Refractive Lens Exchange Surgery Research Articles

A survey of intraocular lens preferences of UK refractive surgeons for cataract surgery and refractive lens exchange

BackgroundTo explore intraocular lens (IOL) preferences of United Kingdom-based (UK) refractive surgeons in cataract and refractive lens exchange (RLE) surgery.MethodsAn online survey on IOL preferences (and reasons for their choice) in cataract and RLE surgery was distributed. It also enquired about implementing mini-monovision with extended depth of field (EDoF) IOLs, about utilising IOL mix-and-match (different IOL types in each eye), and at what level of corneal astigmatism they prefer toric lenses.ResultsFollowing an 81.6% response rate, thirty responses were analysed; median years of refractive surgery experience was 12.5. The most popular IOL choices for cataract surgery were EDoF lenses (30%), monofocals (20%), and trifocals (20%). The most cited reason for each was better overall visual outcomes (88.9%), fewer unwanted symptoms (66.7%) and best spectacle independence (66.7%), respectively.For RLE, EDoF remained most popular (36.7%), followed by trifocals (30%), and multifocals (16.7%) with the same reasons for choice cited above.Mini-monovision with EDoF lenses was well-regarded (83% recommend for most/select patients), unlike utilising IOL mix-and-match (60% did not recommend). 40% prefer toric IOLs for astigmatism of 1 dioptre (D) or higher, whilst 30% opt for them at < 1D.ConclusionsExperienced UK refractive surgeons prefer newer IOLs with enhanced optics; ≥50% of respondents favoured either EDoF or trifocals for a ‘typical’ cataract or RLE patient. Notably, respondents have a low corneal astigmatism threshold for toric lenses. Mini-monovision with EDoF IOLs was well-regarded, whilst mix-and-match of different IOL types was less recommended.

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.

Comparison of Astigmatism Prediction Accuracy for Toric Lens Implantation from Two Swept-Source Optical Coherence Tomography Devices.

To compare the astigmatism prediction accuracy for toric intraocular lens (IOL) implantation between two swept-source optical coherence tomography (SS-OCT) devices: Argos (Movu, a Santec Company) and the IOLMaster 700 (Carl Zeiss Meditec). This was a retrospective chart review of 59 eyes (44 patients) with corneal astigmatism and cataract that underwent cataract surgery or refractive lens exchange surgery with a toric IOL. Biometry was performed on all patients prior to cataract surgery and the Barrett toric IOL calculator was used. Visual acuity was measured postoperatively. Manifest refraction was measured at 1 month and compared to the predicted postoperative residual refraction. Preoperative K measurements between devices were also compared. Mean cylinder prediction error was -0.17 ± 0.43 for Argos and 0.12 ± 0.56 for IOLMaster 700. The cylinder prediction error 0.5 D or less was not significantly different between the devices, with 83.1% (49 eyes) for Argos and 76.3% (45 eyes) for IOLMaster 700 (p = 0.206). Spherical equivalent prediction error was 0.13 ± 0.39 for Argos and 0.25 ± 0.50 for IOLMaster 700. The mean spherical equivalent prediction error 0.5 D or less was significantly different between the devices, with 79.7% (47 eyes) for Argos and 61.0% (36 eyes) for IOLMaster 700 (p = 0.016). The prediction accuracies were similar between the devices, except for spherical equivalent, where a higher percentage of eyes were 0.5 D or less of the prediction with the Argos compared to the IOLMaster.

Refractive and Visual Outcomes After Implantation of a Secondary Sulcus Intraocular Lens with an Extended Depth of Focus.

PurposeTo evaluate the range of vision, visual function, and quality of vision after implantation of a secondary extended depth of focus intraocular lens (EDOF IOL) implanted in the sulcus.SettingOne clinical practice in Haugesund, Norway.DesignProspective single arm non-interventional study.MethodsEligible subjects presenting for surgery, or who had previous successful primary cataract or refractive lens exchange surgery in both eyes were subsequently implanted with the AddOn® secondary EDOF IOL in the sulcus. Manifest refraction and visual acuity at distance, intermediate and near were measured 3 months after surgery, along with the monocular defocus curve. Subjects also completed a visual function and a quality of vision questionnaire.ResultsThe study included 32 eyes of 16 subjects. At 3 months postoperative, the mean refraction spherical equivalent (MRSE) was −0.16 ± 0.30 D, with a residual cylinder of 0.29 ± 0.27 D. The mean monocular uncorrected VA was 0.1 logMAR (20/25) or better at all test distances. The monocular defocus curves showed a depth of focus of 2.0 D. For every category except reading fine print, all but one subject (94%) had no difficulty or little difficulty with near tasks. Glare and halos were the most common visual disturbances, with no reports of starbursts. There was no evidence of any intralenticular opacification in any of the eyes, and no evidence of iris chafing/depigmentation.ConclusionThis secondary EDOF IOL provided excellent distance and intermediate vision, and very good near vision to subjects. Subject reported near visual function was also very good and visual disturbances were limited. This lens appears to be a good option for patients who would like to improve their range of vision. Results appear as good or better than those reported for primary EDOF lenses.

