Presbyopic Lens Exchange Research Articles

Presbyopic lens exchange (PRELEX) cataract surgery outcomes with implantation of a rotationally asymmetric refractive multifocal intraocular lens: femtosecond laser-assisted versus manual phacoemulsification.

To compare the visual and refractive outcomes obtained with the implantation of a rotationally asymmetric refractive multifocal IOL after femtosecond laser-assisted cataract surgery (FLACS) and conventional lens extraction (CLE). A total of 78 eyes of 58 patients that had undergone conventional phacoemulsification (36 eyes, CLE group) or FLACS (37 eyes, FLACS group) with the implantation of the toric multifocal IOL LU-313 MF30T (Oculentis, Germany) were enrolled in this retrospective study. Mean age was 57.0years at the time of surgery, ranging from 44 to 69years. Visual and refractive outcomes were evaluated during a 12-month follow-up. Likewise, contrast sensitivity was assessed at the end of the follow-up. Significant improvements were observed in both groups in uncorrected distance (UDVA) and near visual acuity (UNVA) at 1month postoperatively (p < 0.001). Differences between groups in these parameters as well as in sphere and cylinder did not reach statistical significance during the whole follow-up (p ≥ 0.079), except for UNVA only at 12months postoperatively (p = 0.018). Concerning corrected near visual acuity, only significant differences between groups were found preoperatively (p = 0.020). Furthermore, only a minimal but significant difference between groups was found at 12months postoperatively in contrast sensitivity for the spatial frequency of 18 cycles/° (p = 0.029). The rotationally asymmetric toric multifocal IOL LU-313 MF 30T provides good visual rehabilitation for near and distance vision after presbyopic lens extraction in eyes with preexisting astigmatism, independently whether the cataract surgery is performed with the FLACS or conventional technique.

Chirurgie de la presbytie chez l’hypermétrope de plus de 55 ans : comparaison entre Presbylasik (Supracor) et Prelex (presbyopic lens exchange)

The management of presbyopic patients is a medical, surgical and economic issue. We wondered which procedure, whether a Presbylasik technique called Regular Supracor or the intraocular surgery of clear lens replacement by a trifocal diffractive lens (presbyopic lens exchange [Prelex]), provided the best results (in visual acuity and satisfaction) for our hyperopic and presbyopic patients between 55 and 70. The aim of this study was to compare the safety and efficacy of the two techniques (at one week and three months) and to assess patients' quality of life. This study is a retrospective monocentric clinical trial conducted between June 2011 and March 2014, on 21 hyperopic presbyopic patients (mean age 60.9 years), in the "hôpital d'instruction des armées-Percy" (Clamart); 13 patients underwent the corneal treatment of Presbylasik (with the Intralase FS60 femtosecond laser [AMO, USA] and the Technolas 217P excimer laser [Technolas Perfect Vision, GmbH] following the Zyoptix Tissue-Saving algorithm adjusted with a nomogram and the Regular Supracor mode), and 8 patients underwent clear lens extraction (Prelex), through bimanual phacoemulsification and implantation of diffractive trifocal intraocular lenses (Finevision Micro F, PhysIOL(*)). Mean uncorrected binocular distance and near vision visual acuity in the Supracor group were respectively 0.03 (-0.2-0.1) LogMar and 0.23 (0.06-0.36) one week postoperatively and 0.031 (-0.2-0.1) and 0,166 (0.06-0.36) three months postoperatively. In the Prelex group, the mean uncorrected one week binocular VA was 0.025 (0-0.1) for distance vision and 0.165 (0.06-0.18) for near distance and the three months visual acuity was 0 (-0.1-0.1) and 0.105 (0.06-0.18) for distance and near vision. All Prelex patients were spectacle-free at all distances, whereas 4 Supracor patients required spectacles for near vision postoperatively. Seven of 11 patients in the Supracor group and 100% of the Prelex patients were completely satisfied. Both groups experienced halos, but patients reported more halos in the Prelex group (75%). One eye required intraocular lens exchange and four eyes (16.7%) required a new corneal procedure in the Supracor group. Both surgeries are safe and effective modalities in the management of hyperopic and presbyopic patients. However, the Prelex procedure seems to be more appropriate for patients over 55 years of age.

