Multifocal Intraocular Lens Research Articles

Comparative Analysis of Tolerance to Experimentally Induced Astigmatism with Three Types of Multifocal Intraocular Lenses.

The effect of residual astigmatism and its axis on distance and near visual acuities (VAs) with multifocal intraocular lenses (IOLs) has not been studied extensively. This study compared the tolerance to experimentally induced residual astigmatism among bifocal, trifocal, and extended depth-of-focus (EDOF) IOLs. This retrospective, comparative study included 70 eyes of 70 patients implanted with bifocal, trifocal, or EDOF IOLs. Distance and near VAs were assessed with experimentally induced astigmatism by placing positive cylindrical lenses in increments of 0.50 diopters to 2.00 diopters at 90° and 180° axes over the best distance correction. Both distance and near VAs worsened with increasing magnitudes of experimentally induced astigmatism except in the EDOF group, in which the near VA remained within a clinically acceptable limit, ie, within one line from the best corrected VA under all ranges of experimentally induced astigmatism. Furthermore, the EDOF group showed the highest astigmatic threshold for losing VA lines following experimental astigmatic induction at both distance and near. The distance VA was generally better at with-the-rule (WTR) than against-the-rule (ATR) astigmatism for all three IOL groups. On the other hand, the near VA was generally better at WTR than ATR astigmatism in the bifocal group, comparable between WTR and ATR astigmatism in the trifocal group, and generally better at ATR than WTR astigmatism in the EDOF group. The EDOF IOL demonstrated the highest tolerance to experimentally induced astigmatism at both distance and near. VA was generally less affected by WTR astigmatism than ATR astigmatism, especially at distance. We proposed the residual astigmatism thresholds for clinically acceptable VA reduction in all three IOL groups.

Clinical Outcomes of a Trifocal Versus an Extended Depth of Field Intraocular Lens in Chinese Patients With Cataract: A Prospective Cohort Study.

Purpose: To compare the standard outcomes between the PanOptix and Symfony multifocal intraocular lenses (MIOLs) in Chinese patients. Methods: This prospective observational cohort study enrolled patients with cataracts between April 2021 and December 2021 at Xiamen Eye Center Affiliated to Xiamen University. The patients were grouped in the PanOptix (TIOL group) and Symfony (EDF group) according to the IOLs implanted. Uncorrected distant, corrected distance, binocular uncorrected intermediate, and near visual acuity (UNVA), distance-corrected intermediate and near VA (DCNVA) , defocus curve, spectacle independence, contrast sensitivity (CS), and visual disturbances were evaluated after 3 months. Results: Forty patients (80 eyes) were enrolled in the study (20/group). Three months after the operation, UNVA (0.13 ± 0.16) and DCNVA (0.08 ± 0.08) were better in the TIOL group than in the EDF group (0.22 ± 0.08 and 0.22 ± 0.08, respectively, p=0.003 and p < 0.001, respectively). The TIOL group achieved a better-than-0.15-logMAR VA from +0.5 D to -2.5 D (40 cm). VAs of the TIOL group from -1 D (100 cm) to -4 D (25 cm) were better than in the EDF group (p < 0.05). There were no significant differences in the intermediate and far vision outcomes (p > 0.05). Total near-vision spectacle independence was higher in the TIOL group (80%) than in the EDF group (50%) (p=0.039). Conclusion: Compared with EDF, TIOL leads to better near-vision outcomes without significant differences for intermediate and distant vision outcomes. Trial Registration: ClinicalTrials.gov identifier: ChiCTR2100044558.

Relentless bilateral accommodation spasm in an adolescent treated with clear lens extraction

Introduction: Pathologic accommodation spasm occurs when persistent contraction of the ciliary muscle of the eye induces pseudomyopia. The purpose of this report was to describe the case of an adolescent with recurrent ciliary spasm, refractory to medical treatment for several years. Patient and Clinical Findings: A 10-year-old girl was evaluated because of complaints of decreased visual acuity (VA) and frequent headaches. Diagnosis, Intervention and Outcomes: The diagnosis of pseudomyopia due to accommodation spasm was established. No organic causes were detected. She started treatment with cycloplegics, which were successively titrated at different doses, along with the use of spectacles, over the following years. After 7 years of follow-up, the lack of efficacy of treatment and intolerance to its side effects demanded further action, so a clear lens extraction was performed, with the implantation of continuous focus transition multifocal intraocular lenses. Her final uncorrected distance VA was 6/6 in each eye, with good intermediate vision and J1 near vision with +2.00 addition. Conclusions: In severe cases of ciliary spasm, medical therapy and spectacle prescription may not be sufficient to control the disease. Intraocular lens implantation may be the only remaining therapeutic option to provide quality of life to the patient.

