Extended Depth Of Field Research Articles

Improvements in visual function early after cataract surgery in eyes implanted with multifocal intraocular lenses.

To compare the improvements in all-distance visual acuity (VA) and contrast sensitivity early after cataract surgery among eyes implanted with multifocal and monofocal intraocular lenses (IOLs). Nonrandomized comparative study. Forty-two eyes with a trifocal IOL (Alcon, PanOptix®), 42 eyes with a combined bifocal and extended-depth-of-focus (EDF) IOL (Johnson & Johnson, Synergy®), and 84 eyes with a monofocal IOL were recruited. Uncorrected or corrected VA at various distances, and photopia and mesopic contrast VA were examined at 1day and 3 months postoperatively. Improvements in these VAs were compared between time points and among groups. Mean uncorrected as well as corrected VA improved significantly between 1day and 3 months postoperatively at almost all distances in the trifocal and combined bifocal + EDF groups (P ≤ 0.018), and at the intermediate distance of 1.0m and far distances in the monofocal group (P ≤ 0.031). Mean improvements in near uncorrected VA at 0.3m, intermediate VA at 0.5m, and far VA at 2.0, 3.0, and 5.0m were significantly greater in the multifocal groups than in the monofocal group (P ≤ 0.032). Improvements in photopic and mesopic contrast VA at most contrasts were significantly better in the multifocal groups (P ≤ 0.021). Mean uncorrected or corrected VA at almost all distances and contrast sensitivity at most contrasts improved significantly early after surgery in eyes implanted with multifocal IOLs, and the improvements in VA at most distances and in contrast sensitivity were better with multifocal IOLs than with monofocal IOLs.

Extended-depth of field random illumination microscopy, EDF-RIM, provides super-resolved projective imaging

The ultimate aim of fluorescence microscopy is to achieve high-resolution imaging of increasingly larger biological samples. Extended depth of field presents a potential solution to accelerate imaging of large samples when compression of information along the optical axis is not detrimental to the interpretation of images. We have implemented an extended depth of field (EDF) approach in a random illumination microscope (RIM). RIM uses multiple speckled illuminations and variance data processing to double the resolution. It is particularly adapted to the imaging of thick samples as it does not require the knowledge of illumination patterns. We demonstrate highly-resolved projective images of biological tissues and cells. Compared to a sequential scan of the imaged volume with conventional 2D-RIM, EDF-RIM allows an order of magnitude improvement in speed and light dose reduction, with comparable resolution. As the axial information is lost in an EDF modality, we propose a method to retrieve the sample topography for samples that are organized in cell sheets.

Prospective Evaluation of Clinical and Patient-Reported Outcomes Following Contralateral Implantation of an Extended Depth of Focus (EDOF) and Hybrid EDOF-Multifocal IOL.

To evaluate clinical outcomes following contralateral implantation of a diffractive extended depth of focus (EDOF) and a hybrid EDOF-multifocal intraocular lens (IOL) with a violet filter in a U.S.-based population. In this prospective, non-comparative study, 60 eyes of 30 patients aged 40 years and older underwent bilateral cataract surgery and implantation of a DXR00V IOL (Tecnis Symfony OptiBlue) in the dominant eye and a DFR00V (Tecnis Synergy) IOL in the non-dominant eye. Outcome measures included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, distance-corrected intermediate (DCIVA, 66 cm), near and very near visual acuity (DCNVA, 40 and 33 cm), and patient-reported outcomes. At 6 months postoperatively, binocular mean UDVA and CDVA were -0.10 ± 0.07 and -0.11 ± 0.05 logarithm of the minimum angle of resolution (logMAR), respectively. The mean DCIVA was 0.26 ± 0.08 logMAR in the DXR00V eyes and 0.23 ± 0.06 logMAR in the DFR00V eyes. The mean DCNVA at 40 and 33 cm were 0.28 ± 0.12 and 0.30 ± 0.15 logMAR, respectively, in the DXR00V eyes and 0.07 ± 0.08 and 0.07 ± 0.10 logMAR, respectively, in the DFR00V eyes. The mean binocular DCIVA and DCNVA at 33 and 40 cm were 0.18 ± 0.05, 0.06 ± 0.08, and 0.06 ± 0.07 logMAR, respectively. The percentages of patients achieving spectacle independence at far, intermediate, and near distances were 100%, 100%, and 81%, respectively. Contralateral implantation of the diffractive EDOF and a hybrid EDOF-multifocal IOL yielded excellent binocular visual acuity at all distances, as well as high patient satisfaction and functional performance on visual tasks. [J Refract Surg. 2024;40(10):e699-e705.].