Comparison of two different surgical treatments of presbyopia for hyperopic patients over 55 years old: Presbylasik (Supracor) and Prelex (presbyopic lens exchange)

AbstractPurpose To compare the efficiency and safety of two surgical treatments of presbyopia, Presbylasik and presbyopic lens exchange (Prelex), and to assess patients’ satisfaction with both procedures.Methods It is a retrospective monocentric clinical trial between 06/2011 and 03/2014 comparing implantation of diffractive multifocal intraocular lenses (Finevision Micro F, PhysIOL) and Supracor (Technolas Perfect Vision, GmbH).Results Forty‐two eyes of 21 patients were treated by 3 physicians, with a mean follow‐up of 3 months. Twenty‐six eyes of 13 hyperopic/presbyopic patients were included for Supracor and 16 eyes of 8 patients for Prelex. Patients were aged over 55. Mean uncorrected binocular distance (DV) and near vision (NV) visual acuity (VA) in the Supracor group were respectively 0,03 (‐0,2 – 0,1) LogMar and 0,23 (0,06 – 0,36) one week post‐operatively and 0,031 (‐0,2 – 0,1) and 0,166 (0,06 – 0,36) 3 months post‐operatively. In the Prelex group, the mean uncorrected one week binocular VA was 0,025 (0 – 0,1) for DV and 0,165 (0,06 – 0,18) for NV and the three months VA was 0 (‐0,1 – 0,1) and 0,105 (0,06 – 0,18) for DV and NV. All Prelex patients were spectacle‐free at all distances, whereas 4 Supracor patients required spectacles for NV post‐operatively. Patients’ satisfaction was high in both groups. Patients reported more halos in the Prelex group (75%). One eye required intraocular lens exchange and 4 eyes (16,7%) required a new corneal procedure in the Supracor group.Conclusion Both surgeries have effective and safe modalities in hyperopic and presbyopic patients. Prelex procedure seems to be more appropriate for patients over 55 yo.

Visual Outcomes and Patient Satisfaction After Presbyopic Lens Exchange With a Diffractive Multifocal Intraocular Lens

To investigate the visual outcomes, severity of symptoms, and patient satisfaction after refractive lens exchange (RLE) with a diffractive multifocal intraocular lens (IOL). A nonrandomized, unmasked, retrospective chart review study was performed. Patients who underwent RLE with ZMA00 (Abbott Laboratories) were identified from a hospital database. Eyes with preoperative uncorrected distance visual acuity or corrected distance visual acuity 20/20 or better were included. The study cohort comprised 45 eyes from 29 patients. Monocular uncorrected and distance-corrected visual acuity at distance, 67 cm, and 30 cm were measured 6 months postoperatively. A patient questionnaire assessing visual symptoms (halo, night glare, and starburst) and satisfaction with visual performance was administered. Six months postoperatively, mean uncorrected visual acuity (logMAR) was -0.10±0.13, 0.43±0.25 at 67 m (intermediate), and 0.18±0.05 at 30 m (near). Mean distance-corrected visual acuity at these distances was -0.02±0.06, 0.40±0.21, and 0.17±0.02, respectively. Twenty-seven patients completed the questionnaire. Patients reported postoperative halos (78%), night glare (26%), and starbursts (48%). All bilateral RLE patients were spectacle-free at all distances, whereas 50% of unilateral RLE patients required spectacles postoperatively. Bilateral RLE patients with habitual spectacle use preoperatively were the most satisfied with their postoperative visual performance. Refractive lens exchange with the ZMA00 is an option for presbyopic correction; however, significant glare, halo, and starburst issues are subjectively reported.

Recent studies provide an updated clinical perspective on blue light-filtering IOLs