Clinical Application of Multifocal Intraocular Lens Implantation in Patients with High Myopia and Cataract

Clinical Application of Multifocal Intraocular Lens Implantation in Patients with High Myopia and Cataract

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.

BOLD fMRI in patients before and after multifocal intraocular lens implantation

Background. In practical ophthalmology during cataract surgery, patients are increasingly being implanted with multifocal intraocular lenses (mfIOLs), which form several foci on the retina. The appearing of new factors creates conditions for human neuroadaptation, the parameters of which can be assessed using a modern research method – functional magnetic resonance imaging (fMRI). Purpose: to determine the change in the nature of the activation of the visual brain cortex in response to stimulation after surgery for the implantation of a multifocal artifi cial lens. Materials and methods. The study included patients with cataract (n = 22), who underwent structural neuroimaging and BOLD fMRI to assess neuronal activity before and after mfIOL implantation. The Gabor element was used as a stimulus for performing BOLD fMRI (unilluminated and ill uminated versions). fMRI data (positive BOLD effect) were processed using the SPM 12 software package in the Matlab R2017a environment. Evaluation of the research results was carried out at the individual and group levels. Results. When evaluating individual results after mfIOL implantation, patients show more local activation of the cerebral cortex, gravitating towards the area of the spur sulcus, while before surgery, the cortical response is more diffuse. In a group analysis in patients after mfIOL implantation, the total volume of the activation cluster of the cerebral cortex signifi cantly increased by 27 times. Maximum activation is noted in the pulvinar on the right and the lingual gyrus on the left. The activation of the cortex in the study with red illumination of Gabor element after surgery is less than in the study with white illumination, and less than in the study after surgery without illumination of Gabor element. Conclusions. A signifi cant but ambiguous change in the neuronal activity of the cerebral cortex on various stimulation options in patients after mfIOL implantation was established. Further work in this area is planned

Correlation of angle kappa with biometry and higher-order aberrations of cataract patients at Prof. Ngoerah Hospital Ophthalmology Clinic

Background Advancements in ophthalmic surgery now hinge on intricate interplays among ocular parameters. Angle kappa, measuring deviation between visual and pupillary axes, is crucial, especially in refractive procedures with multifocal intraocular lens implants. The research aimed to correlate angle kappa with biometry and higher-order aberrations (HOA) to enhance surgical outcomes among adult cataract patients at Prof. Ngoerah Hospital Ophthalmology Clinic, Denpasar, Bali. MethodsThis cross-sectional study included 29 male and female cataract patients aged 18-80 years, without prior treatment. All patients had a basic examination that included testing of visual acuity using Snellen chart, autorefractometer, measurement of ocular pressure using non-contact tonometry, and slit-lamp examination for cataract grading. Patients who met the inclusion criteria were then examined for biometry (axial length, spherical equivalent, white-to-white distance, anterior chamber depth) using Nidek AL Scan and for angle kappa and HOA using OPD scan III. ResultsData from 50 eyes of 29 subjects (15 females and 14 males) were analyzed. The mean age of the subjects was 60.6 ± 12.5 years. Age and spherical equivalent had positive correlation with angle kappa (r =0.104, r=0.213), but the correlation was not statistically significant. In this study, interestingly angle kappa was not significantly correlated with HOA, AXL, WTW, and ACD (r = -0.050, r = -0.192, r = -0.104, r = -0.195, p &gt;0.05). ConclusionIn conclusion, angle kappa may increase with age and spherical equivalent. Further study with larger sample size is required.

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.

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.

Premium multifocal intraocular lens: Pearls and practices

Cataract surgery has gradually evolved from being a visual restoration surgery to a refractive surgery. Patients are gradually shifting from traditional intraocular lens (IOL) to high end premium IOL which provide reduced spectacle dependence and in turn greater patient satisfaction. However, these premium lenses are not without cons and calls for meticulous pre-operative calculation, realistic counseling, and perfect surgical technique. This in-depth review provides insight into the varieties of multifocal IOL, selection criteria, pre-operative planning and calculation, surgical technique, and comprehensive post-operative complication management.

