Extended Range Of Vision Intraocular Lens Research Articles

Optical Assessment and Expected Visual Quality of Four Extended Range of Vision Intraocular Lenses.

To assess the optical performance of four extended range of vision (ERV) intraocular lenses (IOLs) and predict the visual quality of the average pseudophakic patient. Four ERV IOLs (LuxSmart, Bausch & Lomb; Vivity, Alcon Laboratories, Inc; Tecnis Eyhance, Johnson & Johnson Vision; and Isopure, PhysIOL) were inserted in an on-bench model eye. Their performance was assessed using through-focus modulation transfer function (MTF)-based metrics, through-focus point spread function, and halo analysis for three pupils (2.0, 3.0, and 4.5 mm). The expected visual acuity and the range of vision was estimated from the through-focus area under the MTF curve. A monofocal IOL (Tecnis ZCB00; Johnson & Johnson Vision) was included as reference. The Tecnis ZCB00 showed the highest image quality at far for all pupil conditions, closely followed by the Tecnis Eyhance. The LuxSmart and Vivity performed similarly in the intermediate range (-1.00 to -2.00 diopters [D]) with a 3.0-mm pupil and showed better performance than the other ERV IOLs for that range. All ERV lenses presented pupil dependent performance. All lenses reached normal expected visual acuity (0.0 logMAR) at far distance. The Tecnis ZCB00, Tecnis Eyhance, and Isopure decreased their expected visual acuity with defocus (0.1 logMAR at 66 cm) faster than the LuxSmart and Vivity (0.0 logMAR at 66 cm). The LuxSmart and Vivity produced greater halos than the Tecnis ZCB00, but they showed little change with larger pupils. The Isopure lens showed a pupil-dependent halo. The expected visual acuity decreased with the object distance differently, depending on the ERV design. The Vivity and LuxSmart lenses showed an expanded imaging capability (⩾ 0.50 D) with respect to a monofocal lens that may benefit intermediate vision. The Tecnis Eyhance and Isopure lenses showed more modest extensions that mainly rely on pupil constriction. [J Refract Surg. 2022;38(11):688-697.].

The Vivity Extended Range of Vision IOL vs the PanOptix Trifocal, ReStor 2.5 Active Focus and ReStor 3.0 Multifocal Lenses: A Comparison of Patient Satisfaction, Visual Disturbances, and Spectacle Independence.

PurposeTo compare patient-reported outcomes (PROs) after intraocular lens (IOL) implantation with the AcrySof IQ Vivity IOL or Vivity Toric IOL to those achieved with other multifocal IOLs.Patients and MethodsProspective, open-label, multicenter analysis of PROs, including spectacle independence, dysphotopsia, and overall satisfaction among patients who underwent cataract surgery at least 1 month previously with bilateral Vivity or Vivity Toric lenses (n=60). Results were compared to outcomes from two similar prospective studies of bilateral AcrySof IQ PanOptix or PanOptix Toric trifocal IOLs (n = 59), blended AcrySof ReSTOR 2.5/3.0 IOLs (n=72) or bilateral ReSTOR ActiveFocus 2.5 D IOLs with a mini-monovision target [n = 95]).ResultsPatients in the Vivity cohort were significantly less likely to notice glare and halo in dim light (85% “none” or “just a little”) compared to PanOptix (69%, p<0.03), 2.5 mini-monovision (75%, p< 0.05) or 2.5/3.0 (71%, p< 0.05) patients. Complete spectacle independence for all visual activities combined (never need glasses) with Vivity was comparable to the mini-monovision and 2.5/3.0 groups (33%, 36%, and 31%, respectively) but significantly lower than in the PanOptix cohort (83%, p < 0.0001). Satisfaction was high across all groups. There were no statistically significant differences in best-corrected visual acuity, and no new safety concerns were reported.ConclusionThe AcrySof IQ Vivity extended depth of focus IOL offers an expanded range of vision and better spectacle independence than has typically been achieved with traditional monofocal IOLs, with high rates of satisfaction and a favorable dysphotopsia profile compared to diffractive multifocal IOLs.

