Monofocal Lens Research Articles

Effect of enhanced monofocal intraocular lenses on glaucoma patients' foveal threshold.

We investigated the effect of enhanced monofocal intraocular lenses (IOL) (TECNIS Eyhance DIB00V) on retinal sensitivity in glaucoma patients after cataract surgery by comparing results with of such patients implanted with non-enhanced monofocal intraocular lenses (TECNIS ZCB00V). This was a multi-facility retrospective study of glaucoma patients who had undergone cataract surgery. We measured the value of the foveal threshold with a Humphrey visual field analyzer before and after cataract surgery and considered this value to represent the sensitivity of the retina. As a sub-analysis, we also compared the mean deviation (MD), pattern standard deviation (PSD), thickness of ganglion cell complex (GCC), and best corrected visual acuity (BCVA) before and after surgery. We used t-tests to determine statistical differences between lens groups. We included 60 glaucoma patients (104 eyes) who underwent cataract surgery: enhanced group, n = 58 eyes; non-enhanced group, n = 46 eyes. In both groups, cataract surgery improved the retinal sensitivity (p < 0.001), MD (p < 0.001) and BCVA (p < 0.001). The postoperative foveal thresholds did not significantly differ by lens type (p = 0.673), at 34.41 ± 2.44dB in the enhanced group and 34.61 ± 2.19dB in the non-enhanced group. Likewise, there was no significant difference (p = 0.942) among advanced glaucoma patients, with postoperative foveal thresholds of 33.08 ± 2.35dB and 33.17 ± 3.45dB in the enhanced and non-enhanced, respectively. Implantation of enhanced monofocal IOLs in glaucoma patients did not result in any apparent loss of sensitivity compared with non-enhanced monofocal lens implantation.

Femtosecond laser assisted cataract surgery in a cataract patient with low vaulted ICL following LASIK: a case report

BackgroundApart from the conventional utilization of ICL implantation for the correction of refractive errors, its recent applications extend to correcting refractive errors post laser refractive surgery. Notably, the development of cataracts stands out as a prevalent postoperative complication, often associated with low vault. Previous cases have demonstrated successful management of cataracts with ICL through the combination of FLACS and ICL removal coupled with IOL implantation, resulting in favorable postoperative visual outcomes. Herein, we present a case of cataract with low vault ICL following LASIK and its subsequent management.Case presentationA 46-year-old male presented with vision loss in the right eye for 9 months, and he had undergone LASIK 22 years prior and had ICL implantation in both eyes 2 years ago to correct refractive error. One day after ICL implantation, both eyes exhibited the UDVA of 1.2 and 1.0, well-positioned ICLs, and approximate vault of 150 μm and 200 μm. Six months ago, the patient became aware of blurred vision in the right eye for a duration of 3 months. Examination revealed cloudy lens cortex in the right eye. During the current review, the UDVA of the right eye was 0.6, where nasal wedge-shaped clouding was evident and worsened, while the left eye lens remained transparent. AS-OCT demonstrated the vault of 54 μm in the right eye and 83 μm in the left eye. Considering the patient’s history of LASIK and the presence of right eye cataract, a monovision approach was adopted. The patient underwent FLACS combined with ICL extraction and monofocal IOL lens implantation in the right eye. At 10 days postoperatively, the patient exhibited the UDVA of 1.0.ConclusionsOur report confirms the feasibility of FLACS in managing cataracts in patients with low vault ICL following LASIK. This procedure does not pose significantly greater challenges than in typical cataract cases, although meticulous care remains essential throughout every step of the surgery, particularly during laser scanning and positioning. With adequate preoperative preparation and precise calculation of the IOL power, surgical outcomes can meet expectations fully.

Power profile and optical performance of two extended range-of-vision intraocular lens designs.