Angle Kappa Influence on Multifocal IOL Outcomes

Purpose: To characterize angle kappa and study the relationship between preoperative angle kappa and postoperative refractive accuracy, visual outcomes, and patient satisfaction in a large population of eyes with multifocal intraocular lens (MIOL) implantation. Methods: A comprehensive electronic medical record chart review of 26,470 consecutive eyes that underwent immediate sequential bilateral cataract or refractive lens exchange with MIOLs was conducted. The primary outcome measures were postoperative monocular uncorrected distance visual acuity (UDVA), manifest refraction sphere and cylinder, spherical equivalent (SEQ), defocus equivalent (DEQ), subjective quality of vision at near, intermediate, and distance, and the likelihood of recommending the procedure. Relationships between preoperative angle kappa and postoperative outcomes were assessed with Pearson correlations. Results: Angle kappa followed a right-skewed normal distribution ( R 2 = 0.99) with a mean ± standard deviation of 0.64 ± 0.27 mm. No clinically meaningful relationship was found between preoperative angle kappa and postoperative sphere, cylinder, SEQ, and DEQ, all with R 2 ⩽ 0.0005. Similarly, there was no clinically meaningful relationship between preoperative angle kappa and postoperative UDVA ( R 2 = 0.001), postoperative satisfaction for near, intermediate, and distance vision (all R 2 ⩽ 0.0023), or for recommending the MIOL surgery to friends and relatives ( R 2 = 0.0000). Conclusions: Preoperative angle kappa does not have a predictive clinical impact on postoperative MIOL visual outcomes, refractive accuracy, or subjective patient satisfaction. Angle kappa as a single variable cannot be used to determine MIOL candidacy. [ J Refract Surg . 2023;39(12):840–849.]

Prospective evaluation of the ESCRS online calculator for calculation of a multifocal intraocular lens.

To evaluate a recently introduced ESCRS online calculator for intraocular lens (IOL) calculation of a multifocal IOL in refractive lens exchange and cataract surgery in a prospective setting. Department of Ophthalmology, Goethe University Frankfurt, Germany. Prospective, consecutive case series. We included eyes that received lens extraction and multifocal IOL implantation. We compared the mean prediction error (MPE), mean and median absolute prediction error (MAE, MedAE) of the online calculator provided by the European Society of Cataract and Refractive Surgeons (ESCRS), and number of eyes within ±0.5, ±1.0, ±2.0 diopters (D) of target refraction. Additionally, the SRK/T formula was included for comparison as well. Postoperative spherical equivalent was measured at 3 months. Only one eye per patient was included. Eighty-eight eyes from 88 patients with mean age of 62 years ± 9.5 were included. The MedAE was low for all formulas and ranged from 0.26D (Kane), Hill-RBF (0.27D), Hoffer QST (0.27D), Barrett (0.28D), EVO (0.29D), Cooke K6 (0.27D), 0.30D (Pearl DGS) to 0.31D (SRK/T). No statistically significant difference was found (p = 0.627). Considering the number of eyes within ±0.5D of the calculated refraction the best performing was again the Hill-RBF (84%, 74 eyes), again followed by Kane (71, 81%), EVO, Pearl DGS, Hoffer QST, Barrett (each 80%, 70 eyes),Cooke K6 (78%, 69 eyes), and SRK/T (74%). Again, no statistically significant difference was found (p = 0.39). Using recently introduced ESCRS online IOL calculator in multifocal intraocular lenses leads to a high number of eyes reaching target refraction and low prediction errors. All formulas performed similar well. However, Hill-RBF showed the highest number of eyes within ±0.5D, but no significance was found regarding this.