Clinical Performance of an Extended Range of Vision Intraocular Lens After LASIK.

To evaluate the clinical and patient-reported outcomes (PROMs) of cataract surgery with implantation of a wavefront-shaping extended depth of focus (EDOF) intraocular lens (IOL) in eyes with previous laser in situ keratomileusis (LASIK) for myopia correction. This prospective observational study enrolled 50 eyes with previous LASIK from 25 patients (age: 46 to 70 years) who underwent cataract surgery with implantation of the AcrySof IQ Vivity IOL (Alcon Laboratories, Inc). Visual and refractive outcomes were evaluated during a 3-month follow-up. PROMs were evaluated with the Intraocular Lens Satisfaction (IOLSAT; Alcon Vision, LLC) (general satisfaction), Catquest-9SF (difficulty in doing vision-related activities), and Questionnaire for Visual Disturbances (QUVID; Alcon Vision, LLC) (photic phenomena) questionnaires. Mean 3-month postoperative binocular uncorrected distance, intermediate, and near visual acuities were 0.02 ± 0.11, -0.02 ± 0.09, and 0.14 ± 0.13 logarithm of the minimum angle of resolution (logMAR), respectively. Mean binocular distance-corrected intermediate and near visual acuities were 0.05 ± 0.11 and 0.32 ± 0.14 logMAR, respectively. All eyes had a postoperative spherical equivalent within ±0.75 diopters (D). The mean defocus curve showed visual acuity values better than 0.20 logMAR for defocus levels from +0.50 to -1.50 D. Most patients (92.0%) confirmed that they had no vision-related difficulties limiting their normal daily life. Perception of starbursts, halos, glare, hazy vision, blurry vision, and double vision was referred by 24%, 24%, 28%, 28%, 8%, and 4% of patients, respectively. Most of symptoms were described as mild and not or a little bothersome. The wavefront-shaping EDOF IOL evaluated provides efficacious distance, intermediate, and near visual restoration in eyes with previous LASIK, with minimal photic phenomena associated. [J Refract Surg. 2024;40(10):e742-e753.].

A survey of intraocular lens preferences of UK refractive surgeons for cataract surgery and refractive lens exchange

BackgroundTo explore intraocular lens (IOL) preferences of United Kingdom-based (UK) refractive surgeons in cataract and refractive lens exchange (RLE) surgery.MethodsAn online survey on IOL preferences (and reasons for their choice) in cataract and RLE surgery was distributed. It also enquired about implementing mini-monovision with extended depth of field (EDoF) IOLs, about utilising IOL mix-and-match (different IOL types in each eye), and at what level of corneal astigmatism they prefer toric lenses.ResultsFollowing an 81.6% response rate, thirty responses were analysed; median years of refractive surgery experience was 12.5. The most popular IOL choices for cataract surgery were EDoF lenses (30%), monofocals (20%), and trifocals (20%). The most cited reason for each was better overall visual outcomes (88.9%), fewer unwanted symptoms (66.7%) and best spectacle independence (66.7%), respectively.For RLE, EDoF remained most popular (36.7%), followed by trifocals (30%), and multifocals (16.7%) with the same reasons for choice cited above.Mini-monovision with EDoF lenses was well-regarded (83% recommend for most/select patients), unlike utilising IOL mix-and-match (60% did not recommend). 40% prefer toric IOLs for astigmatism of 1 dioptre (D) or higher, whilst 30% opt for them at < 1D.ConclusionsExperienced UK refractive surgeons prefer newer IOLs with enhanced optics; ≥50% of respondents favoured either EDoF or trifocals for a ‘typical’ cataract or RLE patient. Notably, respondents have a low corneal astigmatism threshold for toric lenses. Mini-monovision with EDoF IOLs was well-regarded, whilst mix-and-match of different IOL types was less recommended.

Visual and clinical outcomes after bilateral implantation of a novel extended depth of focus lens post cataract surgery.