To assess the power profile and optical performance of 2 extended range-of-vision (ERV) intraocular lenses (IOLs), TECNIS Eyhance (ICB00) and LuxSmart, and compare them with their monofocal counterpart lenses with similar platforms and materials: TECNIS 1-piece (ZCB00) and LuxGood, respectively. Optics and Optometry Faculties of Complutense University (Madrid) and Universitat Politècnica de Catalunya BarcelonaTech (Terrassa) in Spain. Laboratory investigation on optical bench. For each design, the power distribution and (fourth and sixth-order) spherical aberration (SA) across the lens aperture were measured as well as the optical performance using modulation transfer function-based metrics with through-focus evaluation. 3 nominal powers (+10.00 diopters [D], +20.00 D, and +30.00 D) and 3 pupil sizes (2.0 mm, 3.0 mm, and 4.5 mm) were considered to assess whether the base power of the lens and pupillary dynamics have an influence on the depth-of-focus extension. TECNIS Eyhance and LuxSmart IOLs had different power and SA profiles, but both designs shared a positive add power in their central region in comparison with their monofocal counterparts. LuxSmart had a greater add power while TECNIS Eyhance showed higher peak optical quality but smaller depth of focus. Differences of focus extension between the 2 ERV IOL designs are related to differences of power and SA profile. The nominal base power of the IOLs has little effect on their optical quality. However, pupil dynamics plays a key role since it determines the effective add power and optical performance of the ERV IOLs.

Intraocular aphakia correction in patients with prior keratorefractive surgery: literature review. Part 1

Introduction. An increasing number of patients with a history of keratorefractive surgeries are presenting to ophthalmologists with complaints of vision loss due to cataracts. Treating this group poses surgeons with a range of unique challenges: high demands for vision quality, complexities in selecting the appropriate intraocular lens (IOL) power calculation formula and IOL model, target refraction, as well as the need to modify cataract extraction techniques and address specific postoperative considerations. Despite advancements in the development of new IOL designs and calculation formulas, clinical and functional outcomes in this group remain inferior to those in patients without prior keratorefractive procedures. A paradigm shift is emerging, advocating for a personalized approach in the diagnosis and management of cataracts in these patients. However, discussing all aspects within a single review proved impractical, leading us to divide it into two parts. The objective of the first part of this study is to assess the specific considerations for aphakia correction in patients who have undergone keratorefractive procedures, based on literature data, while taking into account the long-term complications of refractive surgery. Additionally, this part will address the fundamental principles of the design and functionality of pseudoaccommodating intraocular lenses (IOLs). Materials and methods. A selection of over 200 peer-reviewed publications from resources such as PubMed, eLibrary, CyberLeninka, Science Direct, and Google Scholar over the past 30 years was conducted. The first part of the review includes 49 publications. This work represents an analysis of contemporary literature, reflecting the impact of keratorefractive surgeries on the successful performance of phacoemulsification with IOL implantation. Results. The findings from the first part of the analysis indicate that a detailed medical history of previously performed keratorefractive corrections – specifically their type and potential long-term complications – play a significant role in determining the surgical treatment strategy. Standard examination methods do not always fully reflect the optical characteristics of the cornea in these patients. Extended preoperative assessments, including specialized techniques such as keratotopography and keratotomography, are crucial for identifying corneal irregularities and for the subsequent selection of the type of intraocular lens (IOL) for aphakia correction in patients who have undergone keratorefractive surgeries. Studies show high effectiveness not only in using monofocal lenses but also in the potential application of pseudoaccommodating IOLs, including those with extended depth of focus and multifocal lenses. The selection of optimal formulas for IOL calculation, as well as the clinical aspects influencing refraction in the postoperative period, will be addressed in the second part of the literature review. Conclusion. The increase in the number of refractive surgeries has led to a growing population of patients with cataracts following ametropia correction. This has spurred the development of new IOL variants with extended depth of focus. However, literature data on their effectiveness in patients who have undergone keratorefractive procedures remain limited. Multicenter prospective studies are needed to evaluate new IOL models and to determine the optimal surgical strategies for this category of patients.

