IOL Implantation Research Articles

FemtoLASIK clinical case of laser visual correction of residual myopia in the eye with IOL by using MEL-90 and VisuMax 500

The authors describe their experience of successful laser additional correction of residual myopic refractive error (Vis OD = 0.04; Sph –5.75 D, Cyl –2.00 D, ax 25° = 0.4) using the FemtoLASIK method with the MEL-90 excimer laser and the VISUMAX femtosecond laser (Carl Zeiss Meditec) in a 15-year-old patient on a pseudophakic eye (Acrysof® Natural, model SN60AT), with moderate glistening and refractive amblyopia after phacoemulsification of congenital posterior capsular cataract with IOL implantation performed at the age of 7 years. Moreover, the very next day after present surgery, the patient’s maximum distance visual acuity without correction increased to 0.5, but she still had the ability to read ordinary magazine text at close distance. Thus, the described clinical case confirms that FemtoLASIK technology can be successfully used as the second stage of bioptics (laser correction of myopia in pseudophakic eyes) in young patients.

Total keratometry for toric intraocular lens calculation: comparison from two swept-source optical coherence tomography biometers.

To compare the astigmatism prediction accuracy of total keratometry (TK) from the IOLMaster 700 and total corneal power (TCP) from Anterion based on swept-source optical coherence tomography (SS-OCT) technology in toric intraocular lens (toric IOL) calculation. A retrospective observational study. Total corneal astigmatism (TCA) were obtained using IOLMaster 700 and Anterion. Z CALC 2.0 was used to calculate the expected postoperative refractive astigmatism in conjunction with TCA. Prediction errors (PE) in refractive outcomes was analyzed 1 month postoperatively using the vector analysis by the Holladay method, including the mean vector PE magnitude, percentage of cases with vector PE in certain intervals, and the centroid PE. A total of 56 eyes from 56 patients were enrolled in the study with an insertion of an AT TORBI 709 toric IOL. The difference in mean vector PE of postoperative refractive astigmatism between TK and TCP was not statistically significant (0.48D versus 0.46D, P = 0.281). TK and TCP yielded 27.3 and 40.0% of eyes with vector PE ≤ 0.25D, and 58.2 and 63.6% with vector PE ≤ 0.5D (both P > 0.05), respectively. TK and TCP resulted in similar ATR centroid PE of 0.10D@35° ± 0.60D and 0.15D@22° ± 0.57D, respectively, and there were no significant differences between x-PE component and y-PE component. IOLMaster 700 and Anterion provided comparable astigmatic predictability in toric IOL implantation using total keratometry and Z CALC 2.0.

Transscleral fixation of intraocular lens in the treatment of lens subluxation in children

This study evaluated the effectiveness and safety of IOL implantation with transscleral fixation using the knotless Z-suture technique in pediatric patients with congenital lens subluxation. The study included 24 children (36 eyes) with grade III congenital subluxation of the lens who underwent phacoaspiration of the subluxated lens with IOL implantation with transscleral fixation using the knotless Z-suture performed in the Kazakh Research Institute of Eye Diseases in Almaty in the period from 2017 to 2021. The average observation period was 31.7±11.3 months (2.0 to 4.5 years). The stability of the IOL position, the state of the intrascleral sutures, visual acuity after surgery, the presence and severity of complications in the long-term period were evaluated. All patients (100%) had a significant improvement in visual acuity after surgery. No intraoperative complications were registered in any of the cases. Postoperative complications were noted in 8.3% of cases (n=3). The final functional outcome of surgical treatment depended on the presence of concomitant pathology, the main cause of low vision was the development of refractive amblyopia due to refractive errors. The presented technique of transscleral fixation of IOL has proven to be reliable, which is especially important for pediatric patients considering their high physical activity and expected lifespan.