Refractive Lens Exchange Surgery in Early-Onset High Myopia Patients With Partial Cataract.

PurposeBy reporting clinical characteristics and retinal image quality before and after refractive lens replacement surgery in early-onset high myopia (eoHM) patients presenting with partial cataract, we emphasized the need for an objective way to grade the severity of partial cataracts.MethodsThis retrospective, consecutive case series included six Chinese patients (nine eyes). Analysis of previous medical records, visual acuity, optometry, retinal image quality, and axial length (AXL) before surgery and after surgery was performed.ResultsFive females and one male (nine eyes) with a mean (± SD) age of 11.6 ± 7.9 years (range: 4–25 years) were included in this study. The preoperative spherical power ranged from −7.5 to −42 D. The mean follow-up time was 36 months (range: 24–48 months). Phacoemulsification was followed by in-the-bag implantation of intraocular lens. For patients who were under 6 years old, posterior capsulotomy + anterior vitrectomy were performed simultaneously. All surgeries were uneventful and no postoperative complications occurred during the entire follow-up period. All patients’ uncorrected visual acuity improved by ≥2 lines postoperatively(Snellen acuity). LogMAR best-corrected visual acuity was improved at 24-month (P = 0.042) and endpoint (P = 0.046) follow-ups. Modulation transfer function cutoff frequency (MTFcutoff) and objective scatter index (OSI) was significantly improved at 12-month (P = 0.025, P = 0.038), 24-month (P = 0.005, P = 0.007) and endpoint (P = 0.005, P = 0.008) follow-ups. Postoperative AXL remained stable during 2–4 year follow-ups (P > 0.05).ConclusionRefractive lens replacement surgery is safe and effective for improving functional vision in eoHM patients presenting with partial cataract. Retinal image quality could provide a useful and objective way to facilitate partial cataract severity evaluation and surgery decision making.

Subjective and objective clinical outcomes of a new trifocal toric intraocular lens and effect of femtosecond laser cataract surgery.

To evaluate the clinical outcomes and quality of life following implantation of PanOptix toric intraocular lens (IOL) and to compare the outcomes following femtosecond laser assisted cataract surgery (FLACS) and standard cataract surgery (SCS). This comparative retrospective study included 79 eyes of 55 patients underwent cataract or refractive lens exchange surgery between April 2017 and January 2020 in Bayindir Hospital and Kaskaloglu Eye Hospital. Corneal (CA) and refractive astigmatism (RA), uncorrected visual acuities for distant, intermediate, and near (UDVA, UIVA, and UNVA), low contrast distance visual acuity, rotational stability, defocus curves, photopic and mesopic contrast sensitivity (CS), visual function-14 (VF-14) test, presence of dysphotopsia, and need for spectacles were evaluated at postoperative third month. Outcomes were compared between FLACS and SCS group. The mean UDVA, UIVA, and UNVA were 0.05 ± 0.07, 0.08 ± 0.08, and 0.06 ± 0.07 logMAR, respectively. All patients achieved ⩾0.3 logMAR uncorrected visual acuity for all distances. UDVA was found significantly better in FLACS group (p = 0.03). All eyes had ⩽1 D of subjective postoperative RA. Defocus curve had two peaks at 0 and -1.50 D. Spectacle independence was achieved in 88.7% of patients. Photopic and mesopic CS was within normal range in all patients. The mean VF-14 score was 98 ± 2. The mean IOL axis rotation was 2.1° ± 2.3°. Only one patient reported seeing disturbing halos. This trifocal toric IOL effectively reduced refractive astigmatism and provided excellent visual outcomes with high spectacle independence, patients' satisfaction, and good rotational stability. FLACS might have an impact on optimal postoperative results.