To evaluate the outcomes of cataract treatment by Phacoemulsification with a trifocal intraocular lens

Backgroud: Phacoemulsification with trifocal intraocular lens helps patients achieve clear vision at all distances, reponding their needs and desires. Therefore, we have studied to evaluate the effectiveness of a trifocal intraocular lens. Objectives: (1) To describe the clinical features of cataract patients. (2) To evaluate the outcomes of cataract treatment by phacoemulsification with a trifocal intraocular lens. Methods: A prospective interventional clinical study was conducted on 80 eyes of 68 cataract patients who underwent phacoemulsification with a trifocal intraocular lens at the Ophthalmology Center, Hue Central Hospital. Results: At the 3-month postoperative period, 65.0% of the operated eyes had distance vision of 20/25 or better, 52.5% had intermediate vision of 20/25 or better, and 57.5% had near vision of 20/25 or better. The patient satisfaction rate was 91.2%. Conclusion: Phacoemulsification with a trifocal intraocular lens provides high effectiveness in terms of visual acuity and patient satisfaction. Key words: Phaco, Multifocal IOL, trifocal.

Effect of astigmatism on visual outcomes after multifocal intraocular lens implantation: a systematic review and meta-analysis

PurposeTo investigate the effects of postoperative astigmatism on the visual outcomes following presbyopia-correcting surgery with multifocal intraocular lens implantation.MethodsA comprehensive literature search was conducted using PubMed, Embase, and Web of Science for articles published until January 2023. Additionally, we included retrospective case series and prospective comparative studies. The combined mean difference (MD) with 95% confidence intervals (CI) and odds ratio (OR) with 95% CI were used to express continuous and categorical outcomes, respectively. All statistical analyses were performed using Review Manager (version 5.4.1).ResultsWe included nine eligible studies that analyzed 3,088 eyes. The proportion of eyes with useful postoperative visual acuity (logMAR ≤ 0.20) and residual astigmatism significantly differed with respect to the magnitude of astigmatism and presence/absence of blurred vision (p &amp;lt; 0.001 for both). Additionally, the mean uncorrected distance visual acuity (MD, 0.14; 95% CI, 0.06 to 0.21; p = 0.0003) and uncorrected intermediate visual acuity (MD, 0.07; 95% CI, 0.00 to 0.13; p = 0.04), but not the uncorrected near visual acuity (MD, 0.02; 95%CI-0.01 to 0.05; p = 0.17), significantly differed according to the magnitude of astigmatism.ConclusionAstigmatism, even at low levels (≥ 0.5D), has a significant effect on visual outcomes, especially on UDVA and UIVA, following multifocal intraocular lens implantation. Accurate preoperative and postoperative evaluation of astigmatism is important.

Application of Femtosecond Laser + Piggyback Multifocal Intraocular Lens Implantation in Patients with Super-High Myopia Complicated with Cataract

ABSTRACT Objective To observe the clinical effect of piggyback multifocal intraocular lens (IOL) implantation in treating patients with high myopia complicated with cataract. Methods This was a prospective controlled study. We compared 32 eyes of 32 patients who underwent femtosecond laser-assisted cataract surgery with piggyback IOL implantation (two IOLs were implanted into the capsule) with 32 eyes of 32 patients who also underwent the same surgery (one IOL implanted into the capsule) due to high myopia complicated with cataract at the Wuhan Aier Eye Expert Hospital between January 2019 and October 2020. All patients were followed up for three months after surgery. Uncorrected distance visual acuity (UCDVA), uncorrected intermediate visual acuity (UCIVA), uncorrected near visual acuity (UCNVA), best-corrected distance visual acuity, distance-corrected intermediate visual acuity (DCIVA), distance-corrected near visual acuity (DCNVA), postoperative spectacle independence, postoperative visual interference, equivalent spherical lens, defocus curve, and IOL tilt and eccentricity were evaluated. Results Three months after surgery, the patients’ UCIVA, UCNVA, DCIVA, and DCNVA were 0.49 ± 0.07, 0.38 ± 0.15, 0.47 ± 0.09, and 0.36 ± 0.12, respectively, in the research group and 0.56 ± 0.18, 0.72 ± 0.22, 0.55 ± 0.13, and 0.69 ± 0.15, respectively, in the control group; the differences between the two groups were statistically significant (P < .05). The spectacle independence rate was higher in the research group (93%) than in the control group (13%). The overall satisfaction regarding postoperative visual quality was also higher in the research group than in the control group. The absolute mean value of the spherical equivalents was 0.48 ± 0.28 D in the research group and 0.62 ± 0.33 D in the control group; the difference between the two groups was statistically significant (P < .05). Conclusion Piggyback multifocal IOL implantation can expand the multifocal IOL application range, and satisfy the desire of patients with high myopia complicated with cataract to see both near and far.

