Intraocular Lens Selection Research Articles

Large-scale observational study of AI-based patient and surgical material verification system in ophthalmology: real-world evaluation in 37 529 cases

BackgroundSurgical errors in ophthalmology can have devastating consequences. We developed an artificial intelligence (AI)-based surgical safety system to prevent errors in patient identification, surgical laterality and intraocular lens (IOL) selection....

Intraocular lens exchange or explantation post cataract surgery.

To report incidence, indications, and visual outcomes of intraocular lens (IOL) exchange/explantation surgery. Retrospective analysis of 60 eyes requiring IOL exchange/explantation surgery between 1st January 2017 and 31st December 2022. The overall outcomes as well as comparison between the trainee versus experienced surgeons were analyzed. Out of 39 778 cataract surgeries (with no preexisting ocular co-morbidities) during a six-year period (2017-2022), 60 (0.15%) needed IOL exchange/explantation. Surgeons-under-training performed 36/60 cases (60%) while 24/60 (40%) were by experienced surgeons. The commonest indication was subluxated IOL in 26 (43.3%), followed by dislocated IOL in 20 (33.3%), postoperative refractive surprise in 7 (11.6%), IOL induced uveitis in five and broken haptic in two eyes. Twenty-four (40%) eyes had intraoperative complications during primary surgery. Posterior chamber IOL (PCIOL) was the commonest secondary IOL in 21 (35%) eyes, scleral fixated in 20 (31.6%), anterior chamber IOL (ACIOL) in 13 (21.6%), iris fixated IOL in three (5%) and three eyes (5%) were left aphakic. The mean time between primary and secondary surgery was 168d (168±338.8). Best corrected visual acuity (BCVA) of >20/60 was obtained in 43 eyes (71.66%), 20/80-20/200 in 14 (23.33%), 20/250 in two and hand movements in one. No statistically significant difference in visual outcome was noted at post-op one month between trainees versus experienced surgeons (UCVA 0.45±0.29 vs 0.53±0.32, P=0.20, BCVA 0.34±0.25 vs 0.37±0.26, P=0.69). IOL subluxation as the commonest indication and posterior capsular rupture is the commonest intraoperative risk factor. This complication can be effectively addressed with selection of the appropriate secondary IOL achieving good visual outcomes in over 70% of patients.

Intraocular lens simulator using computational holographic display for cataract patients.

To develop and validate a holography based vision simulator for the demonstration of expected postoperative vision corresponding to monofocal and multifocal intraocular lenses (IOL) to cataract patients before surgery. An artificial eye model is used to measure the optical performance of different IOL types. The resultant aberrations and degradations are then modeled using phase holograms and shown to subjects on a holographic display. We measure the contrast and resolution loss, halos around the light sources, and point spread function (PSF) corresponding to three different IOLs. We tested the holography based vision simulator on 13 healthy subjects and 6 cataract patients. Monofocal, bifocal, and trifocal IOLs exhibited a contrast decrease of 5%, 42%, and 45% and a resolution limit of 4.49, 4.00, and 4.00 lp/mm (using 0.05 MTF criteria), respectively. Monofocal IOLs have the best resolution and contrast at the optimal focus distance, and multifocal lenses offer extended depth-of-field but exhibit prominent halos and reduced contrast/resolution. We confirmed that the visual functions of IOLs could be successfully modeled using phase holograms and simulated using a holographic display without using a physical IOL. Patients can experience the effects of different IOL options prior to surgery, which helps with IOL selection, expectation management, and patient satisfaction.

Ocular dominance shift in refractive cataract surgery: prospective, observational study.

To explore the features of the dominant and nondominant eyes in patients with cataracts and predict ocular dominance shift (ODS) based on preoperative indicators. Changsha Aier Eye Hospital, Changsha, Hunan, China. Prospective, observational study. Patients with age-related cataracts who underwent unilateral cataract surgery were enrolled in this study. Before the procedure, uncorrected distance visual acuity (UDVA) was assessed and noncycloplegic subjective refraction evaluations were conducted to determine corrected distance visual acuity. Total astigmatism, corneal astigmatism, and intraocular astigmatism were measured using OPD-Scan III. Cataract type was assessed using slitlamp biomicroscopy based on the Lens Opacities Classification System III. Ocular dominance (OD) was determined under corrected conditions using the hole-in-card test. Follow-up visits occurred at 1 day, 1 week, and 1 month postoperatively. After 1 month, OD was re-evaluated, and participants completed the 9-item Short-Form Cataract Questionnaire. 94 patients (188 eyes) were enrolled in the study. The analysis showed that the ODS rate of unilateral cataract surgery was 40.4%. In addition, age, UDVA of the nondominant eye, posterior subcapsular cataract, and total astigmatism were risk factors for ODS. No difference in vision-related quality of life was detected between patients who had ODS and those who did not. Several preoperative parameters as potential risk factors of ODS after cataract surgery were identified. These findings provide guidance for predicting changes in the dominant eye and may improve the precise selection of intraocular lenses and implementation of monovision strategies.