Effect of residual astigmatism on uncorrected visual acuity and patient satisfaction in pseudophakic patients.

To evaluate the effect of residual astigmatism on postoperative visual acuity and satisfaction after intraocular lens (IOL) surgery. Private practice, United Kingdom. Retrospective case series. Postoperative data of patients who had previously undergone refractive lens exchange or cataract surgery were used in a multivariate regression model to assess the effect of residual astigmatism on 3 months postoperative monocular uncorrected distance visual acuity (UDVA) and patient satisfaction. The analysis was based on residual refraction in the dominant eye of each patient. Odds ratios were calculated to demonstrate the effect of increasing residual astigmatism on UDVA and satisfaction with separate calculations for monofocal and multifocal IOLs. Three months postoperative outcomes of 17 152 dominant eyes were used in multivariate regression analysis. Compared with eyes with 0.00 diopter (D) residual astigmatism, the odds of not achieving 20/20 vision in eyes with 0.25 to 0.50 D residual astigmatism increased by a factor of 1.7 and 1.9 (P < .0001) in monofocal and multifocal IOLs, respectively. For the residual astigmatism 0.75 to 1.00 D, the odds ratio for not achieving 20/20 vision compared with eyes with no astigmatism was 6.1 for monofocal and 6.5 for multifocal IOLs (P < .0001). The effect of residual astigmatism on satisfaction was more evident at the 0.75 to 1.00 D level, where the odds of not being satisfied with vision increased by a factor of 2.0 and 1.5 in patients with monofocal and multifocal IOLs, respectively (P < .0001). The orientation of astigmatism was not a significant predictor in multivariate analysis. Multivariate analysis in a large population of patients demonstrated that low levels of residual astigmatism can degrade visual acuity. Corneal astigmatism of 0.50 D or greater should be included in surgical planning.

One-Year Outcomes in a Large Series of Patients Following Implantation of an Extended Depth of Focus Intraocular Lens.

To evaluate clinical outcomes 1 year after implantation of an extended depth of focus intraocular lens (IOL) in a large series of patients. Outcomes of patients who underwent refractive lens exchange or cataract surgery with the implantation of the AT LARA 829MP IOL (Carl Zeiss Meditec AG) were retrospectively reviewed. The near (40 cm), intermediate (66 cm), and distance visual acuity, refractive outcomes, and cumulative rate of adverse events and secondary procedures were evaluated at 12 months postoperatively. A total of 1,894 eyes of 977 patients were implanted with the AT LARA 829MP IOL, with 62.1% of eyes available for the 12-month visit. The overall secondary procedure rate for the whole cohort was: Nd:YAG = 7.8%, laser vision correction = 7.5%, and IOL explantation = 0.63%. The reasons for IOL exchange were intraoperative complications (3 eyes/0.16%) and quality of vision issues (9 eyes/0.48%). Of all eyes available for the 12-month visit that did not undergo laser vision correction or an IOL exchange, 72.0% had monocular uncorrected distance visual acuity of 20/20 or better and the percentage of eyes with monocular uncorrected intermediate and near visual acuity of 20/50 or better was 96.2% and 81.0%, respectively. At 12 months postoperatively, 87.6% of eyes were within ±0.50 diopters of emmetropia. No change in refraction occurred between the 6- and 12-month postoperative visits. The AT LARA 829MP extended depth of focus IOL is able to provide functional distance, intermediate, and near visual acuity. Complications related to the platform of the IOL were uncommon. [J Refract Surg. 2021;37(6):380-388.].

Predictability of Refractive Outcome of a Small-Aperture Intraocular Lens in Eyes With Irregular Corneal Astigmatism.