May a post‐radiation ocular surface disorder compromise penetrating keratoplasty surgery? A case report

Aims/Purpose: Ocular surface disorder after ocular radiation therapy, even commonly reported, remains overlooked. Any delay in diagnosis may lead to vision threatening complications. The presented case highlights the clinical outcome of a severe post‐radiation ocular surface disorder, the importance of intense therapy and the limitations of further surgical interventions.Methods: Case report.Results: A 34‐year‐old woman was referred with complains of painful and reddish right eye since years. Her medical history revealed an iris melanoma excision at the age of 29 years. Due to recurrence, a proton beam treatment has been performed thereafter. Consequently, the patient developed post‐radiation retinopathy with macula edema, secondary glaucoma, cataract, as well as a severe ocular surface disorder with corneal decompensation and band keratopathy. Several surgical treatments have been attempted among which: phacoemulsification with IOL implantation, trabeculectomy with mitomycin C. Due to refractory glaucoma a Baerveldt glaucoma drainage was necessitated, thereafter. Despite these various therapeutic approaches, there was no improvement of the ocular surface problem. With increasing deterioration of the corneal situation, a penetrating keratoplasty, has been discussed.Conclusions: The continuous worsening of clinical symptomatology of the proton beam radiotherapy ocular surface disorder can be the result of a post‐radiation syndrome. An ischaemic retinopathy and anterior segment disorder lead to engorgement of posterior and anterior segment tissues. Gradual expansion of ischemia, vasculitis and inflammatory mediators compresses the retinal tissue leading to recurrent macular oedema; as well as to secondary glaucoma and corneal decompensation. Due to the worsening of the clinical presentation of ocular surface disorder a penetrated keratoplastic surgery has been discussed. It remains however still questionable whether such patients would make profit from penetrated keratoplastic surgery, as the resulting corneal stromal lymphangiogenesis and hemangiogenesis, in the presence of post‐radiation keratopathy, are essential conditions for allograft rejection.

Capsule block syndrome – A case series

The Purpose of the study was to describe 4 cases of Capsule Block Syndrome. The cases described in this study presented to a Tertiary Eye Care Hospital OPD for undergoing cataract surgery. It was a Prospective Case Series. Four patients who underwent uneventful cataract surgery and developed Capsule Block Syndrome (CBS) were observed for 1 month post operative period. Their post operative unaided and best corrected vision, slit lamp examination findings were noted. We observed that all 4 patients showed Early non cellular CBS, all 4 patients were hyperopic and were implanted with Indian Hydrophobic IOL in the bag. This observation was unusual from the cases described in the literature. In management plan, two patients required ND YAG Capsulotomy whereas 2 resolved spontaneously. We concluded that CBS is a rare but known complication of cataract surgery. It can be avoided by doing thorough OVD wash after IOL implantation. Some cases may improve spontaneously while some may require intervention like ND YAG posterior capsulotomy to relieve the distension.

Successful management of cataracts in dogs by phacoemulsification with IOL implantation: Review of two cases

Successful management of cataracts in dogs by phacoemulsification with IOL implantation: Review of two cases

Outcomes of hemi-Descemet membrane endothelial keratoplasty and phacoemulsification for the treatment of primary Fuchs' endothelial corneal dystrophy combined with cataract

This study evaluates the long-term results of surgical treatment of patients with Fuchs' endothelial corneal dystrophy and cataract. The study included 24 patients (24 eyes) with primary Fuchs' endothelial corneal dystrophy and cataract, who underwent cataract phacoemulsification with IOL implantation and of Descemet's membrane endothelial keratoplasty with a semicircular graft (hemi-DMEK). The effect of treatment was assessed by best corrected visual acuity (BCVA), central corneal thickness (CCT) and endothelial cell density (ECD). In total, surgical treatment involved 14 donor corneas that were divided in half during the preparation and isolation of the Descemet's membrane (DM). By month 12 after the surgery an increase in visual functions and graft transparency were observed in 23 patients (23 eyes) out of 24. Repeated keratoplasty was required in one case due to fibrosis of the posterior layers of recipient's corneal stroma. At 12 months postoperatively, the study group showed an increase in BCVA from 0.16±0.1 to 0.75±20, a decrease in CCT from 650.9±4.5 μm to 519.6±43.9, and a decreased in ECD from 2850.5±84.7 cells/mm2 up to 1285.5±277.2 cells/mm2. Thus, the loss of endothelial cells at one year after surgery amounted to 54.9%. The developed method for transplantation of a semicircular DM fragment provides a tissue-saving approach to endothelial keratoplasty, and considering the high percentage of transparent engraftment of grafts and complete visual rehabilitation, it can be recommended in the treatment of patients with cataract and Fuchs' endothelial corneal dystrophy.