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.

Unusual after cataracts: A case series

Posterior capsular opacification (PCO) or “after cataract,” a common complication after cataract surgery, occurs due to abnormal proliferation and differentiation of the residual lens epithelial cells in the capsular bag. It can significantly affect visual acuity and contrast sensitivity. Though it cannot be eliminated, meticulous surgery coupled with appropriate intraocular lens selection can definitely reduce the incidence of PCO, especially in young patients undergoing cataract surgery. A routine neodymium-doped yttrium aluminum garnet (Nd:YAG) capsulotomy can solve the problem easily in most of the patients, but some can have atypical presentations due to angle closure from Soemmering’s ring. The purpose of this report is to present unusual after cataracts and the utility of imaging techniques in the diagnosis of the same.

Intraocular lens selection in diabetic patients: How to increase the odds for success.

The incidence of cataracts is significantly higher in diabetic individuals, particularly in younger age groups, with rates quadrupled in those under 65 and doubled in those over 65 compared to non-diabetics. Cataract surgery in diabetic patients poses many challenges: Poor epithelial healing, decreased corneal sensitivity, increased central corneal thickness, decreased endothelial cell count, variable topography, poor pupillary dilatation, anterior capsular phimosis, posterior capsular opacification (PCO), chances of progression of diabetic retinopathy (DR), zonular weakness, and vitreous prolapse and diabetic macular edema. Selection of an appropriate intraocular lens (IOL) is crucial for visual rehabilitation and monitoring DR. The choice of IOL in diabetic cataract patients is a challenging scenario. Square-edge IOLs are favored for their capacity to mitigate PCO, whereas hydrophilic counterparts may incur calcification in the setting of proliferative DR. The advisability of premium IOLs for achieving spectacle independence warrants judicious evaluation, particularly in the presence of advanced retinopathy. Optimal IOL placement within the capsular bag is advocated to minimize postoperative complications. Rigorous preoperative assessment and informed patient counseling regarding IOL options are indispensable for optimizing surgical outcomes. This review article covers various aspects regarding the choice of IOLs in different case scenarios and complications in the diabetic population.

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.

Current Status of Shared Decision-Making in Intraocular Lens Selection for Cataract Surgery: A Cross-Sectional Study.

To explore 1) the level of shared decision-making (SDM) participation in intraocular lens (IOL) selection in cataract patients and the factors that influence this participation and 2) the relationships between preparation for decision-making (PrepDM)and the level of SDM participation and satisfaction with the decision (SWD). Provide guidance for improving SDM in ophthalmology. 176 cataract patients were asked to complete the PrepDM scale, the 9-item Shared Decision Making Questionnaire (SDM-Q-9) and the SWD instrument in IOL decision-making process. Multiple linear regression was used to analyze the influencing factors of the level of SDM. The Process program and bootstrap sampling method was used to test whether the level of participation in SDM was a mediating variable among the three. The SDM-Q-9 median score was 77.78 (IQR 31.11-88.89). Patients with a history of surgery in the operative eye (P=0.022) or PrepDM <60 points (P<0.001) had lower SDM-Q-9 scores than patients with no history of surgery in the operative eye or PrepDM ≥60 points. Patients with an education level lower than primary school had lower SDM-Q-9 scores than patients with other education levels (P<0.05). The PrepDM of cataract patients was positively correlated with the level of SDM (r=0.768, P<0.001) and with the SWD (r=0.727, P<0.001), and the level of SDM was positively correlated with the SWD (r=0.856, P<0.001). The level of SDM fully mediated PrepDM and SDW, with a mediating effect value of 0.128 and a mediating effect of 86.66% of the total effect. The SDM of cataract patients involved in IOL selection was in the upper middle range. Education, history of surgery in the operated eye, and PrepDM were factors that influenced the level of SDM. The level of participation in SDM fully mediated the relationship between PrepDM and SWD.