BackgroundRecent reviews of blue light-filtering intraocular lenses (IOLs) have stated their potential risks for scotopic vision and circadian photoentrainment. Some authors have challenged the rationale for retinal photoprotection that these IOLs might provide. Our objective is to address these issues by providing an updated clinical perspective based on the results of the most recent studies.MethodsThis article evaluates the currently available published papers assessing the potential risks and benefits of blue light-filtering IOLs. It summarizes the results of seven clinical and two computational studies on photoreception, and several studies related to retinal photoprotection, all of which were not available in the previous reviews. These results provide a clinical risk/benefit analysis for an updated review for these IOLs.ResultsMost clinical studies comparing IOLs with and without the blue light-filtering feature have found no difference in clinical performance for; visual acuity, contrast sensitivity, color vision, or glare. For blue light-filtering IOLs, three comparative clinical studies have shown improved contrast sensitivity and glare reduction; but one study, while it showed satisfactory overall color perception, demonstrated some compromise in mesopic comparative blue color discrimination. Comparative results of two recent clinical studies have also shown improved performance for simulated driving under glare conditions and reduced glare disability, better heterochromatic contrast threshold, and faster recovery from photostress for blue light-filtering IOLs. Two computational and five clinical studies found no difference in performance between IOLs with or without blue light-filtration for scotopic vision performance and photo entrainment of the circadian rhythm. The rationale for protection of the pseudophakic retina against phototoxicity is discussed with supporting results of the most recent computational, in-vitro, animal, clinical, and epidemiological investigations.ConclusionsThis analysis provides an updated clinical perspective which suggests the selection of blue light-filtering IOLs for patients of any age, but especially for pediatric and presbyopic lens exchange patients with a longer pseudophakic life. Without clinically substantiated potential risks, these patients should experience the benefit of overall better quality of vision, reduced glare disability at least in some conditions, and better protection against retinal phototoxicity and its associated potential risk for AMD.Electronic supplementary materialThe online version of this article (doi:10.1007/s00417-011-1697-6) contains supplementary material, which is available to authorized users.

Outcomes and Patient Satisfaction After Presbyopic Bilateral Lens Exchange with the ResTOR IOL in Emmetropic Patients

To assess efficacy, safety, predictability, stability, and patient satisfaction after presbyopic lens exchange in emmetropic patients. A prospective, nonrandomized, masked, observational case series (self-controlled) of 46 emmetropic eyes of 23 consecutive patients (age range: 50 to 60 years) after presbyopic lens exchange with bilateral AcrySof ReSTOR Natural (SN60D3) intraocular lens (IOL) (Alcon Laboratories Inc) implantation were evaluated. Mean spherical equivalent refraction (SE) was -0.04±0.14 diopters (D) (range: +0.25 to -0.25 D). Monocular and binocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), distance-corrected near visual acuity (DCNVA), and patient satisfaction were recorded preoperatively and 6 months after surgery. At 6 months postoperative, efficacy index at distance was 1.00. No eye lost ≥2 lines of CDVA, 5 eyes lost 1 line, 24 eyes did not change after surgery, 14 eyes gained 1 line, and 3 eyes gained 2 lines of visual acuity. Safety index at distance was 1.03. All eyes had a manifest SE within ±0.50 D of emmetropia. Mean postoperative SE was +0.14±0.22 D (range: -0.25 to +0.37 D). No eye lost >2 lines of DCNVA, 1 eye lost 2 lines, 3 eyes lost 1 line, 34 eyes did not change after surgery, and 8 eyes gained 1 line of visual acuity. Uncorrected near visual acuity was 0.95±0.07. Safety and efficacy indexes at near were 1.01 and 1.03, respectively. A patient satisfaction questionnaire showed that patients had a high level of satisfaction after presbyopic lens exchange surgery. Presbyopic lens exchange with implantation of the ReSTOR multifocal IOL in emmetropic eyes is an effective and safe procedure for presbyopia correction.

058 Chirurgie du cristallin clair (PRELEX) avec différents implants multifocaux. Qualités optiques

Multifocal lenses are more and more used for refractive surgery, especially as presbyopic lens exchange (PRELEX). With this indication postoperative optical qualities in comparison to preoperative results should be of main concern. Therefore we examined contrast sensitivity, low contrast visual acuity, glare visual acuity and night driving ability in PRELEX patients pre- and postoperatively. 20 patients (40 eyes) after PRELEX with different multifocal lenses of the new generation (*Acri.Twin, ReSTOR, ReZoom, Tecnis ZM001) were examined preoperatively and 6 months postoperatively. Contrast sensitivity (Pelli Robson charts), low contrast visual acuity (Humphrey AR 570), glare visual acuity (Humphrey AR 570) and night driving ability (Mesoptometer II, Fa. Oculus) were tested binocularly. Preoperative contrast sensitivity was 1.5 on average, postoperative it was 1.65. Low contrast visual acuity dropped from 68% preoperatively to 49% postoperatively, glare visual acuity from 55% to 35%. Mesoptometer measurements revealed night driving ability under strict criteria for 16 patients pre- and postoperatively as well. The new generation multifocal lenses show limitations concerning low contrast and glare visual acuity. Whereas postoperative Mesoptometer measurements correspond with preoperative measurements. Correction of presbyopia with multifocal lenses (PRELEX) is reliable, but also with the lenses of the newest generation it is still a compromise concerning optical qualitites.