To compare different new-generation biometric formulas and ray-tracing for small-aperture intraocular lens (IOL) (IC-8; Acufocus, Inc) implantation in patients undergoing cataract and refractive lens exchange surgery with highly irregular corneas. This monocenter study included 17 eyes of 17 patients with highly irregular corneas of different genesis. Biometric and topographic corneal data were assessed using the IOLMaster 700 (Carl Zeiss Meditec) and Pentacam (Oculus Optkigeräte GmbH). Prediction and absolute error were compared after 3 months based on manifest refraction. Furthermore, change of total corneal refractive power in different corneal pathologies was also evaluated. For IOL power calculation, three fourth-generation IOL formulas were compared (Haigis, SRK-T, and Barrett Universal II). The dataset was then checked against ray-tracing and analyzed to improve prediction error in these highly irregular corneas. All patients showed an improvement in visual acuity postoperatively with a mean spherical equivalent of -1.22 ± 0.49 diopters (D). Overall comparison of the three formulas showed the Haigis formula to be superior in terms of the smallest deviation of predictive and absolute error. IOL calculations with ray-tracing were possible in all eyes, but showed inaccurate results with keratometric values of 48.00 D and greater. The IC-8 IOL is well suited for patients with lens exchange in highly irregular corneas. The Haigis formula seemed to be the most accurate in the patient group. Ray-tracing confirmed the results of biometric formulas up to a keratometric value of 48.00 D and should be compared with standard biometric formulas to address corneal irregularities and to minimize refractive surprises after surgery. A comparison with ray-tracing in eyes with a keratometric value of greater than 48.00 D should not be considered due to the inaccurate results. [J Refract Surg. 2021;37(5):312-317.].

The incidence and results of laser enhancement after cataract and refractive surgery with trifocal lens implantation

To evaluate the incidence of laser enhancement following cataract surgery and refractive lens exchange (RLE) with FineVision Micro F trifocal lens implantation (PhysIOL, Liège, Belgium). Retrospective study of patients who had undergone cataract or RLE surgery and had received a FineVision Micro F intraocular lens. Laser enhancement of residual refractive error was determined. Visual acuity (VA) assessments were performed before and after surgery: uncorrected distance VA (UCDVA), best-corrected distance VA (BCDVA), uncorrected near VA (UCNVA), plus preoperative and postoperative spherical equivalent (SE) assessments. Of the 1129 eyes from 596 patients, 61 (5.4%) required laser enhancement to correct residual refractive error (by group: 30/679 eyes [4.4%] cataract; 31/450 eyes [6.9%] RLE). Eleven eyes received FemtoLASIK; 50 eyes received PRK. Mean UCDVA before laser enhancement was 0.26±0.19 logMAR and 0.24±0.14 in the FemtoLASIK and PRK groups, respectively. After laser enhancement, these were 0.04±0.05 logMAR and 0.13±0.19, respectively; BCDVA values were 0.00±0.00 logMAR in the FemtoLASIK group and 0.06±0.11 in the PRK group. Laser enhancement improved UCNVA (Jaeger) from 2-3 to 1-2 in both groups. Enhancement reduced preoperative SE of -0.39±0.99 D and -0.53±0.58 D (FemtoLASIK and PRK groups, respectively) to 0.24±0.36 D and 0.04±0.47 D. The FineVision Micro F trifocal lens is an effective solution for gaining increased spectacle independence. The incidence of residual refractive error requiring laser enhancement is low, and laser procedures are a safe and effective solution for improving the quality of vision and patient satisfaction. Laser enhancement rates and outcomes were determined following cataract / refractive lens exchange surgery that used a trifocal IOL. Enhancement was safe and effective and rates were low (5.4%).

Clinical Results After Precision Pulse Capsulotomy.

PurposeTo compare residual refractive error and complication rates between eyes undergoing a manual capsulotomy and those receiving a precision pulse capsulotomy using an automated device.Patients and MethodsThis study was a non-interventional two-arm retrospective chart review of clinical results after bilateral cataract surgery or refractive lens exchange (RLE) surgery with a monofocal toric intraocular lens (IOL) or a trifocal IOL where a manual capsulorhexis (Manual) or automated precision pulse capsulotomy (PPC) was performed.ResultsExams from 243 eyes (122 PPC, 121 Manual) from 124 patients were reviewed; about 75% of which had a trifocal IOL implanted. There was no statistically significant difference in the MRSE with either IOL type, or overall. The overall percentage of eyes with residual refractive cylinder ≤ 0.50 D was significantly higher in the PPC group (89% vs. 79% in the manual group, p = 0.03), primarily driven by results with the toric IOL. Best corrected distance visual acuity was not statistically significantly different by group. Capsulotomy-related complications were lower in the PPC group relative to the manual group (4.1% vs. 6.6%), but this result was not statistically significant (p = 0.38).ConclusionSignificantly more eyes had refractive cylinder ≤0.50 D in the PPC group. For all other measures, the automated PPC device produced clinical results equivalent to those achieved with a manual capsulorhexis.