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

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

Functional Approach to IOL Selection in Eyes With Combined Cataract and Keratoconus With an Option for Refractive Lens Exchange.

To evaluate spherical intraocular lens (IOL) implantation for cataracts in keratoconic eyes followed by optional refractive toric lens exchange to improve uncorrected visual acuity. This retrospective study evaluated cataract surgery outcomes in keratoconic eyes. Eyes treated with a spherical IOL targeted for -2.00 diopters (D) either achieved acceptable manifest refraction and desired exchange with a toric IOL (Group 1); achieved satisfactory manifest refraction and chose to use spectacles or contact lenses (Group 2); or did not achieve acceptable refraction and used contact lenses (Group 3). Group 4 had single-stage toric IOL implantation with plano target. Corrected and uncorrected distance visual acuity (CDVA and UDVA) and keratometry were analyzed. Groups 1 to 4 had 18, 23, 18, and 26 eyes, respectively. A staged toric exchange resulted in significantly better (P = .02) UDVA (mean: 0.15 logMAR; 20/25 Snellen) than initial toric IOL implantation (0.24 logMAR; 20/30 Snellen). All toric IOL exchange eyes achieved 20/30 or better CDVA and 94% had 20/40 or better UDVA. Mean manifest cylinder significantly decreased from 3.39 D before lens exchange to 1.10 D postoperatively. Initial implantation of a spherical IOL in keratoconic eyes allows basing toric calculations on the manifest refraction, which may be more reliable than keratometry measurements in keratoconic eyes. UDVA after staged toric IOL exchange was significantly better than after initial toric IOL implantation. Importantly, by staging use of toric lenses, the authors avoided cases where patients required a rigid contact lens after a toric IOL was implanted. [J Refract Surg. 2024;40(4):e207-e217.].

Effects of reduction in intraocular pressure after trabeculotomy on axial length and intraocular lens selection.

To investigate the relationship between intraocular pressure (IOP) and axial length (AL) and to compare the refractive predicted error in patients who have undergone cataract surgery alone or in combination with trabeculotomy. Hospital. Single-center, retrospective, case-control. The medical records of patients who had undergone cataract surgery alone or in combination with trabeculotomy using the Tanito microhook were retrospectively reviewed. Patients were grouped into cataract surgery alone (CAT) or cataract surgery combined with trabeculotomy (LOT) groups. Demographic data, preoperative and postoperative IOP and AL, and surgically induced astigmatism (SIA) were analyzed before and 1 month postoperatively to evaluate the interplay between IOP, AL, and refractive outcomes. 52 eyes (52 patients) underwent LOT, and 67 eyes (67 patients) underwent CAT. The mean IOP at baseline did not differ between the groups; the change in IOP (dIOP) was significantly higher in the LOT group than in the CAT group. The mean AL at baseline and the change in AL (dAL) were 24.0 ± 1.2 mm and 0.16 ± 0.11 mm, respectively, in the LOT group, and 23.8 ± 1.1 mm and 0.11 ± 0.070 mm, respectively, in the CAT group. The difference in dAL was also significant. In the LOT group, dIOP and dAL were significantly correlated. The mean SIA vectors did not significantly differ between the groups. AL decreased because of the reduction in IOP after cataract surgery combined with trabeculotomy. Consequently, the refractive target error was greater, and the postoperative refractive outcome showed a tendency toward hyperopia.

