul, Korea. Nonrandomized prospective comparative case series. Patients presenting for cataract surgery and meeting all inclusion and exclusion criteria were implanted with a new monofocal IOL with enhanced intermediate function (Tecnis Eyhance ICB00) or an EDoF IOL (Tecnis Symfony ZXR00) bilaterally. Uncorrected (UDVA), uncorrected intermediate (UIVA), uncorrected near (UNVA), and corrected distance visual acuity (CDVA), defocus curves, and contrast sensitivity were compared after 3 months. Patients were administered questionnaires regarding visual symptoms, spectacle independence, overall satisfaction, and lens recommendations. 24 patients (48 eyes) were enrolled in the Eyhance group and 20 patients (40 eyes) in the Symfony group. Monocular and binocular UDVA, UIVA, and CDVA were similar in the 2 groups. Monocular UNVA and spectacle independence for near distance were better in the Symfony group, whereas binocular UNVA did not differ significantly in the 2 groups. Contrast sensitivity, glare and halo, satisfaction, and recommendation rates were similar in the 2 groups. Although some dissatisfaction and severe glare and halo were reported in the Symfony group, none of these was reported in the Eyhance group. Bilateral implantation of the Eyhance ICB00 IOL provided comparable clinical performances as bilateral implantation of the Symfony ZXR00 IOL. Binocular UNVA was similar, although spectacle independence was higher in the Symfony group, but this was at the expense of more glare and halos.

The Importance of IOL Selection in Patients With Young-age Cataracts: a Case Report

Background: A cataract is a type of degenerative change of the lens, which is characterized by the clouding of the lens followed by symptoms of optical deterioration. Over 70 years ago, Sir Harold Ridley implanted the first useable modern-day intraocular lens (IOL) implant. A lot has happened since then. The IOL is arguably the most life-changing and innovative implant in the history of medicine. Currently, there are several types of intraocular lenses on the market. The main classification could be monofocal lenses, multifocal, trifocal, extended depth of focus (EDOF) lenses, and toric lenses. Objective: The aim of this case report is to report the importance of IOL selection in patients with young-age cataracts. Case report: A 35-year-old patient presented first time at our Clinic. In the last six months, he noticed poor vision in his left eye, even with spectacles. The right eye was operated on in another institution in 2020, due to the presence of a young-age cataract. After a complete preoperative ophthalmological examination, we discovered the presence of a cataract in the left eye. UDVA of the left eye was 0.4, and CDVA was +0.50/+0.50/30°=0.5. UNVA and DCNVA was J2. We decided to implant TECNIS Synergy™ IOL (Johnson &amp; Johnson Vision, Santa Ana, CA, USA) during the cataract surgery. That EDOF IOL bridges the gap between the performance of monofocal and multifocal IOLs and delivers continuous high-contrast vision for patients with cataracts from far through near, even in low-light conditions. There were no intraoperative or postoperative complications. On a 7-day, check-up UDVA of the left eye was 1.0, and UNVA was J1. The patient was satisfied with the vision in the left eye, so he wanted to correct the vision of the right eye which was implanted with SENSAR® IOL (Johnson &amp; Johnson Vision, Santa Ana, CA, USA), with a residual diopter of +2.00/+1.00/120 for distance, and +4.50/+1.00/120 for near vision. This choice of IOL in the other institution was not an ideal solution for this patient due to his young age and occupation. The capsular bag was already in slight fibrosis, so the explantation of the existing IOL and implantation of the new one was not a reasonable option. We decided to go with the multifocal AddOn® toric lens (1stQ GmbH, Mannheim, Germany), the refractive-surgery platform for vision enhancement of pseudophakic eyes, that also correct residual astigmatism. On a 7-day check-up, this patient’s UDVA was 1.0 and UNVA was J1. The result was a happy patient, who could go back to his everyday life without spectacle independence. Conclusion: Good unaided distance visual acuity (VA) is now a realistic expectation following cataract surgery and intraocular lens (IOL) implantation. We should be aware of patient expectations and demands, especially when having a patient with young-age cataracts. Often more time should be spent on preoperative IOL planning than cataract surgery itself.

Comparison of Patient Outcomes following Implantation of Trifocal and Extended Depth of Focus Intraocular Lenses: A Systematic Review and Meta-Analysis.