Comparing Visual Acuity, Low Contrast Acuity and Refractive Error After Implantation of a Low Cylinder Power Toric Intraocular Lens or a Non-Toric Intraocular Lens.

PurposeTo compare uncorrected and best-corrected visual acuity, low contrast acuity, residual refraction and ocular biometry after low cylinder power toric intraocular lens (IOL) or non-toric IOL implantation.Patients and MethodsThis was a non-interventional comparative study of visual outcomes after uncomplicated cataract or refractive lens exchange surgery with either a low cylinder (Low_Cyl) or non-toric (Non_Toric) IOL of similar design implanted (AcrySof® T2 IQ Toric IOL and AcrySof® IQ IOL). Subjects in both groups had to have been eligible for the low cylinder IOL based on biometry. They had to have uncorrected distance visual acuity (UDVA) of 20/32 (0.2 logMAR) or better at the time of their single diagnostic study visit. Clinical evaluation included the manifest refraction, visual acuity (VA), low contrast VA and ocular biometry.ResultsA total of 94 eyes were enrolled, 51 Low_Cyl and 43 Non_Toric. The mean manifest refractive cylinder was statistically significantly lower (~0.25 D) in the Low_Toric group (p < 0.01) and significantly more eyes had 0.25 D or less of refractive cylinder in that group (p = 0.03). The orientation of the preoperative anterior corneal astigmatism was a significant cofactor, with the difference between groups more evident when astigmatism was against the rule. Uncorrected high contrast visual acuity was statistically significantly better in the Low_Toric group (p = 0.02) as was the percentage of eyes with 20/20 visual acuity (p = 0.05). Uncorrected low contrast visual acuity was not statistically significantly different in mesopic or photopic conditions.ConclusionThe low cylinder power toric IOL provided better uncorrected visual acuity and lower residual refractive cylinder than a similar non-toric IOL after cataract surgery.

Refractive and Visual Outcomes After Implantation of a Secondary Toric Sulcus Intraocular Lenses.

PurposeTo evaluate the rotational stability, visual acuity and refractive error after sulcus implantation of a secondary toric IOL.SettingOne clinical practice in Haugesund, Norway.DesignNon-interventional single-arm diagnostic study.MethodsEligible subjects who had previous successful primary cataract or refractive lens exchange surgery in one or both eyes and the AddOn® secondary toric IOL implanted in the sulcus were evaluated at a single postoperative diagnostic visit to measure visual outcomes. Subjects with surgical complications (either primary or secondary) or pathology that would affect best-corrected visual acuity (eg, amblyopia) were excluded. Clinical evaluations at the diagnostic visit included measurement of visual acuity, manifest refraction and IOL orientation.ResultsEighteen eyes were evaluated. After secondary IOL implantation, mean residual refractive astigmatism was significantly reduced (1.66 ± 0.92 to 0.32 ± 0.25 D). There was no appreciable change in the spherical equivalent refraction. Sixteen of 18 eyes (89%) had residual refractive astigmatism ≤0.50D, and no eye had more than 0.75D after secondary IOL implantation. Mean UCVA was 0.00 ± 0.03 logMAR, with no eyes worse than 0.10. Mean BCVA was −0.05 ± 0.03 logMAR (20/20+2), with all eyes having BCVA of 0.00 logMAR. The mean change in orientation was near zero, with a mean absolute change of 4.9 ± 3.7 degrees. Sixteen of 18 eyes (89%) had a lens orientation ≤10 degrees from intended, with no eye oriented more than 13 degrees from intended.ConclusionThe AddOn® toric sulcus IOL significantly reduced postoperative refractive astigmatism in patients with high astigmatism after their primary cataract or RLE surgery, providing very good uncorrected distance vision.

Patients satisfaction and clinical outcomes of binocular implantation of a new trifocal intraocular lens.