Post-Operative Refractive Changes After Cataract Surgery in Children Less Than 4 Years of Age

Aim: To observe the changes in refraction after Cataract surgery in children less than 4 years of age using Dahans formula. Methods: The retrospective evaluation of the records of children with congenital and developmental cataracts who underwent cataract operations with intraocular lens implantation was conducted. The patients’ ages ranged from 6 months to 4 years. All the sutures of cornea were removed after 1 month of surgery. IOL power was calculated using Dahan’s formula based on axial length. Refraction was performed after 1, 3, 6, and 12 months. Results: About 40 eyes of 20 children with bilateral congenital & developmental cataract (11 males and 9 females) were included. The age range was 6 months to 4 years & mean was 28.8±1.38 months. Significant myopic shift was observed in all the children and maximum myopic shift was observed in children below 2 (0-24 months) years of age. Conclusion: Significant myopic shift has been observed in children. So, under corrected IOL implantation is safe to achieve target refraction.

Aberracje wyższego rzędu jako coraz istotniejszy parametr podczas kwalifikacji pacjenta do operacji usunięcia zaćmy

Higher order aberrations are complex optical errors that affect the quality of vision, especially in low light conditions. The article discusses the impact of higher order aberrations on the choice of intraocular lens during cataract removal surgery. These aberrations affect the patient’s vision quality after the surgery, and their analysis allows for a more precise selection of intraocular lens, increasing the chances of achieving better clinical outcomes. The article covers the main types of higher order aberrations and their impact on the choice of intraocular lens. The number of higher order aberrations changes with the patient’s age and can be the cause of suboptimal outcomes after the implantation of multifocal IOLs. Preoperative examination of the patient, taking into account higher order aberrations, is crucial for obtaining satisfactory postoperative results. Further research on higher order aberrations is essential for the development of technologically advanced intraocular lenses.

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

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

Assessment of Safety, Efficacy and Predictability of a Trifocal Intraocular Lens. Performance of PanOptix Trifocal Versus Monofocal IOL

Purpose. To evaluate the performance and the visual outcomes of Acrysof PanOptix trifocal IOL in terms of safety, efficacy, predictability and assessment of the quality of vision after implantation as regards; contrast sensitivity and ocular aberrations. Methods. A prospective interventional non randomized study that included forty eyes of twenty one patients with senile cataract. All surgeries were carried out between September 2019 and January 2020. Patients underwent phacoemulsification for cataract removal with IOL implantation. They were divided into two groups; group(A) included twenty eyes of eleven patients who were implanted with AcrySof IQ PanOptix trifocal IOL Model TFNT00. While group (B) included twenty eyes of ten patients who were implanted with monofocal AcrySof IOLs as a control group. Results. There were 21 subjects enrolled in our study. Mean age was 56.6 ± 6.9 years in group (A) and 62.8 ± 7.1 years in group (B),(range 50–70).We found statistical significant difference between both groups with group A showing better post operative uncorrected distance, intermediate, near, and best corrected near visual acuity . Group (B) showed statistically significant better post operative contrast sensitivity compared to group (A). Conclusion: In this study, Acrysof PanOptix trifocal IOL showed excellent safety, efficacy, predictability and spectacle independence at all distances, This prospective interventional non-randomized study showed excellent safety, efficacy and predictability of the PanOptix IOL with higher spectacle independence, slightly impaired contrast sensitivity without affecting daily activities. However, contrast sensitivity was compromised in comparison to the monofocal group and high order aberrations (coma, trefoil) were noted to be higher affecting the quality of vision but not the daily activities of the patient.