Clinical outcomes after femtosecond laser assisted cataract surgery with implantation of the TECNIS Symfony intraocular lens

AIM: To evaluate the clinical outcomes in terms of vision across distances (near, intermediate, and far), contrast sensitivity and subjective patient satisfaction after femtosecond laser-assisted cataract surgery (FLACS) with implantation of an extended range of vision (ERV) intraocular lens (IOL). METHODS: Forty patients (55 eyes) undergoing bilateral or monocular FLACS with implantation of the ERV IOL TECNIS Symfony (Johnson &amp; Johnson Vision) were enrolled. Uncorrected distance (UDVA), intermediate (UIVA) and near visual acuities (UNVA) were evaluated at 3mo after surgery, as well the defocus curve, contrast sensitivity, patient satisfaction and spectacle independence. RESULTS: No severe complications occurred. All eyes showed a central position of the IOL in the capsular bag without tilting at 3mo after surgery. 3mo postoperative mean logMAR visual acuity at 5 m, 67 cm and 40 cm were -0.04 ±0.08, -0.17±0.22, 0.37±0.17, respectively. All patients obtained satisfactory UDVA and UIVA, as well as functional UNVA, meeting the needs of daily life. Spectacle independence rate was 94.55%. Contrast sensitivity results did not differ from those obtained with monofocal aspheric lenses. Likewise, no moderate and severe photic phenomena were reported. Mean patient satisfaction scores with distance, intermediate and near vision were 9.0, 9.0, and 7.0, respectively. CONCLUSION: FLACS with implantation of the ERV IOL TECNIS Symfony provides a successful visual restoration at far, intermediate distance and a functional-range near vision acuity, with minimal level of disturbing photic phenomena, and high rates of spectacle independence and patient satisfaction.

Rotational stability and visual performance 3 months after bilateral implantation of a new toric extended range of vision intraocular lens.

PurposeTo evaluate the clinical outcomes after implantation of Symfony® toric extended range of vision (ERV) intraocular lenses (IOLs) in subjects with preoperative corneal astigmatism.SettingIfocus Øyeklinikk, Haugesund, Norway.DesignProspective non-comparative study.Patients and methodsThe study population consisted of 30 patients, with preoperative corneal astigmatism between 0.88 and 3.29 D, undergoing bilateral cataract removal or refractive lens exchange with implantation of Tecnis Symfony toric ERV IOLs. Main outcome measures were visual acuity, refraction, IOL axis rotational stability, patient and surgeon satisfaction, photic phenomena, and quality of life at 3 months.ResultsPostoperatively, mean binocular uncorrected distance, intermediate, and near visual acuities (logMAR) were −0.05±0.11, −0.03±0.08, and 0.09±0.10, respectively. A significant reduction in manifest cylinder (P<0.001) and spherical equivalent (P=0.001) was found after 3 months. Monocular and binocular corrected distance visual acuity also improved significantly with surgery (P<0.001). In terms of binocular uncorrected intermediate and near visual acuity, a total of 96% and 82% of patients achieved 0.1 logMAR (Snellen: 20/25) or better, respectively. Toric IOL axis showed a median rotation of 2.0 degrees (range 0.0–16.0 degrees) from the end of surgery to 3 months. The median patient satisfaction scores for distance, intermediate, and near vision were 9.0, 9.0, and 8.0, respectively. Fifty percent of patients reported complete spectacle independence and most patients (89%) were not bothered by any photic phenomena.ConclusionBilateral implantation of the Symfony toric ERV IOL appeared to be safe and achieved good visual performance and high satisfaction.