To assess the visual and clinical outcomes after bilateral implantation of the novel extended depth of focus (EDOF) (AcrySof IQ Vivity) intraocular lens (IOL) using a micromonovision strategy. This was a prospective interventional study at a tertiary care center. Twenty patients (40 eyes) underwent bilateral implantation of AcrySof IQ Vivity IOL. Twelve weeks postoperatively, both uncorrected vision and corrected vision were assessed. Uniocular and binocular defocus curves with and without correction were noted subjectively as well as objectively on I-trace. Contrast sensitivity was assessed with a FACT (Functional Acuity Contrast Testing) machine, and objective parameters like modulation transfer function and Strehl ratio were also measured on I-Trace. Subjective quality of vision using a subjective questionnaire was also evaluated. The mean binocular postoperative uncorrected distance visual acuity in LogMAR was -0.03 ± 0.09, the uncorrected intermediate visual acuity was 0.03 ± 0.09, and the uncorrected near visual acuity was 0.28 ± 0.18. All defocus curves were smooth and broad with the uncorrected defocus curve (with the micromonovision strategy) better than the corrected defocus curve. The subjective depth of focus (DOF = 3.73) was more than objective DOF (1.93) (P < 0.05). Photopic contrast was better than mesopic at all frequencies. All aberrations increased at 5 mm pupil size compared to 3 mm pupil size and were statistically significant, except for the total eye spherical aberration, which shows no significant difference at 3 mm and 5 mm pupil size (P = 0.27). Spectacle independence for distance, intermediate, and near was achieved in 100%, 94.7%, and 94.7% cases in this study, respectively. Using the micromonovision strategy, the visual performance of this novel EDOF IOL was outstanding both subjectively and objectively.

Refractive power profiles of commercially available soft multifocal contact lenses for myopia control.

Lens power profiles can provide valuable insights on the imposed optical defocus and visual experience of contact lens wearers, especially in the context of myopia control. This study measured the refractive power profiles of multifocal soft contact lenses (MFCLs) currently used or that have the potential for use in myopia control using high spatial resolution aberrometry. The instrument's repeatability for determining MFCLs power profiles was also assessed. The power profiles of 10 MFCLs of various designs (centre-distance, centre-near and extended depth of focus) were measured using the Lambda-X NIMOEVO, a phase shifting Schlieren-based device. Power profiles were graphically expressed as measured power at each chord position and the maximum add power was calculated. The repeatability of the NIMOEVO was expressed as the within-subject standard deviation at each chord position for a subset of five MFCLs. The measured distance powers differed from nominal powers for more than half of the MFCLs with a definable distance zone. There were variations in the chord position of the distance and near correction zones, rate of power transitions and calculated maximum add between the MFCLs which did not depend on lens design. For half of the MFCLs, the power profile shape was inconsistent between different nominal back vertex powers of the same design. The repeatability of the NIMOEVO was dependent on the lens design, with designs featuring faster rates of power change exhibiting worse repeatability. Significant differences in MFCL power profiles were found which were not adequately represented in labelling. This is likely due to the small number of parameters used to define lens power characteristics. Eye health care practitioners should be aware of potential differences in power profiles between different MFCLs, which will impact the retinal defocus introduced during lens wear and the wearer's visual experience.

Stereopsis Following Implantation of Presbyopia-Correcting Intraocular Lenses: A Narrative Review.

Recent advancements in cataract surgery have broadened its scope from mere vision restoration to include correction of refractive errors and presbyopia. This evolution has introduced multifocal and extended depth-of-focus (EDOF) intraocular lenses (IOLs), allowing enhanced vision across multiple distances. However, the influence of these advanced IOLs on stereopsis remains controversial. Factors influencing stereopsis after surgery include visual acuity, interocular differences, residual astigmatism, and the type of IOL, etc. Binocular vision integration and neuroadaptation further affect stereopsis, especially in cases of presbyopia-correcting IOLs. It is widely acknowledged that bilateral implantation of presbyopia-correcting IOLs yield superior stereopsis compared to unilateral implantation. However, there remains no consensus on whether binocular implantation of multifocal or monofocal IOLs provides superior stereopsis. Most studies suggest no significant difference in stereopsis between these two types of implants. Among different types of multifocal IOLs, refractive multifocal IOLs may offer better stereopsis than diffractive multifocal IOLs when implanted bilaterally. Emerging EDOF and hybrid multifocal-EDOF IOLs also demonstrate promising postoperative stereopsis. Additionally, a mix-and-match strategy with different types of IOLs implanted in each eye may result in interocular differences in visual acuity at certain distances, potentially affecting stereopsis. Nevertheless, with appropriate selection, most patients can achieve satisfactory postoperative stereopsis. This review synthesizes current literature on the effects of presbyopia-correcting IOLs on postoperative stereopsis recovery following cataract surgery. Studies on stereopsis outcomes with different IOLs have yielded mixed results, urging further investigation for optimized surgical strategies and patient outcomes.