Cataract surgery with corneal endothelial pathology

Abstract: It is not uncommon for Fuch’s endothelial corneal dystrophy (FECD) patients to present with a co-existent cataract. Surgeons are often faced with a choice between simultaneous and staged corneal and cataract surgery. Descemet’s membrane endothelial keratoplasty (DMEK) has been found to have better visual outcomes as compared to Descemet’s stripping endothelial keratoplasty (DSEK) and penetrating keratoplasty and is currently the preferred surgery for FECD. Endothelial cell count and pachymetry cutoffs were earlier used for decision-making. Various other investigations such as Scheimpflug imaging and confocal microscopy are now used to prognosticate the outcome when performing cataract surgery only. Triple DMEK has the advantage of a definite treatment in a single sitting. Whereas, a staged approach with DMEK followed by cataract surgery has a better visual outcome. This is due to variable refractive changes in the cornea post-DMEK or DSEK that can lead to inaccurate intraocular lens (IOL) power calculation. Even though the graft detachment rates and rebubbling rates have been found to be comparable in triple DMEK versus a staged surgery, in view of increasing patient demands and expectations for a spectacle-independent outcome, a staged surgery is now preferable. Conventionally, surgeons favored the use of only monofocal lenses; however, the use of premium IOLs, especially extended depth of focus lenses, is now increasing. In this review, we will discuss the various advantages and disadvantages of a simultaneous and staged approach and pearls on decision-making in FECD with cataracts.

Clinical Outcomes of Enhanced Monofocal (Mono-EDOF) Intraocular Lenses with the Mini-Monovision Technique versus Trifocal Intraocular Lenses: A Comparative Study.

It was aimed to compare the clinical results of the mini-monovision technique (MMV) with enhanced monofocal intraocular lens (IOL) and trifocal IOL applications and to evaluate the intereye differences in the MMV group. This retrospective observational study evaluated the results of cataract surgeries performed on 48 eyes of 24 patients. Surgeries in Group I were performed for MMV using the RayOne EMV IOL targeting emmetropia in dominant eyes (Group IA) and -0.70 diopter (D) myopia in non-dominant eyes (Group IB), while those in Group II were performed with the AcrySof® IQ PanOptixTM TNFT00 IOL targeting emmetropia. After the surgeries, uncorrected and corrected distance, intermediate, and near distance visual acuities, contrast sensitivity measurements, and defocus curves were determined. Subjective evaluation was made with the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). The groups were compared statistically. Postoperative refraction mean spherical equivalent was -0.25±0.22 D, -0.67±0.33 D, and -0.16±0.31 D in the three groups, respectively. A statistical difference was identified in favor of Group IA for uncorrected distance vision and in favor of Group IB for near vision (p<0.05). There was no difference in bilateral uncorrected visions in Groups I and II (p>0.05). While contrast sensitivity was better in Group I at all spatial frequencies (p<0.05), better vision was achieved in the defocus curve at distance in Group IA and at near in Group IB. In the binocular evaluation, it was seen that Groups I and II had similar results. In the subjective evaluation, NEI-VFQ-25 scores were 94.1±4.2/100 in Group I and 91.5±3.0/100 in Group II at 6 months (p>0.05). Photic complaints were significantly more common in Group II. With the MMV technique, it was observed that enhanced monofocal lenses provided better visual acuity at all distances and less dysphotopsia than trifocal lenses, whereas trifocal lenses were better at providing independence from glasses.

Functional Design Analysis of Two Current Extended-Depth-of-Focus Intraocular Lenses.

To evaluate the differences between two extended depth-of-focus intraocular lenses, the Alcon IQ Vivity and the Bausch & Lomb LuxSmart and to compare them with a simple monofocal lens, the Alcon IQ, using a simulation-based approach. A mathematical lens model was created for each lens type based on a measured surface geometry. The lens model was then used in a raytracer to calculate a refractive power map of the lens and a ray propagation image for the focal zone. The simulations confirm the enhanced depth of focus of these two lenses. There are apparent differences between the models. For the Vivity, more light is directed into the far focus in low light conditions, whereas the LuxSmart behaves more pupil independent and prioritizes intermediate vision. The simulation-based approach was effective in evaluating and comparing the design aspects of these lenses. It can be positioned as a valuable third tool for lens characterization, complementing in vivo studies and in vitro measurements. With this approach not only focusing on the resulting optical performance, but the underlying functional mechanisms, it paves the way forward for a better adaptation to the individual needs and preferences of patients.

Incorrectly Focused Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) Laser Beam Leads to Massive Destructive Effects in Small-Aperture (Pinhole) Intraocular Lenses.