Profile of a large cohort of children with persistent fetal vasculature and their predictors of poor visual outcome in a tertiary eye hospital in Saudi Arabia.

To present the profile of a large cohort of children with persistent fetal vasculature (PFV) and identify their predictors of poor visual outcome in a tertiary eye hospital in Saudi Arabia. This was a single-center study. Medical records of children diagnosed with persistent fetal vasculature between January 1990 and January 2020 at King Khaled Eye Specialist Hospital (KKESH), Riyadh, were reviewed. Data were collected on PFV type, presenting features, management, and visual acuity. Poisson regression with robust error variance was used to identify the predictors of poor visual outcome. Data of 175 eyes of 170 children with PFV were analyzed. Most had unilateral disease (n = 165, 96.2%), and over half of them (57.1%) were males. The main presenting complaints were leukocoria (n = 126, 72.0%), followed by smaller eye (n = 36, 20.6%), poor vision (n = 15, 8.6%), and strabismus (n = 13, 7.4%). Anterior, posterior, and combined PFV were present in 30.9%, 10.9%, and 58.3% eyes, respectively. In eyes with measurable visual acuity (n = 124), BCVA at the last follow-up was ≥20/100, <20/100-20/400, CF/HM and LP/NLP in 11 (8.9%), 32 (25.8%), 43 (34.7%), and 38 (30.6%) eyes, respectively. In the multivariable poisson regression analysis, eyes with posterior PFV were approximately two times more likely to have a BCVA of CF or worse than those with anterior PFV (Adjusted incidence ratio: 1.82 (95%: 1.23, 2.70; P = 0.003). Compared with eyes with primary or secondary IOL implantation, aphakic eyes or those with no cataract surgery were significantly more likely to have BCVA of CF or worse (adjusted incidence ratio: 1.84 [95%: 1.18, 2.86], p = 0.007 and adjusted incidence ratio: 1.64 [95%: 1.08, 2.50], p = 0.020, respectively). The prognosis of PFV varies depending on the severity of the disease. Patients with posterior PFV had worse visual outcome than anterior or combined type. Whether primary or secondary, IOL implantation increases the probability of having BCVA better than CF.

К вопросу о врожденных заболеваниях хрусталика глаза у детей

Material and methods. 110 children with congenital cataract and 16 with lens subluxation aged 1–17 years (on average 8.7±2.3) were under observation, 57 of them boys and 69 girls. All patients were examined using standard ophthalmological techniques: visometry, autorefractometry, keratometry, ultrasound biometry, an optical biometer IOL Master-500 was used to calculate IOL. Surgical treatment was required only by patients with monocular vision – with a number of 32 (45 eyes) and 6 (11 eyes). Surgical method of traetmen was presented in Saint-Petersburg brunchof S. Fyodorov Eye Microsurgery Federal State Institution. It included phacoaspiration, implantation of IOLs, including monofocal, toric and IOLs with aExtended Depth of Focus (EDOF). In cases of congenital pathology of the ligaments, an intracapsular ring (ICR) was used, including its suture fixation. Results. Children with congenital cataracts showedseveral prognostic symptoms – relatively favorable, conditionally favorable, negative and critical. Surgery of the first two of them allowed to increase monocular visual acuity (with correction) in the range from 0.1–0.4 (44.0%;) to the level of 0.9 (31%), all in binocular cases. Patients with negative symptoms (strabismus) showed low vision due to functional disorders, especially with congenital amblyopia (caused by obscuration, strabismus, and refractive changes). It required long-term pleoptoorthoptic treatment, but without a guarantee of restoration of binocularity. Finally, children with critical symptoms had extremely low vision (less than 0.09 and up to light perception) and was practically not acceptable for rehabilitation. Children with lens subluxation also required specific surgery. Their monolateral visual acuity with correction ranged from 0.13 to 0.39 (children 3–7 years old) and 0.13–0.8 (12–15 years old), that was sufficiently high, but without binocularity. Key words: congenital cataract, subluxation of the lens, clinical refraction, axial length, strabismus

Surgical outcome comparisons of multifocal IOLs of Lentis Comfort LS-313 MF15 and Tecnis Eyhance DIB00V.