The Postoperative Visual and Refractive Outcomes of Trifocal and Extended Depth-of-Focus Intraocular Lenses in Patients with Different Biometric Characteristics.

We aimed to survey the potential correlation between biometric parameters and postoperative outcomes after implanting extended depth-of-focus (EDOF) intraocular lenses (IOLs) and trifocal IOLs. A retrospective cohort study was conducted, and patients receiving EDOF or trifocal IOL implantations were included. In total, 36 and 26 eyes were enrolled in the EDOF and trifocal groups, respectively. The primary outcomes of this study were the postoperative uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), and spherical equivalent (SE). The generalized linear model was applied to evaluate the adjusted odds ratio (aOR) and 95% confidence intervals (CIs) of primary outcomes in patients with different biometric characters. The final UDVA of the EDOF group was significantly better than that of the trifocal group (p = 0.020), and the UNVA and SE did not show significant differences between the two groups throughout the postoperative period (all p > 0.05). In a multivariable analysis, the UDVA was significantly better in the EDOF group than in the trifocal group (p = 0.038). For the subgroup analysis, the high axial length (AXL) value correlated to a lower postoperative UDVA in the EDOF group (both p < 0.05). Additionally, a large white-to-white (WTW) diameter was related to worse postoperative UNVA in the trifocal group (p = 0.042), and a high AXL was associated with higher SE in both the EDOF and trifocal groups (both p < 0.05). In conclusion, a high AXL correlates to worse postoperative outcomes in both the EDOF and trifocal IOLs, and trifocal IOL outcomes could be affected by large WTW diameters.

Combination of a monofocal and one type of extended depth-of-focus (zonal refractive) intraocular lens (COMEDI) in bilateral cataract surgery protocol: a monocentric, randomised, parallel group trial in cataract surgery

IntroductionModern intraocular lens (IOL) designs for cataract treatment can be broadly classified into three focal range categories; monofocal, extended depth-of-focus (EDOF) and multifocal IOLs.Monofocal IOLs allow spectacle independence for one...

Clinical outcomes and optical performance of a new segmental refractive extended depth-of-focus intraocular lens

BackgroundThe visual performance and the optical quality of a segmental refractive extended depth-of-focus (EDoF) intraocular lens (IOL) were evaluated in a prospective, single-arm, single-center study.MethodsA total of 20 patients (40 eyes) after bilateral implantation of the refractive segmental EDoF Acunex Vario AN6V were included. Assessment procedure: refraction outcome, monocular and binocular uncorrected (UCVA) and distance-corrected visual acuity (DCVA), defocus curve, contrast sensitivity (CS), higher-order aberrations (HOAs) and patient satisfaction were evaluated 1 and 3 months after surgery.ResultsAt 3-month follow-up, mean spherical equivalent was − 0.23 ± 0.32 D. Binocular uncorrected distance visual acuity (VA) at distance, intermediate and near was − 0.08 ± 0.06 logMAR at 4 m, -0.03 ± 0.06 logMAR at 66 cm and 0.16 ± 0.06 logMAR at 40 cm, respectively. The binocular defocus curve showed a VA better than 0.20 logMAR over a range from + 1.50 to − 2.45 D. Contrast sensitivity aligned with monofocal lenses, highlighting the lens’s clinical value. Aberrometry showed minimal changes in corneal aberrations. NEI-RQL-42-Questionnaire showed a high patient satisfaction for daily activities and revealed reduced dependence on glasses, particularly for near and intermediate vision. The Acunex Vario AN6V demonstrated minimal dysphotopsias, making it a promising option for those seeking spectacle independence.ConclusionThis segmental refractive EDoF IOL provides a high degree of spectacle independence for far and intermediate distances with functional near VA. Although inducing residual coma aberrations, it showed subjectively good results with little dysphotopsias.Trial registrationThis study protocol was reviewed and approved by ethics committee of Charité University, Berlin, Germany, with approval number EA4/126/20.