Chirurgie de la presbytie : principes et orientation des indications

Presbyopia surgery is not yet a corrective option that can restore effective accommodation, but a compensation option which aims at creating depth of field. Monovision preserves a good close-vision quality for myopes. Multifocality is well tolerated by hyperopes if it is compatible with good far-vision quality. Monovision and multifocality can be applied to surgery by using corneal or intraocular implantation techniques. Presby LASIK and Presbyopic Lens Exchange (PRELEX) are the most effective techniques but they are still controversial. Indications depend on preoperative ametropia and patient age.

Multifocal intraocular lenses

Multifocal intraocular lenses (IOLs) are growing in popularity among patients and surgeons, and opened the way to refractive lens exchange. Still they are not used routinely in cataract surgery, for reasons probably connected to the frequently observed reduction in contrast sensitivity. Recent papers with clinical study outcomes can help in understanding the advantages and the limits of multifocal IOLs. Emerging from every published study, both refractive and diffractive multifocal IOLs usually provide good near visual acuity with distance correction. As many multifocal IOLs are distance-dominant, near vision can be improved by correcting for near the distance focus. The near contrast sensitivity thus obtained is similar to that of monofocal IOLs. Multifocal IOLs have been employed with success in complicated cataract surgery and in trauma cases, with the same outcome as in normal cataract cases. Presbyopic lens exchange remains controversial, with a high success rate in original ametropic eyes, but limited success in original emmetropic eyes. Secondary procedures to improve the refractive outcome are usually of little efficacy in improving patient satisfaction. A new anterior chamber phakic multifocal IOL has been designed to correct presbyopia and small refractive errors. The first clinical results indicate high patient satisfaction, with 7.3% explantation rate. Multifocal IOLs can be more widely used after cataract surgery, but should be used with caution in almost emmetropic eyes with little or no cataract. Refractive lens exchange with multifocal IOL is especially worthwhile in hyperopic eyes. The new phakic multifocal IOL adds the concept of reversibility to presbyopic lens exchange.

Secondary procedures after presbyopic lens exchange

Purpose: To assess the indications, incidence, and outcome of secondary procedures after presbyopic lens exchange (PRELEX). Setting: Private practice, Siena, Italy. Methods: This prospective nonrandomized single-surgeon study comprised 52 patients having PRELEX by phacoemulsification and multifocal intraocular lens (IOL) implantation. The preoperative mean spherical equivalent (SE) was +2.50 diopters (D) ± 1.38 (SD) (range 0 to +6.0 D). Results: Monocular PRELEX was performed in 8 patients who canceled the fellow-eye surgery because of halos; in this group, the residual refractive error was corrected by photorefractive keratectomy (PRK) in 4 eyes, but this did not alleviate halos and IOL exchange was ultimately needed in 7 eyes. Binocular PRELEX was completed in 44 patients; in this group, 14 eyes (8 patients) had PRK for a residual error. The postoperative mean absolute SE in the 18 PRK-treated eyes was 0.33 D (95% confidence interval [CI] of improvement, 0.57-1.32) and the mean uncorrected visual acuity, 0.8 (95% CI of improvement, 0.32-0.45). The final SE was within ±0.5 D in 15 eyes (83.0%) and within ±1.0 D in 18 eyes. Halos after PRK were unchanged in 6 patients, slightly improved in 4, and improved in 2. Photorefractive keratectomy or IOL exchange was needed in eyes with a preoperative SE between plano and +1.75 D (15/40 eyes, 38%) and not needed in eyes with a preoperative SE greater than +1.75 D (0%) (95% CI of difference, 23%-53%). Conclusions: Presbyopic lens exchange in eyes with emmetropia and low hyperopia was associated with a significantly higher percentage of secondary procedures. Photorefractive keratectomy enhancement can improve distance vision but has a limited effect on halos.