To compare the surgical outcomes of a multifocal intraocular lens (IOL; Lentis Comfort LS-313 MF15) with those of an enhanced monofocal IOL (Tecnis Eyhance DIB00V). This retrospective study included patients who underwent cataract surgery with LS-313 MF15 or Eyhance IOL implantation. Data regarding patient demographics, surgical records, and ophthalmic examination before the cataract surgery and one and three months postoperatively were collected. Visual acuities, refractive values, defocus curves, contrast sensitivities and subjective symptoms were evaluated. Among the 71 eyes (47 patients) included in this study, 32 eyes (20 patients) underwent LS-313 MF15 IOL implantation, and 39 eyes (27 patients) underwent Eyhance IOL implantation. No significant differences were observed in age, axial length, or refractive error between the two groups preoperatively. Furthermore, the distance-corrected and uncorrected distance visual acuities one month postoperatively did not differ between the groups, and both groups had sufficient visual acuities at the distances of 5, 1 m, 70, 50, and 30 cm. Other ophthalmic data, including subjective symptoms based on the 14-item Visual Function Index Questionnaire, monocular defocus curves, contrast sensitivities, and halo and glare, did not differ between the groups three months postoperatively. Moreover, both groups had good outcomes. The spherical equivalent one month postoperatively was significantly myopic in the LS-313 MF15 group compared with that in the Eyhance group (P=0.033); however, this difference was not observed three months postoperatively (P=0.471). Comparison of the surgical outcomes of LS-313 MF15 with those of Eyhance with different optical properties reveal that both IOLs show good postoperative outcomes, with no significant differences being noted between the two IOLs.

Experience in the management of patients with cataract-associated glaucoma

The results of 269 cases of performing of cataract phacoemulsification with IOL implantation (PHACO) and microinvasive nonpenetrating deep sclerectomy (MNPDS) at various stages have been analyzed. The main group included patients who underwent PHACO, followed by MNPDS 64 persons, 65 eyes. The group was divided into a subgroup based on the date of the second intervention. 1 subgroup patients who underwent MNPDS 1 month after PHACO (30 cases); 2 subgroup 3 months after PHACO (35 cases). The control group included patients who underwent MNPDS followed by PHACO 196 persons, 204 eyes. Patients of the main group showed a significant decrease in intraocular pressure after each stage of treatment. in the control group, intraocular pressure decreased after the first stage of treatment, but increased 6 months after surgery. In primary open-angle glaucoma associated with cataract, the most persistent hypotensive effect is observed when the first stage of cataract phacoemulsification is performed, and the second stage is antiglaucoma surgical intervention.

Способ подбора данных кератометрии для расчета торичности ИОЛ

Purpose. To elaborate the customized principle of determining the actual zone of the corneal astigmatism based on keratotopographic data and compare the accuracy of calculating the toric IOL according to the actual zone and conventional keratometry. Material and methods. The study included 48 patients (48 eyes) who underwent toric IOL implantation. 3–6 months (5.1±0.6) after surgery, all patients were measured the residual refractive astigmatism. The toric IOL was retrospectively calculated according to the data of the actual keratotopographic zone determined by the proposed method (1st group) and according to conventional keratometry (2nd group). Vector and centroid analyses were used to estimate the error in calculating the IOL toricity. Results. The principles of determining the actual zone are based on the assumption that maximum visual acuity and visual quality can be achieved when the regularity of astigmatism in the central parts of the cornea corresponds to the regularity of toric IOL. The mean diameter of the selected actual zone was 2.93±0.61 (from 2.0 to 4.3 mm respectively). The average vector error of toricity calculation in 1st group was 0.30±0.31, in 2nd group – 0.42±0.30 (p=0.006). Centroid analysis showed similar values of centroid error in 1st group and 2nd group (0.09 and 0.08), while the dispersion was higher in 2nd group (0.42 and 0.51, respectively). Conclusion. The customized principle of selecting the actual zone according to topographic maps of the cornea showed a more accurate calculation of the IOL toricity compared with the use of conventional keratometry data. Key words: toric IOL, corneal astigmatism, IOL calculation accuracy, keratometry, keratotopography