Pinhole intraocular lenses (IOLs) were developed to improve reading by compensating for loss of accommodative function. The IC-8® Apthera™ is a small-aperture presbyopia-correcting IOL that combines the proven principle of small-aperture optics with an aspheric monofocal lens to deliver a continuous range of vision for patients withcataractsfrom distance to near vision. Posterior capsule opacification is the most common sequela after cataract surgery. It is effectively treated by laser capsulotomy. However, if the laser beam is incorrectly focused, the IOL can be permanently damaged (pits/shots). In this experimental study, yttrium-aluminum-garnet (YAG) pits were purposefully created. Defects were analyzed and compared between the periphery of the ring in the clear area of the hydrophobic acrylic lens and at the carbon black (CB)-polyvinylidene fluoride (PVDF) filtering component (FilterRing™) of the pinhole lens. All defects were made using identical settings/energy levels (2.6mJ). The damage induced to the IC-8® Apthera™ IOL was examined by low-magnification images, light microscopy, scanning electron microscopy, and micro-computed tomography (micro-CT). YAG defects in the carbon black filter ring were much more severe than those in the clear zone due to the high absorption of the carbon black. Massive defects and destruction of the lens with tearing out of fragments and particles were observed. The missing volume calculated from the micro-CT reconstruction was 0.266 mm3, which is 1.6% of the entire IOL volume, or more than 1000 times the volume damaged in the largest shot in the periphery. Based on the results, we highly recommend using the lowest possible energy levels, posterior offset setting, and circular pattern for maximum safety when performing laser capsulotomy with pinhole implants. Care should be taken to avoid creating irreversible iatrogenic defects that may affect overall quality. The safest area for performing capsulotomy seems to be the periphery of the ring segment. Video available for this article.

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.

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.

Overview of visual acuity improvement in postoperative cataract patients using a monofocal lens and phacoemulsification techniques

Overview of visual acuity improvement in postoperative cataract patients using a monofocal lens and phacoemulsification techniques

Prospective Evaluation of Results of Surgical Treatment of Patients with Idiopathic Macular Hole by Phacovitrectomy and Combined Cataract and Vitrectomy Surgery

Purpose of the study:The purpose of the study was to compare the morphological and functional results of the studied patients with idiopathic macular hole treated with a one-stage method (phacovitrectomy) and combined cataract and vitrectomy surgery.Material and methods:The study included 33 patients (33 eyes) with idiopathic macular hole treated at the Department of Retina and Vitreous Surgery in Lublin. Twenty-one eyes were surgically treated with phacovitrectomy (Group 1 MH). Twelve patients underwent two-stage, combined treatment with removal of the lens in the first stage and vitrectomy in the second (Group 2 MH). The assignment of patients to groups was random. All patients underwent 23-gauge sutureless vitrectomy with removal of the internal limiting membrane (internal limiting membrane peeling). SF6 gas was used as an intraocular tamponade at an isovolumetric concentration of 20% and face down position recommendation for 7 days. Cataract surgery was performed using the phacoemulsification method with an incision in the transparent part of the cornea with intracapsular, posterior chamber implantation of a monofocal lens. A 12-month observation period was established, measured from the date of vitrectomy performance, and in the case of a combined procedure, this period was extended by the time between each stage of treatment. At subsequent check-ups, the subjects underwent a complete ophthalmological examination, which included: best corrected distance visual acuity and best corrected near visual acuity, assessment of the anterior and posterior segments, in a slit lamp, measurement of retinal sensitivity in the macula using microperimetry, the Amsler test and optical coherence tomography examination of the macula.Results:In patients of the total studied group, an improvement in the best-corrected visual distance and near acuity was obtained, and in 88% retinal sensitivity in the macula was also achieved. In the group of patients subjected to phacovitrectomy (Group 1 macular hole) with an average minimum hole diameter of 487.48 µm before the procedure, after a one-year follow-up the mean best corrected distance visual acuity was 0.57 and best corrected near visual acuity 0.51, with macular retinal sensitivity of 26.65 dB. However, in the group of patients subjected to combined cataract and vitrectomy, an average minimum hole diameter of 521.58 µm 12 months after trans pars plana vitrectomy was performed as well as an average best corrected distance visual acuity of 0.64, best corrected near visual acuity of 0.5, and retinal sensitivity in the macula of 25.98 dB. There were no statistically significant differences between phacovitrectomy and the combined procedures in terms of the improvement in the values of distance and near visual acuity and macular retinal sensitivity 12 months after trans pars plana vitrectomy. A statistically significant improvement in retinal sensitivity in the macula was observed in Group 1 macular hole during the 12-month follow-up, while in the combined procedure group the improvement was not statistically significant.Conclusions:Vitrectomy is an effective method of treating maculopathy in the form of macular hole. Morphological and functional improvement was noted in all patients, regardless of the treatment method used. There were no statistically significant differences between phacovitrectomy and the combined procedure in terms of the improvement achieved in the values of distance visual acuity parameters, near vision and retinal sensitivity in the macula 12 months after trans pars plana vitrectomy. A common feature of patients with worse results on individual variables was a longer duration of the disease and a larger size of the hole prior vitrectomy.