Visual outcomes following bilateral implantation of a non-diffractive extended depth of focus toric intraocular lens using a mini-monovision approach.

To evaluate the clinical outcomes following bilateral implantation of the AcrySof™ IQ Vivity™ toric extended depth of focus (EDOF) intraocular lens (IOL). Prospective interventional case series. Patients with bilateral significant cataracts and pre-existing corneal astigmatism underwent cataract surgery and implantation with the AcrySof™ IQ Vivity™ toric IOL. Dominant eyes were targeted at emmetropia and non-dominant eyes at -0.50D. Primary endpoints were binocular uncorrected distance (UDVA), intermediate (UIVA at 66cm) and near (UNVA at 40cm) acuities at 3months. Secondary outcomes were corrected distance (CDVA), distance corrected intermediate (DCIVA) and distance corrected near (DCNVA), refractive predictability, rotational stability, binocular defocus curve, contrast sensitivity, Questionnaire for Visual Disturbances (QUVID) and Visual Function Index (VF-14) questionnaire scores. All visual acuities were converted to logarithm of minimum angle of resolution (logMAR) for analysis. 30 patients underwent uneventful phacoemulsification. The mean binocular UDVA, UIVA and UNVA were 0.06 ± 0.12, 0.11 ± 0.10 and 0.26 ± 0.10 respectively. The mean refractive spherical equivalent (MRSE) for dominant and non-dominant eyes were - 0.07D ± 0.27 and - 0.12D ± 0.54 respectively. 92.4% of dominant eyes and 84.6% of non-dominant eyes within 0.50D of target. The mean IOL rotation was 3.85° ± 5.09 with 86.7% of eyes with less than 5° of rotation. 26.7%, 20% and 36.7% of patients reported starbursts, haloes and glare respectively. The mean VF-14 score was 91.77. Bilateral implantation of the AcrySof™ IQ Vivity™ Toric IOL resulted in very good unaided visual acuities for far and intermediate distance with functional near vision. Dysphotopsias were reported but despite this, a high level of visual function was achieved.

Performance of Extended Depth of Focus Intraocular Lens in Eyes with Preexisting Retinal Disease

Introduction: Extended depth of focus (EDOF) intraocular lens (IOL) offers improved near and intermediate vision, aiming to reduce spectacle dependence in cataract patients. This research aimed to evaluate the performance of EDOF IOL in patients with retinal pathologies following cataract surgery. Methods: The medical charts of thirty-three eyes with retinal pathologies and 100 healthy eyes that underwent cataract extraction with implantation of an EDOF IOL and had at least 3 weeks of postoperative follow-up were retrospectively included. Patients’ overall satisfaction, spectacle dependence, visual perception, and side effects were evaluated with a self-reported questionnaire. Results: Mean uncorrected visual acuities (LogMAR) were significantly better in the healthy eyes compared with the eyes with retinal pathologies: 0.05 and 0.10, p = 0.011 (distance), 0.06 and 0.16, p = 0.001 (intermediate), and 0.20 and 0.28, p = 0.026 (near), respectively. No or rare use of spectacles for any distance was reported by 71% and 38% of patients, respectively (p = 0.004). Haloes/glare were reported by 17% and 23%, respectively (p = 0.556); only in 7% and 4% it was clinically disturbing (p > 0.999). The same IOL would be chosen again in 77% and 73% of patients, respectively, (p = 0.550). Conclusion: Patients with retinal pathologies who were implanted with an EDOF IOL demonstrated excellent distant uncorrected visual results with reasonable intermediate and near uncorrected visual results alongside high satisfaction; however, results were inferior to those of the control healthy eyes.

Changes in visual performance after implantation of different intraocular lenses.

To evaluate the trending visual performance of different intraocular lenses (IOLs) over time after implantation. Ninety-one patients received cataract surgery with implantations of monofocal (Mon) IOLs, segmental refractive (SegRef) IOLs, diffractive (Dif) IOLs, and extended-depth-of-focus (EDoF) IOLs were included. The aberrations and optical quality collected with iTrace and OQAS within postoperative 6mo were followed and compared. Most of the visual parameters improved over the postoperative 6mo. The postoperative visual acuity (POVA) of the Mon IOL, SegRef IOL, and EDoF IOL groups achieved relative stability in earlier states compared with the Dif IOL group. Nevertheless, the overall visual performance of the 3 IOLs continued to upturn in small extents within the postoperative 6mo. The optical quality initially improved in the EDoF IOL group, then in the Mon IOL, SegRef IOL, and Dif IOL groups. POVA and objective visual performance of the Mon IOL and EDoF IOL groups, as well as POVA and visual quality of the Dif IOL group, improved in the postoperative 1mo and stabilized. Within the postoperative 6mo, gradual improvements were observed in the visual acuity and objective visual performance of the SegRef IOL group, as well as in the postoperative optical quality of the Dif IOL group. The visual performance is different among eyes implanted with different IOLs. The findings of the current study provide a potential reference for ophthalmologists to choose suitable IOLs for cataract patients in a personalized solution.