К вопросу расчета ИОЛ у пациентов с витреоретинальной патологией

Purpose. To estimate the probability of a change in the calculated IOL after microinvasive vitrectomy 25G in patients with operated macular rupture. Methods. A retrospective analysis of patients operated on for a macular rupture with a diameter from 400 microns to 1000 microns was performed. The exclusion criteria were: the axial length of the eye is less than 22.0 mm and more than 26.0 mm, recurrence of previously operated macular ruptures, the presence of concomitant ocular pathology that can affect the final postoperative result (macular degeneration, glaucoma, diabetic and postocclusive retinopathy), the presence of previously performed surgical interventions on the retina. The study involved 64 eyes, of which 34,37 % (22 eyes) with a native lens; 14,06 % (9 eyes) with artifacia before vitrectomy; 6,25 % (4 eyes) vitrectomy with cataract phacoemulsification and IOL implantation and 45,31 % (29 eyes) cataract phacoemulsification with IOL implantation was performed within 4–9 months after primary vitrectomy. These patients were the study group. The comparison parameters are best corrected visual acuity, K1, K2, Ave. K1, Ave. K2, Axis, Ave. K2-K1, axial length of the eye, Ave. axial length of the eye, as well as calculated models of IOL and implantable after vitreoretinal surgery. Results. The change in the optical strength of the IOL occurred in 44,82 %. The change in the IOL model is 37,93 %. The change in the optical strength and model of the IOL is 20,68 %. The change in the optical strength of the previous IOL model is 24,1%. The change in the strong axis of more than 20 ° with the previous IOL parameters is 13,79 %. Only in 27,58 % there were no changes in the calculation of IOL. Conclusion. An individual approach to the calculation and selection of intraocular lenses in patients with vitreoretinal pathology allows implantation of all types of IOLs with maximum patient satisfaction with the functional result. Keywords: biometric indicators, IOL, vitrectomy, cataract, phacoemulsification, keratometry

Screening of positive dysphotopsia before multifocal intraocular lens implantation.

To assess the photic phenomena (PP) and positive dysphotopsia in candidates for presbyopia or cataract surgery and to evaluate their relationship with cataract grading systems. Retrospective observational. Monocular data for 82 subjects measured during the preoperative screening were retrospectively retrieved from our database. The evaluated variables consisted of two methods for PP measurement: light distortion index (LDI) and parameters obtained from a simulator, both of which were combined with subjective bother related to PP. The cutoff for LDI that better predicted patients passing from slightly to moderately bothersome was estimated. The relationships between LDI and the following objective cataract grading methods were also assessed: objective scatter index (OSI), dysfunctional lens index (DLI), and Pentacam Nucleus Staging (PNS). LDI was the best method for measuring PP, which showed a significant correlation with the bothersome question (rho = 0.34, P = 0.002) and also with OSI (rho = 0.67, P < 0.0005), DLI (rho = -0.29, P = 0.007), and PNS (rho = 0.48, P < 0.0005). The number/percentage of patients who found it bothersome was as follows: "Not at all" (18/22%), "Slightly" (41/50%), "Moderately" (15/18.3%), and "Very" (8/9.7%). The cutoff value that predicted the transition from slightly to moderately bothersome was ≥15.20% according to LDI, which could be estimated with the following values for grading: ≥2.8 for OSI, ≤7.6 for DLI, and ≥2 for PNS. Patients reporting moderately or higher bothersome levels in the preoperative period and with LDI <15.20%, <2.8 for OSI, >7.6 for DLI, and <2 for PNS might deserve special attention in the multifocal intraocular lens selection.

Artificial intelligence in cataract and refractive surgery

Artificial intelligence (AI) technology is proving to be promising in the field of healthcare, especially in the areas relying on big data and image‐based analysis. In Ophthalmology, AI was already tested in majority of subspecialities, including cataract and refractive surgery. There were interesting studies showing the benefits of using AI algorithms in early keratoconus detection, to predict the outcomes of laser refractive surgery, and to cataract surgery training and monitoring. Moreover, AI models using fundus images to diagnose and grade cataract have been developed. New intraocular lens (IOL) formulas are applying big data and computational methodologies to achieve better prediction of targeted refraction and simplify the IOL selection process. Recent developments in AI have shown their potential possibility for the diagnosis and management of paediatric cataract using slit‐lamp images.

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.

Comparisons of biometric parameters measurements by OPD-SCAN Ⅲ and Pentacam in cataract