Characterizing glare effects associated with diffractive optics in presbyopia-correcting intraocular lenses.

To objectively quantify glare of intraocular lenses (IOLs) utilizing a diffractive principle to extend visual range. To identify models with increased susceptibility to inducing glare. David J Apple Laboratory, Heidelberg, Germany. Laboratory investigation. Glare was assessed by means of straylight parameter with a standard C-Quant (Oculus GmbH) intended for 7°. In addition, two C-Quant modifications were used to test lower angles (i.e., 2.5° and 3.5°). The following IOL models were assessed: PanOptix (Alcon Inc.) and AT Lisa Tri (Zeiss Meditec), Synergy (J&J Vision), and Triumf (BVI Medical), the latter two with chromatic-aberration correction at distance. Straylight from trifocals was compared against a monofocal W-60R lens (Santen). The C-Quant test was performed through the studied IOLs via additional optical components attached to its ocular. Straylight (deg2sr-1) of the control was <1 at all tested angles, with the trifocal models showing comparable straylight at 7°. At 3.5°, Triumf's straylight increased to 15.5 ±0.6, followed by Synergy (6.2 ±1.1), PanOptix (4.1 ±0.3), and AT Lisa Tri (2.0 ±0.8). The chromatic-aberration correcting models demonstrated correspondingly high straylight (Synergy: 18.8 ±1.3; Triumf: 17.3 ±0.5) at 2.5° compared to PanOptix (4.3 ±0.4), AT Lisa Tri (2.1 ±0.1) and monofocal IOLs yielding minimal or no increase. Trifocal IOLs induced increased straylight, but it was limited to lower angles, which may cause difficulties detecting these effects using a standard clinical approach. The latest IOL designs featuring chromatic aberration correction at far-focus appear more susceptible than the established trifocals to inducing glare phenomena.

Migraine is a risk factor for pseudophakic positive dysphotopsia following monofocal lens implantation

ObjectiveTo identify neuroadaptation-related risk factors for persistent positive dysphotopsia (>6 months) following monofocal lens implantation. DesignRetrospective cohort study. ParticipantsPatients of an academic institution and a private practice in Saint Louis, Missouri. Inclusion criteria were adults with cataract extraction between January 2010 and April 2021 with monofocal intraocular lens implantation. Exclusion criteria included dementia, <20/40 acuity, visual pathway damage, visual field loss, and significant pathology causing photopsia. MethodsParticipants were surveyed via telephone. ResultsThere were 385 participants (385 eyes), of whom 66 had persistent dysphotopsia (58 positive), 298 had none, and 21 had nonpersistent dysphotopsia. Among the 58 who had positive persistent dysphotopsia, mean Pseudophakic Dysphotopsia Questionnaire 6 (PDQ-6) score was 14.11 (SD, 8.46). There were no significant differences in sex or race. Migraine prevalence was greater among those with dysphotopsia (21.2%) than among those without (11.4%; p = 0.054). History of migraine was associated with an increase in PDQ-6 score of 2.76 points (p = 0.006). Six people in each group had Visual Aura Rating Scale (VARS) scores greater than zero. Mean VARS score was 0.48 for those with dysphotopsia and 0.14 for those without (p = 0.03). History of migraine or increased VARS score, younger age, and female sex were associated with lower satisfaction. ConclusionHistory of migraine was associated with increased dysphotopsia severity and decreased patient satisfaction. Although further study with a larger sample size is warranted, these preliminary results highlight the potential of simple questions to individualize lens choice, reduce the risk of dysphotopsia, and improve patient satisfaction.