Tecnis Symfony Intraocular Lens with a “Sweet Spot” for Tolerance to Postoperative Residual Refractive Errors

Purpose: To investigate the impact of residual astigmatism on visual acuity (VA) after the implantation of a novel extended range of vision (ERV) intraocular lens (IOL) based on the correction of spherical and chromatic aberration. Method: The study enrolled 411 patients bilaterally implanted with the ERV IOL Tecnis Symfony. Visual acuity and subjective refraction were analyzed during the 4- to 6-month follow-up. The sample of eyes was stratified for four groups according to the magnitude of postoperative refractive astigmatism and postoperative spherical equivalent. Results: The astigmatism analysis included 386 eyes of 193 patients with both eyes of each patient within the same cylinder range. Uncorrected VAs for distance, intermediate and near were better in the group of eyes with lower level of postoperative astigmatism, but even in eyes with residual cylinders up to 0.75 D, the loss of VA lines was clinically not relevant. The orientation of astigmatism did not seem to have an impact on the tolerance to the residual cylinder. The SE evaluation included 810 eyes of 405 patients, with both eyes of each patient in the same SE range. Uncorrected VAs for distance, intermediate and near, were very similar in all SE groups. Conclusion: Residual cylinders up to 0.75 D after the implantation of the Tecnis Symfony IOL have a very mild impact on monocular and binocular VA. The Tecnis Symfony IOL shows a good tolerance to unexpected refractive surprises and thus a better “sweet spot”.

Clinical outcomes of a new extended range of vision intraocular lens: International Multicenter Concerto Study

To analyze the clinical outcomes after implantation of an extended range of vision intraocular lens (IOL), the Tecnis Symfony, in a routine clinical setting. Forty clinical sites in Finland, France, Germany, Norway, Spain, Sweden, and the United Kingdom. Prospective case series. The study comprised 411 patients who had bilateral implantation of the extended range of vision IOL, with intended micro-monovision in 1 group (monovision group) and intended emmetropia in the other group (non-monovision group). Visual acuity, spectacle independence, patient and surgeon satisfaction, and photic phenomena were analyzed during the 4- to 6-month follow-up. The monovision group comprised 112 patients and the non-monovision group, 299 patients. The mean decimal uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuities were 0.95, 0.81, and 0.69, respectively, 4 to 6months postoperatively. Significantly better UIVA (P=.003) and UNVA (P=.011) were found in the monovision group than in the non-monovision group. Spectacle independence was high, with 14.4% of eyes requiring reading spectacles frequently. More than 90% of patients reported no or mild halos, glare, starbursts, or other photic phenomena. Patient satisfaction scores (median) for distance, intermediate, and near vision were 9.0, 10.0, and 8.0, respectively. The satisfaction score for near vision increased to 9.0 in the monovision group. More than 91% of patients said they would recommend the same procedure to their friends and family. The extended range of vision IOL provided successful visual restoration across all distances after cataract surgery, with a minimal level of disturbing photic phenomena and high levels of patient satisfaction. Dr. Cochener is a clinical investigator for Revision Optics, Inc., Horus Vision LLC, Alcon Laboratories, Inc., Abbott Medical Optics, Inc., Théa Pharma GmbH, and Santen, Inc.; she is also a consultant to Alcon Laboratories, Inc., Abbott Medical Optics, Inc., Théa Pharma GmbH, and Santen, Inc.

Preclinical metrics to predict through-focus visual acuity for pseudophakic patients.

This study compares the clinical through-focus visual acuity (VA) in patients implanted with different intraocular lens (IOL) to optical bench testing of the same IOLs to evaluate the suitability of optical metrics of predicting clinical VA. Modulation transfer function and phase transfer function for different spatial frequencies and US Air Force pictures were measured using an optical bench for two monofocal IOLs, three multifocal IOLs and an extended range of vision IOL. Four preclinical metrics were calculated and compared to the clinical through-focus VA collected in three different clinical studies (243 patients in total). All metrics were well correlated (R2≥0.89) with clinical data and may be suitable for predicting through-focus VA in pseudophakic eyes.