Visual and Refractive Outcomes of IOL Implantation Combining Extended Depth of Focus and Multifocal Profile in Cataract Surgery

Visual and Refractive Outcomes of IOL Implantation Combining Extended Depth of Focus and Multifocal Profile in Cataract Surgery

Early Postoperative Complications of Trabeculectomy and Their Management: A Hospital Based Study

Purpose: To study the early post operative complications of trabeculectomy, Phaco trabeculectomy and their management in a tertiary care center. Study Design: Interventional case series. Place and Duration of Study: Al-Ehsan Welfare Eye Hospital from 1st November 2020 to 30th January 2022. Methods: One hundred and two patients who underwent glaucoma filtration surgery were selected through convenient sampling. The patients were followed up for 12 weeks and early post-operative complications, if any, were noted and managed. Results: There were 58 (56.86%) males and 44 (43.14%) females. The age ranged from 35 to 70 years. There were 48 (47.06%) pseudophakic and 54 (52.94%) phakic patients. Mean pre-operative IOP was (31.99 ± 5.66 mm Hg) which reduced to 12.35 ± 4.30 mm Hg one month after surgery. Trabeculectomy with 5-Fluorouracil (5-FU) was performed in 48 patients (47.06%) while trabeculectomy combined with phacoemulsification and IOL implantation was performed in 54 patients (52.94%). Primary open angle glaucoma (POAG) was present in 94 patients (92.16%) while 8 patients (7.84%) had chronic angle closure glaucoma. The early postoperative complications were shallow anterior chamber in 17.6%, pupillary membrane in 2.9% and choroidal detachment in 2.9%. Six patients (5.9%) were steroid responder and these patients were shifted to topical Loteprednol from topical prednisolone. Conclusion: Majority of early post operative complications of trabeculectomy are transient and settled in first two to three weeks without any surgical intervention. Anticipation, timely diagnosis and early intervention is the key to success in management of complications of trabeculectomy.

Unilateral intraindividual comparison and bilateral performance of a monofocal spherical and diffractive extended depth of field intraocular lens mix-and-match approach.

To evaluate the intraindividual visual performance of a spherical and extended depth of field (EDOF) IOL used in a mix-and-match approach. Single centre (tertiary care centre), retrospective consecutive case series. Included patients had uneventful cataract surgery with implantation of a spherical monofocal IOL (CT Spheris 204) in the dominant eye and a diffractive EDOF IOL (AT LARA 829) in the non-dominant eye. Monocular and binocular defocus curves and visual acuity at various distances were assessed. In addition, binocular reading speed, contrast sensitivity, and patient satisfaction using QOV, Catquest 9SF, and glare/halo questionnaires are reported. A total of 29 patients (58 eyes) were included. We observed significant intra-individual differences for monocular DCIVA, DCNVA, UIVA, and UNVA. There were no differences in monocular BCDVA or UDVA. The monocular defocus curves for the two IOLs significantly differed at defocus steps between -1.0 and -3.5 D. 93.10% of patients reported they would opt for the same combination of IOLs. Excellent uncorrected and corrected distance visual acuity was demonstrated in both groups. The mix-and-match approach described in this study yielded good intermediate vision and improved near vision with high-patient satisfaction.

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

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