Comparison of Visual Acuity and Defocus Curve after Cataract Surgery with Pure Extended Depth Focus Lens and Mini-Monovision - Interim Analysis -

Abstract&#x0D; Introduction &amp; Objectives : Presbyopia after cataract surgery is still a problem despite recent surgical techniques and intraocular lens technology development. Mini-monovision techniques and pure extended depth of focus (EDoF) lenses are alternatives to achieve good distance and intermediate visual acuity at relatively inexpensive.This study aims to compare the clinical outcome after cataract surgery with binocular mini-monovision and cataract surgery using a pure monocular EDoF lens.&#x0D; Methods : Subjects were randomized into the mini-monovision group (standard monofocal lenses with -1.25 D of anisometropia) and the pure EDoF group. The blinding was achieved by masking the clinical outcome examiners.&#x0D; Results : Interim analysis of 16 patients revealed the outcome of uncorrected and corrected distance visual acuity (UCDVA and BCDVA) were not significantly different between groups. Median of uncorrected intermediate visual acuity (UIVA) and mean of uncorrected near visual acuity (UNVA) of binocular mini-monovision were 0.10 (0-0.10) LogMar and 0.26 + 0.12 LogMar. Median UIVA &amp; mean UNVA monocular EDoF were 0.19 (0.14-0.50) LogMar and 0.54 + 0.11 LogMar, respectively. The Mann- Whitney U test of UIVA between groups revealed p=0.001, and the unpaired T-test of UNVA revealed p=0.000. Mean defocus curve of -2.50 D lens were 0.31 LogMar in binocular mini- monovision group and 0.51 LogMar monocular in EDoF group (p=0.019).&#x0D; Conclusion : UIVA, UNVA and defocus curve of -2.50 D lens in the mini-monovision group were better than the EDoF group.

Enhanced Monofocal Intraocular Lenses in Fuchs' Endothelial Dystrophy Patients: Results from Triple Descemet Membrane Endothelial Keratoplasty Procedure.

Descemet membrane endothelial keratoplasty (DMEK) is currently regarded as the most effective surgical procedure for addressing Fuchs Endothelial Corneal Dystrophy (FECD), frequently performed in conjunction with cataract surgery. In this retrospective study, we present a comparison of visual performance, clinical outcomes, and optical quality between two types of monofocal Intraocular Lenses (IOLs): one standard and one enhanced intermediate vision model, implanted in patients who underwent combined phacoemulsification and DMEK surgery. This single center comparative retrospective study was conducted at the Eye Clinic of the University of Florence (Italy) and included a total of 48 eyes of 48 patients affected by FECD and cataract. All patients underwent combined DMEK with phacoemulsification procedures. The patients' data were analyzed and divided into two groups: one group (standard group) consisted of 24 eyes that underwent phaco-DMEK with implantation of a monofocal IOL, and the second group (enhanced monofocal group) included 24 eyes that underwent phaco-DMEK with implantation of an enhanced monofocal IOL. In both groups, the following monocular visual outcomes were evaluated 6 months after surgery: Uncorrected Distance Visual Acuity (UDVA) and Best-Corrected Distance Visual Acuity (BCDVA) at 4 mts; Uncorrected Intermediate Visual Acuity (UIVA), Distance-Corrected Intermediate Visual Acuity (DCIVA) at 66 cm; Uncorrected Near Visual Acuity (UNVA) and Best Corrected Near Visual Acuity (BCNVA). Monocular defocus curves were also assessed. Furthermore, optical quality in terms of Contrast Sensitivity (CS) in photopic conditions, Higher-Order Aberrations (HOAs) at a pupil size of 5 mm. Modulation Transfer Function (MTF), Objective Scatter Index (OSI), and Strehl ratio, were also analyzed. A Patient-Reported Spectacle Independence Questionnaire was revised to evaluate spectacle independence outcomes. the two groups did not exhibit statistically significant differences in terms of UDVA, BCDVA, UNVA and BCNVA, photopic CS, HOAs, OSI, Strehl ratio, and MTF. However, in the phaco-DMEK enhanced monofocal IOL group, significantly better results were observed in terms of UIVA and DCIVA as well as a different defocus curve profile at 1.50 D, providing better defocus results at intermediate distance compared with the ZCB00 IOL. In our study, we found that enhanced monofocal lens performed favorable visual outcomes, even in cases of FECD, compared to standard monofocal IOLs. Comparable optical quality observed in the Eyhance group could allow surgeons to consider these lenses as a viable option for selected patients with FECD.