Purpose The purpose is to compare the outcomes of implantation of trifocal intraocular lenses (TIOLs) and extended depth of focus (EDOF) intraocular lenses (IOLs). Methods A comprehensive search of PubMed, Cochrane Library, EMBASE, and ClinicalTrial.gov was conducted in March 2020 to identify relevant studies. A meta-analysis of the results was performed. Patients implanted with EDOF IOLs or TIOLs in previous studies were included. The primary outcomes of the study were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), and defocus curve. Results TIOLs and EDOF IOLs provided comparable binocular UDVA (MD = -0.01, 95% CI: -0.04, 0.03, logMAR). However, EDOF IOLs provided better UIVA (MD: -0.08, 95% CI: -0.14, -0.01, logMAR) and worse UNVA (MD: 0.10, 95% CI: 0.06, 0.14, logMAR) than TIOLs. Fewer patients achieved spectacle independence after implantation of EDOF IOLs (RR: 0.74, 95% CI: 0.63, 0.87) than after implantation of TIOLs, especially for near vision (RR = 0.82, 95% CI: 0.68, 0.99). There was no statistically significant difference in contrast sensitivity (CS) under photopic or mesopic conditions with both IOLs. Patient satisfaction after implantation of both IOLs was high. Conclusion EDOF IOLs and TIOLs provide comparable distance vision. However, EDOF IOLs provide better intermediate vision and worse near vision than TIOLs. The advantages of EDOF IOLs over TIOLs in terms of CS, aberrations, and visual disturbance are not significant. Patients are satisfied with both types of IOLs.

Functional visual acuity after implantation of diffractive extended depth-of-focus intraocular lenses using an echelett optics

BackgroundThe prospective comparative case series aimed to evaluate all-distance visual acuity, contrast sensitivity, and functional visual acuity (FVA) of eyes with diffractive extended depth-of-focus (EDOF) intraocular lenses (IOLs) using an echelett optics and monofocal IOLs with the same platform.MethodsDiffractive EDOF and monofocal IOLs were implanted in 27 eyes of 27 patients each. At 3 months after implantation, all-distance visual acuities at distances of 0.3, 0.5, 0.7, 1, 2, 3, and 5 m were measured under distance-corrected. Static visual function was also examined using photopic contrast sensitivity and area under the logarithmic contrast sensitivity function (AULCSF). Dynamic visual function was examined with FVA, and mean FVA value, visual maintenance ratio (VMR), mean response time, and number of blinks were evaluated. These outcomes were compared between the two IOLs.ResultsThe mean distance-corrected visual acuities were better at distances of 0.7 m or nearer in eyes with EDOF IOLs. There was no difference in the contrast sensitivities (P > 0.22). In the FVA results, no difference was found in mean FVA and VMR (P > 0.68).ConclusionThe static and dynamic evaluations of postoperative visual functions demonstrated that the visual function of eyes with EDOF IOLs under photopic and distance-corrected conditions was comparable to eyes with monofocal IOLs.

Increased Near Vision Spectacle Dependence of Patients With Preoperative Myopia After Mix-and-Match Implantation of Trifocal EDOF and Trifocal IOLs.

To investigate the factors affecting near vision spectacle dependence after mix-and-match implantation of the trifocal extended depth of focus (EDOF) and trifocal intraocular lens (IOL). A total of 204 eyes of 102 patients who underwent mix-and-match implantation of one trifocal EDOF and one trifocal IOL were enrolled in this study. Patients were divided into two groups according to spectacle dependence for near vision: reading glasses and no glasses. Clinical characteristics were compared between the two groups and multivariate binary logistic regression analysis was performed to determine the odds ratio of factors potentially associated with the need for reading glasses. Eighty-one patients (79.4%) did not need reading glasses and 21 (20.6%) did. The mean age of the no glasses group (55.6 ± 5.6 years) was significantly higher than that of the reading glasses group (52.7 ± 4.1 years). Preoperative refractions were more myopic in the reading glasses group than in the no glasses group. The postoperative uncorrected near visual acuities were better and the satisfaction scores were higher in the no glasses group compared to the reading glasses group. Multivariate binary regression analysis revealed that only pre-operative spherical equivalent (odds ratio: 1.397; P = .025) was related to the spectacle independence for near vision. Patients who had preoperative myopia and underwent mix-and-match implantation of trifocal EDOF and tri-focal IOLs tended to need spectacles for near vision. Surgeons should be aware of patients with myopia when considering mix-and-match implantation of trifocal EDOF and trifocal IOLs. [J Refract Surg. 2021;37(11):746-753.].