Comparison of the optical behaviour of five different multifocal diffractive intraocular lenses in a model eye

The purpose of this study was to investigate and compare the optical performance of five trifocal intraocular lenses (IOLs) following the ISO 11979-2 standards, analysing the impact of tilt and decentration. Five different diffractive trifocal IOLs were evaluated in this experimental study: Acriva Trinova (VSY-Biotechnology) (AT), FineVision HP (PhysIOL) (FVHP), AT LISA tri 839 MP (Zeiss) (ATLT), PanOptix TFNT00 IOL (Alcon) (PO), and Tecnis Synergy (J&J Vision) (TS). In-vitro optical quality analysis of them was performed with the Lambda PMTF system that has an aberration neutral cornea model (Lambda-X Ophthalmics). Measurements were performed on-axis, with 5º of IOL tilt and with 0.5 mm of IOL decentration using 543-nm monochromatic light. Finally, IOL dimensions and diffractive disk profile inspection was performed using the VisIOLA system (Rotlex). On-axis measurements showed a far through-focus MTF > 0.3 at 3 mm aperture, except for TS. FVHP and PO showed better far MTFs for larger apertures (3.75 mm and 4.5 mm) while AT showed good intermediate and near vision for such apertures. With 5º of IOL tilt, the better optical performance at all distances was found with AT for medium-sized pupils (3 mm) and an important reduction of MTF was found for ATLT and PO, especially in the intermediate focus. The induction of 0.5 mm of IOL decentration especially affected the intermediate focus of ATLT and TS and the far focus of FVHP and PO. IOL dimensions and diffractive profile were consistent with those described by the manufacturer. In conclusion, there are differences in the optical performance according to the pupil aperture of the five trifocal IOLs evaluated and this should be considered in clinical practice when selecting the most appropriate implant in each specific case. IOL tilt and decentration can affect significantly in most of the designs evaluated the performance of the IOL at intermediate vision range. It should be noted that measurements were made with an aberration-free cornea, being necessary future studies analysing the impact of different levels of corneal aberrations.

Multifocal Polypseudophakia With Rayner Sulcoflex Trifocal and In-the-Bag Alcon PanOptix Diffractive Trifocal Intraocular Lenses: A Case Report

Purpose: To describe the use of a sulcus diffractive multifocal intraocular lens (IOL) used in series with an intracapsular diffractive multifocal IOL to improve uncorrected near visual acuity (UNVA). Methods: A 66-year-old pseudophakic woman with bilateral multifocal IOLs presented with symptoms of negative dysphotopsia and poor reading vision in the right eye. A diffractive multifocal sulcus IOL was inserted in the right eye. Results: After 1 month, the patient's right UNVA had improved from N10 to N6. Subjectively there was a 50% improvement in negative dysphotopsia and no increase in photic phenomena. Conclusions: A diffractive trifocal secondary sulcus IOL can be used in series with an intracapsular diffractive trifocal lens. The success of this approach suggests that it may be used to both improve negative dysphotopsia and address postoperative refractive error. [ Journal of Refractive Surgery Case Reports. 2023;3(4):e53–e55.]

Effect of mydriasis on chord mu value in cataract surgery candidates.

This study investigates the relationship between pupil size during biometry examinations and the chord mu value in candidates for cataract surgery. Retrospective analysis of ocular biometry measurements was performed on consecutive cataract surgery candidates above 50 years of age, examined between 2018 and 2020 at a single tertiary referral center. Statistical analysis assessed the association between pupil size and the chord mu value. The population was categorized into groups based on pupil size, and an analysis was conducted on the barycenter positions of the iris and pupil center for each group. The analysis included 2877 patients. A weak positive correlation was observed between the chord mu value and pupil size using Pearson's test (r = 0.160, p < 0.01). Group stratification by pupil size indicated temporal and inferior shifts in pupil center barycenter as pupil size increased, reflecting asymmetrical pupil dilation during mydriasis. A moderate positive correlation between the chord mu value and chord alpha value was identified (Pearson's test, r = 0.641, p < 0.01). As expected, no correlation was found between chord alpha value and pupil size. Chord mu values were higher in patients with mydriatic pupils, likely due to asymmetric pupil dilation and center displacement. Evaluating chord mu values requires considering pupil status and conducting biometry under standardized lighting to prevent misinterpretation caused by pharmacological dilation. This caution is crucial to avoid erroneously excluding eligible patients from multifocal IOL implants. Alternatively, the chord alpha value could serve as a more appropriate alternative in such scenarios.