Prospective clinical study of a new intraocular lens with extended depth of focus: ISOPURE, 1 year follow‐up

Aims/Purpose: Monofocal lenses are currently the most frequently implanted intraocular lenses (IOL). New implants with enhanced depth of focus (EDOF) could improve intermediate and near visions with uncompromised far visual acuity and limited dysphotopsia. The objective of this study is to compare Group 1 – a bilateral implantation of an EDOF IOL‐ Isopure® versus Group 2 – a bilateral monofocal IOL – Micropure® – (BVI, Belgium).Methods: Eligible patients with bilateral cataracts were randomly assigned to two groups. Monocular, binocular, corrected, uncorrected, near, intermediate and far visions were measured before, 1 month and 1 year after surgery using ETDRS charts. A pre‐ and post‐operative questionnaire was realized to assess the impact of their vision on daily routine.Results: One year after the surgery near median visions were respectively 0.22 ± 0.18 and 0.44 ± 0.10 LogMar (p‐value = 0.0515) while intermediate visions were −0.02 ± 0.12 and 0.14 ± 0.07 LogMar (p‐value = 0.0595). No significant difference was demonstrated in the binocular distance visual acuities, respectively −0.09 ± 0.14 and −0.12 ± 0.15 (p‐value = 1.00). The study revealed no significant difference regarding sensitivity of contrast and the defocus curve had a larger curve plate of good visual acuity in the Isopure® group. The questionnaire's analysis showed no significant difference between the groups.Conclusions: Although no significant difference was demonstrated, this study suggests that with a larger patient sample, the Isopure® implant may provide better near and intermediate visual activity, since our p‐values are close to 0.05, with the same distance vision and no deterioration of the contrast sensitivity. This implant provides a daily visual comfort and the patients reported a better satisfaction, fewer dysphotopsias, less difficulties with daily activities and less dependence on their glasses.

Electrophysiological response of myopic young adults with a novel ophthalmic lens for the control of myopia progression

Aims/Purpose: To evaluate the changes in the electrophysiological response of the retina induced by a novel perifocal ophthalmic lens designed for myopia control.Methods: This experimental cross‐sectional study, evaluated eleven myopic participants (24.9 ± 4.5 years) with refractive errors lower than 6.00 D (spherical equivalent of −2.40 ± 1.32 D in the right eye and − 2.24 ± 1.56 D in the left eye). Refraction, best‐corrected visual acuity, and axial length were obtained at baseline. The global flash multifocal electroretinogram (gf‐mfERG) was assessed for the sensorial dominant eye with the RETI‐port/scan21 (Roland Consult, Wiesbaden, Germany). The gf‐mfERG recordings were performed with a stimulus array pattern of 61‐scaled hexagons displayed on a 19‐inch RGB monitor at a 33 cm distance (optically corrected). The retina was divided into three groups ‐ the fovea (that included concentric ring 1), the parafovea (rings 2 and 3) and the peripheral retina (rings 4 and 5). The peak‐time (in milliseconds, ms), the amplitude (in nano‐volts, nV) and the mean response density (nV/deg2) of the direct and implicit components (DC and IC, respectively) were analysed and compared between control (monofocal contact lenses) and test conditions (perifocal lenses). These lenses have an add power of +2.50 D on the temporal side, and + 2.00 D on the nasal side, intended to change the peripheral refraction.Results: No differences were found in the DC and IC peak time between the control and test measurements, for the fovea, parafovea and peripheral retina. The mean response density of the DC was higher with the perifocal lens for the perifovea (p‐value = 0.033) and for the peripheral retina (p‐value = 0.026). For the IC, the mean response density was also higher with the perifocal lens, only for the parafovea (p‐value = 0.003).Conclusions: Perifocal lenses for myopia control upregulate the parafoveal and peripheral retinal electrical activity.