The Preoperative Factors for the Undercorrection of Myopia in an Extend Depth-of-Focus Intraocular Lens: A Case-Control Study.

We aim to investigate the potential risk factors for undercorrection in those who have received extend depth-of-focus (EDOF) intraocular lens (IOL) implantation. A retrospective case-control study was conducted in which patients who had received one type of EDOF IOL implantation were included. The patients were divided into the residual group and non-residual group according to the final postoperative sphere power. The preoperative data include the refractive, topographic, endothelial, and biometric parameters obtained. A generalized linear model was generated to yield the adjusted odds ratio (aOR) and 95% confidence interval (CI) of each parameter of the residual myopia. One month postoperatively, the UDVA was better in the non-residual group than in the residual group (p = 0.010), and the final SE was significantly higher in the residual group than in the non-residual group (p < 0.001). In the multivariable analysis, the high preoperative cycloplegia sphere power, higher TCRP, higher corneal cylinder power, and longer AXL significantly correlated to the presence of postoperative residual myopia (all p < 0.05). Furthermore, the higher preoperative cycloplegia sphere power, higher TCRP, higher corneal cylinder power, longer AXL, larger ACD, and larger WTW were significantly associated with postoperative residual myopia in the high-myopia population (all p < 0.001), while the higher preoperative cycloplegia sphere power, higher TCRP, and longer AXL were related to postoperative residual myopia in the low-myopia population (all p < 0.05). In conclusion, high preoperative myopia and corneal refractive power correlate to high risk of residual myopia after EDOF IOL implantation, especially in the high-myopia population.

Overview of intraocular lenses with optics for correcting presbyopia

In recent years intraocular lenses (IOLs) for correcting presbyopia have been significantly improved and diversified. There are currently many different IOL models based on awide variety of optical designs. The wide variety of available IOL solutions to correct presbyopia can be challenging for surgeons and patients. In everyday practice, the question is which IOL is best for which patient. This overview describes and categorizes the currently available implants. The respective optical properties are analyzed and clinical study results are discussed, in particular those evaluating visual performance and the occurrence of photic phenomena. Monofocal-plus IOLs provide improved intermediate visual acuity with optimal distant visual acuity and minimal photic phenomena. Extended depth of field (EDoF) IOLs extend the depth of field through different optical principles and provide good distant and intermediate visual acuity. Trifocal lenses enable the greatest independence from spectacles at the price of ahigher probability of dysphotopsia. The selection of the most suitable IOL for correction of presbyopia requires abalance between the patient's visual needs and possible side effects. An adequate knowledge of the currently available implants allows a patient-oriented selection of IOLs.

Optical benchtop evaluation of special intraocular lens optics

Intraocular lenses (IOL) featuring complex optical designs can pose achallenge in understanding their performance, which may hinder making an informed decision when selecting suitable lenses for patients. This underlines the importance of collecting optical quality data of IOLs and making them available. The deployment of benchtop systems for IOL testing offers not only insights into the design features of various IOL solutions but also provides aplatform for objective comparisons of special optics designs, including information about their susceptibility to photic phenomena. Recent advances in IOL testing have improved the ability to predict functional effects on visual acuity and contrast sensitivity from objective optical quality metrics. This, for instance, can be used to study monofocal lenses and the impact of asphericity on vision and IOLs tolerance to misalignment. Monofocal-plus IOLs consistently show only aslight improvement in the depth of focus when tested on the optical bench and in clinical settings. Although the pupil dependence found in this technology may limit the advantages of monofocal-plus over standard monofocal technology to extend the range of vision, it is the key to reduce photic phenomena. Refractive and diffractive extended depth of focus (EDOF) IOLs can effectively enhance intermediate vision, with the latter offering aslightly broader depth of focus but potentially increasing the risk of dysphotopsia. However, the limitation of EDOF IOLs is that they often fail to deliver spectacle independence for reading, which can be overcome by trifocal technology. Still, the available trifocal IOLs differ in their location of intermediate and near foci and the susceptibility to produce glare effects. Therefore, the knowledge from optical benchtop testing of IOLs can support optimizing the IOL selection by aligning the patient's visual needs with the IOL's properties, setting the right expectations, and assessing the risk profile for the occurrence of photic phenomena, potentially leading to improved decision-making.