Tear Film Stability Affects Visual Acuity After Implantations of Monofocal and Multifocal Intraocular Lenses: An Evaluation by Objective Scatter Index.

To assess the impact of tear film on postoperative visual acuity after cataract surgery to implant an intraocular lens (IOL). Tear break-up time (TBUT), Schirmer I test, objective scatter index (OSI), and uncorrected distance visual acuity (UCDVA), intermediate visual acuity (UCIVA), and near visual acuity (UCNVA) were collected 6months after cataract surgery. Fifteen eyes with monofocal (Mo-) IOLs and 15 eyes with multifocal (Mu-) IOLs from 30 subjects were included. The Mu-IOL group exhibited higher baseline OSI (1.92 ± 0.69, P < 0.001). Negative correlations-both groups: tear film-related OSI (TF-OSI) and TBUT/Schirmer I test; Mo-IOL: TBUT and logMAR UCDVA-and positive correlations-both groups: TF-OSI and baseline OSI, baseline OSI/TF-OSI and logMAR UCDVA; Mu-IOL: baseline OSI/TF-OSI and logMAR UCIVA/UCNVA-were found. Linear regression showed associations between TF-OSI and TBUT (Mo-IOL: R2=0.455, P=0.006; Mu-IOL: R2=0.454, P=0.006)/Schirmer I test (Mo-IOL: R2=0.527, P=0.002; Mu-IOL: R2=0.266, P=0.049). Multiple regression showed associations between baseline OSI (Mo-IOL: R2=0.309, P=0.032; Mu-IOL: R2=0.305, P=0.033)/TF-OSI (Mo-IOL: R2=0.332, P=0.025; Mu-IOL: R2=0.523, P=0.002)/TBUT (Mo-IOL only: R2=0.315, P=0.029) and logMAR UCDVA. TF-OSI reflects the UCDVA performance in eyes with IOLs and facilitates a better understanding of the effects of the tear film. TF-OSI offers a developmental and objective approach to assessing the changing visual performance caused by tear film after cataract surgery and IOL implantation in clinical practices.

Effect of presbyopic correction lens on humphrey visual field testing in patients with multifocal intraocular lens.

Most previous studies on the effects of multifocal intraocular lenses (MIOL) on Humphrey visual field (HVF) used presbyopic corrective lens (PC). There has been insufficient data from patients with MIOL performing HVF with and without PC. This study aimed to determine the effect of PC on HVF testing in patients with MIOL. This was a prospective, comparative crossover study at the Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University between June 2015 and July 2018. Early-stage glaucomatous and non-glaucomatous pseudophakic patients with 2 models of MIOL completed HVF testing with and without PC. Mean deviation (MD), pattern standard deviation (PSD), and reliability indices (fixation losses, false positives, and false negatives) were compared. Ninety-four eyes of 59 patients were enrolled. After excluding patients with confirmed unreliable visual field, 82 eyes of 51 patients (male, 22; female, 29) with a mean age of 65.4 years were included in the study. Forty-nine eyes were non-glaucoma and 33 eyes were early-stage glaucoma. Forty-four eyes received TECNIS ZM900 and 38 eyes received Acrysof IQ ReSTOR SN6AD1. The overall MD standard deviation was -3.5 (2.1) with PC and -3.1 (2.1) without PC (P = .01). The overall PSD standard deviation was 2.8 (1.5) with PC and 2.7 (1.5) without PC (P = .93). The reliability indices were not statistically significantly different with and without PC. There was a good intraclass correlation (ICC) of MD (ICC = 0.87) and PSD (ICC = 0.88) with and without PC. Eyes with TECNIS ZM 900 had significantly better MD when performing HVF without PC (mean difference -0.7, P < .01), but not with Acrysof IQ ReSTOR SN6AD1 (mean difference -0.1, P = .74). Pseudophakic eyes with MIOL may not require PC during HVF testing regardless of the MIOL model. Although eyes with TECNIS ZM900 performed HVF without PC resulted in a significantly better MD value compared with PC, the difference was not clinically significant.