Altering chromatic aberration: how this latest trend in intraocular-lens design affects visual quality in pseudophakic patients

BackgroundChromatic aberration of the eye results from the dispersion of polychromatic light at the interfaces of ocular media. An intraocular lens (IOL) based approach utilizing the diffractive-multifocal principle has been proposed for its correction, but the clinical evidence on the impact of reducing or increasing chromatic aberration on the visual quality of pseudophakic patients remains scarce.MethodsIn this cross-sectional study, longitudinal chromatic aberration (LCA) effects were studied monocularly in 37 patients implanted with a monofocal lens. LogMAR corrected distance visual acuity (VA) and defocus curve at the + 1.0 D to − 2.0 D range were assessed. Contrast sensitivity (CS) was evaluated at far and at four spatial frequencies. Measurements were performed with the eye's natural conditions, as well as with increased and corrected (by the same amount) LCA, which was altered by introducing zero-power trial triplets.ResultsThe mean (± standard deviation) logMAR VA was − 0.11 ± 0.07 for the natural condition, − 0.13 ± 0.07 for the LCA-corrected eye, and − 0.06 ± 0.08 for the eye with increased LCA. A sharp decline of the defocus tolerance was found after the LCA correction with the VA value of 0.38 ± 0.15 logMAR at − 1.5 D. However, for the natural and increased LCA, it was 0.32 ± 0.16 logMAR and 0.25 ± 0.13 logMAR, respectively. CS was improved at all spatial frequencies after the LCA correction, which was closely followed by the natural-eye performance. Increased LCA resulted in reduced CS, mainly at higher spatial frequencies.ConclusionsWe demonstrated that elevating chromatic aberration above the natural level of monofocal patients extends their depth of focus while causing a measurable albeit minimal reduction in visual function. Still, the observed changes indicate that neither correction nor increase of LCA yields a substantial clinical effect on distance VA and CS in monofocal pseudophakia.

Incidence and factors for pseudoaccommodation after monofocal lens implantation: the Monofocal Extended Range of Vision study.

To screen patients with a monofocal intraocular lens (IOL) for incidence of unaided 20/40 and 0.3 LogMAR for distance and near (pseudoaccommodation) and to find factors for pseudoaccommodation. University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom. Prospective study. This was a single-eye study ( ClinicalTrials.gov : NCT04011696). At 3 to 9 months, refraction, uncorrected and corrected distance and uncorrected near visual acuity (logMAR), spherical equivalent (SEQ), mesopic pupil size (PS), total eye spherical (Z 40 ), vertical coma (Z 3-1 ) aberrations, reading speed and smallest print size were assessed. Refractive astigmatism (RA) was classified as against-the-rule, with-the-rule, oblique and no astigmatism. Data on preoperative axial length (AL) and anterior chamber depth (ACD) were collected. 29 patients (9.6%, 95% CI, 6.5-13.5) had pseudoaccommodation. In cases vs controls, median SEQ, PS, total Z 40 , Z 3-1 , reading speed, smallest print size, preoperative ACD, preoperative AL were: -0.39 vs 0.0 diopters; 3.62 vs 4.10 mm; 0.01 vs 0.02 μm; 0.018 vs 0.022 μm; 106 vs 133 words per minute; 0.30 vs 0.50 logMAR; 2.94 vs 3.13 mm, 23.4 vs 23.7 mm, respectively. RA was not different between the groups. Univariate analysis revealed preoperative ACD (odds ratio [OR], 0.38, 95% CI, 0.16-0.94, P = .04), SEQ (OR, 0.61, 95% CI, 0.42-0.88, P = .01), total Z 40 (OR, 0.0003, 95% CI, 0.00-0.39, P = .03) and PS (OR, 0.39, 95% CI, 0.22-0.69, P < .041) to be significant. Whereas multivariable logistic regression identified: preoperative AL (OR, 0.62, 95% CI, 0.42-0.91, P = .02), SEQ (OR, 0.49, 95% CI, 0.31-0.78, P = .01), Z 40 (OR, 0.00, 95% CI, 0.0-0.01, P = .01) and PS (OR, 0.41, 95% CI, 0.23-0.75, P = .01) to be significant. A combination of low myopic SEQ, lower Z 40 , shorter preoperative AL, and smaller PS increases the chances of pseudoaccommodation.