BackgroundComparison of OPD-Scan III and Pentacam measurements of relevant parameters guiding the selection of multifocal intraocular lenses in cataract patients. MethodsA retrospective study included 120 patients (120 eyes) with cataract. Their chord kappa, chord alpha, corneal spherical aberration, and pupil size were measured by OPD-Scan Ⅲ and Pentacam. Pairwise t-tests, Pearson tests, and Bland-Altman analyses were used, respectively, to assess the difference, correlation, and agreement between the devices. ResultsThere was no significant difference in photopic chord kappa and corneal spherical aberration between the two instruments (P = 0.054, P = 0.065). Chord alpha and pupil size varied significantly between the two instruments (P < 0.001). OPD-Scan III results revealed a significant association between photopic chord kappa and mesopic chord kappa (r = 0.823, P < 0.001). There was a significant positive correlation between photopic and mesopic chord kappa measured by OPD-Scan Ⅲ and chord kappa measured by Pentacam (r = 0.840, r = 0.757, P < 0.001). The chord alpha evaluated by the two tools had a moderate correlation (r = 0.442, P < 0.001) between them. Bland-Altman analysis showed that there was excellent agreement between the two instruments in measuring chord kappa and corneal spherical aberration, while the chord alpha and pupil size were not consistent. ConclusionsThe chord kappa and corneal spherical aberration measured by OPD-Scan III and Pentacam were consistent in the preoperative decision making of multifocal intraocular lens implantation in cataract patients, both of which have clinical guiding significance. In addition, OPD-Scan III provides more comprehensive day and night chord kappa and pupil diameters, which improves clinical advice for patients with complicated ocular diseases and high demands for nocturnal vision.

Comparative Evaluation of Visual Performance and Patient Satisfaction following Cataract Surgery: A Retrospective Analysis of an Extended Depth-of-Focus Intraocular Lens and a Diffractive Multifocal Lens with Extended Depth of Focus

(1) Background: Cataract surgery has evolved significantly with the development of multifocal and extended depth-of-focus intraocular lenses (IOLs), driven by increasing patient desire for spectacle independence. (2) Methods: This retrospective, single-center study conducted on 86 eyes from 59 patients aged 40–80 years compared the performance and patient satisfaction of Symfony® and Synergy® (Johnson &amp; Johnson Vision) IOLs during a follow-up of 1 year postsurgery. Uncorrected and corrected distance, intermediate, and near visual acuities were assessed (UDVA, CDVA, UIVA, CIVA, UNVA, and CNVA, respectively). (3) Results: Although both IOLs demonstrated a commendable distance VA, Synergy® outperformed in near VA (UNVA, p = 0.040; CNVA, p = 0.014), and Symfony® slightly excelled in intermediate VA (UIVA, p = 0.014; CIVA, p = 0.040). The defocus curve of Synergy® maintained a higher VA even at −4 D with a smoother curve and a broad landing zone. Although the optical quality assessments were similar, Symfony® had a nonsignificant edge. Patients indicated higher satisfaction and reduced reliance on spectacles with Synergy® despite more frequent reports of glare and halos. (4) Conclusions: These findings highlight the importance of personalized IOL selection in cataract surgery, which must be customized to apply the distinctive advantages of each IOL to address the unique visual requirements and lifestyle of patients.

Comparison of the accuracy of 9 intraocular lens power calculation formulas after SMILE in Chinese myopic eyes

As of 2021, over 2.8 million small-incision lenticule extraction (SMILE) procedures have been performed in China. However, knowledge regarding the selection of intraocular lens (IOL) power calculation formula for post-SMILE cataract patients remains limited. This study included 52 eyes of 26 myopic patients from northern China who underwent SMILE at Tianjin Eye Hospital from September 2022 to February 2023 to investigate the suitability of multiple IOL calculation formulas in post-SMILE patients using a theoretical surgical model. We compared the postoperative results obtained from three artificial intelligence (AI)-based formulas and six conventional formulas provided by the American Society of Cataract and Refractive Surgery (ASCRS). These formulas were applied to calculate IOL power using both total keratometry (TK) and keratometry (K) values, and the results were compared to the preoperative results obtained from the Barrett Universal II (BUII) formula for the SMILE patients. Among the evaluated formulas, the results obtained from the Emmetropia Verifying Optical 2.0 Formula with TK (EVO-TK) (0.40 ± 0.29 D, range 0–1.23 D), Barrett True K with K formula (BTK-K, 0.41 ± 0.26 D, range 0.01–1.19 D), and Masket with K formula (Masket-K, 0.44 ± 0.33 D, range 0.02–1.39 D) demonstrated the closest proximity to BUII. Notably, the highest proportion of prediction errors within 0.5 D was observed with the BTK-K (71.15%), EVO-TK (69.23%), and Masket-K (67.31%), with the BTK-K showing a significantly higher proportion than the Masket-K (p < 0.001). Our research indicates that in post-SMILE patients, the EVO-TK, BTK-K, and Masket-K may yield more accurate calculation results. At their current stage in development, AI-based formulas do not demonstrate significant advantages over conventional formulas. However, the application of historical data can enhance the performance of these formulas.