A novel focus measure algorithm for three-dimensional microscopic vision measurement based on focus stacking

The three-dimensional (3D) microscopic vision measurement methods based on focus stacking are widely used because of their outstanding advantages such as noncontact, high accuracy, high flexibility, and low cost. On-site focus stacking 3D microscopic measurement is susceptible to environmental disturbances, surface dirt, illumination occlusion, and the shape of the object itself. This leads to the difficulty of obtaining the focus position accurately, stably, and quickly with the existing focus measure function. To improve the ability to extract the focus signals from the image, high-pass mask operators and band-pass mask operators are designed. A new high-pass and band-pass energy weighting focus measure function with rotation invariance is proposed. A focus stacking microscopic measurement system is constructed to validate the proposed focus measure function. Six classical and latest focus measure functions are selected for the quantitative performance comparison experiments. The experimental results show that the proposed algorithm has the best performance in accuracy, sensitivity, unimodality, and monotonic interval range. This measure function has a high operational efficiency, nearly three times the computational efficiency of the frequency domain measure function. The measure function also drastically reduces the evaluation curve fluctuation, peak collapse, and other anomalies, and shows good robustness.

Criteria for premium intraocular lens patient selection.

To discuss available premium intraocular lenses (IOLs), patient selection, and important considerations for each premium IOL. We review important topics and considerations for premium IOL selection: specifically, toric, extended depth of focus (EDOF), multifocal/trifocal, light adjustable lenses (LALs), and small aperture IOLs. Toric lenses are an excellent option for patients with astigmatism. However, to achieve optimal patient satisfaction, it is critical to account for the ATR astigmatism contribution from the posterior cornea and high angle alphas. Additionally, examining the ocular surface prior to placement of EDOF/multifocal IOLs is important, yet the significance of HOAs on outcomes after implantation still must be elucidated more. Finally, recent studies reveal that the small aperture lens is a good alternative for those with corneal irregularities, and second generation LALs are a great option to achieve target refractions in those with less predictable refractive outcomes, such as in Fuchs' dystrophy or in eyes with previous refractive surgery.

Fellow-Eye Comparison of Monocular Visual Outcomes Following Monofocal Extended Depth-of-Focus (EDOF) and Trifocal EDOF Intraocular Lens Implantation

To compare intraindividual monocular visual performance of a monofocal extended depth-of-focus (EDOF) and a trifocal EDOF intraocular lens (IOL) following bilateral cataract surgery. Single-center, prospective, fellow-eye comparison clinical trial. All patients received uneventful bilateral cataract surgery with implantation of the monofocal EDOF Isopure IOL in the dominant eye and the trifocal EDOF FineVision Triumf IOL in the nondominant eye. Intraindividual monocular comparison included visual acuity at various distances, defocus curves, internal total higher-order aberration (HOA), spherical aberration (SA) Z(4.0), IOL decentration, and tilt. Additionally, subjective outcomes were evaluated using Halo and Glare simulation and the Seven-Item Visual-Functioning Index questionnaire. In total, 25 patients (50 eyes) were included. Intraindividual monocular best-corrected distance visual acuity, distance-corrected intermediate visual acuity, and best-corrected near visual acuity were comparable (P > .05). However, monocular contrast acuity (P = .019), distance-corrected near visual acuity (P < .001), and defocus curves at defocus levels of 0.0 D (P = .005) and between -1.5 and -4.0 D (P < .001) differed significantly. At 5 mm, internal HOA and SA Z(4.0) were significantly different (P < .001) and comparable at 3-mm pupil diameter, as were IOL tilt and decentration (P > .05). In this combined fellow-eye comparison, near vision was significantly better with the trifocal EDOF IOL. The monofocal EDOF IOL demonstrated similar distance and intermediate visual performance as the trifocal EDOF IOL. Overall, low values of photic phenomena and visual impairment were observed.