To evaluate the clinical outcomes following bilateral implantation of PanOptix intraocular lens (IOL). This study included consecutive patients scheduled to undergo cataract or refractive lens exchange surgery between October 2017 and June 2018 at two centers. Manifest refraction, uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA, 60cm) and uncorrected near visual acuity (UNVA, 40cm), defocus curves, presence of dysphotopsia, need for spectacles, presence of posterior capsule opacification and visual function were evaluated at 6months after surgery. The IOL was implanted in 138 eyes of 69 patients. The mean binocular UDVA was 0.02 ± 0.05 logMAR, UIVA 0.06 ± 0.07 logMAR and UNVA 0.05 ± 0.07 logMAR. Defocus curve showed two peaks at 0.00 D and - 1.50 D. Complete spectacle independence was reported in 94.2% of the patients. The mean VF-14 test result was 97.7 ± 2.2 (93.2-100). Only one patient (1.4%) reported seeing bothersome halos. The presence of posterior capsule opacification was noted in seven eyes (10%), whereas Nd:Yag capsulotomy was required only in one eye. This trifocal IOL provided excellent visual outcomes at all distances with high spectacle independence and patient's satisfaction.

Comparing Visual Acuity, Low Contrast Acuity and Contrast Sensitivity After Trifocal Toric and Extended Depth of Focus Toric Intraocular Lens Implantation.

PurposeThe aim of this study was to compare visual acuity at various distances (far, intermediate and near), low contrast acuity and contrast sensitivity after trifocal toric and extended depth of focus (EDOF) toric intraocular lens (IOL) implantation.Patients and MethodsThis was a non-interventional two-arm comparative study of visual outcomes after uncomplicated bilateral cataract or refractive lens exchange surgery with IOL implantation between 6 months and 5 years before a single diagnostic examination visit. There was no masking and no control group. Subjects had to have uncorrected distance visual acuity (UDVA) of 20/40 (0.3 logMAR) or better measured at the time of their study visit. Clinical evaluations included the manifest refraction, visual acuity (VA) at distance, intermediate (60 cm) and near (40 cm), low contrast (10%) VA and contrast sensitivity.ResultsA total of 50 bilaterally implanted patients (25 trifocal, 25 EDOF) were examined; the two groups had similar characteristics, including corneal astigmatism. Postoperative refractive outcomes were also similar. There were no statistically significant differences in distance or intermediate VA between groups, but the trifocal group had significantly better near VA both uncorrected (p = 0.009) and distance-corrected (p = 0.014). There were no statistically significant differences in the low contrast acuity measures between IOLs at either distance or 40 cm, with or without glare. Contrast sensitivity in mesopic and photopic conditions was similar.ConclusionThe trifocal and EDOF toric IOLs performed similarly for all measures except near VA, where the trifocal toric provided significantly better acuity. For subjects interested in reducing spectacle independence at near, this may be an important consideration.

Visual and refractive outcomes, spectacle independence, and visual disturbances after cataract or refractive lens exchange surgery: Comparison of 2 trifocal intraocular lenses

To compare the clinical performance of a hydrophobic (AcrySof PanOptix) and a hydrophilic (AT LISA tri 839MP) diffractive trifocal intraocular lens (IOL). Kaskaloglu Eye Hospital, Izmir, Turkey. Prospective case series. Patients had bilateral cataract surgery or refractive lens exchange with implantation of the hydrophobic diffractive IOL or hydrophilic diffractive IOL. The binocular corrected distance visual acuity (CDVA) at 4m, corrected intermediate visual acuity (CIVA) at 80cm and 60cm, and corrected near visual acuity at 40cm; low-contrast CDVA; spherical equivalent refraction; binocular corrected defocus curve; photic phenomena; and spectacle use were compared. The study comprised 238 eyes (119 patients). The mean CIVA at 60cm was better in the hydrophobic diffractive IOL group than in the hydrophilic diffractive IOL group (0.07 logarithm of the minimum angle of resolution [logMAR]±0.07 [SD] versus 0.22±0.10 logMAR; P<.001). The mean CIVA at 80cm was better in the hydrophilic IOL group (0.07±0.08 logMAR versus 0.17±0.09 logMAR; P<.001). Visual acuity at 1.00 diopter (D) to -2.50 D was significantly better in the hydrophobic diffractive group (P=.011 to <.001). The rate of severe and bothersome halos was higher in the hydrophilic diffractive group (P=.032 and P=.004, respectively). The percentage of patients reporting never using spectacles for intermediate vision was significantly higher in the hydrophobic group (P=.016). Both IOLs gave similar and favorable visual and refractive outcomes. The hydrophobic diffractive IOL might be more suitable for patients who require good closer intermediate viewing.

Incidence of Intraoperative and Early Postoperative Adverse Events in a Large Cohort of Consecutive Refractive Lens Exchange Procedures

To evaluate the incidence of adverse events (AEs) in patients who underwent refractive lens exchange. Retrospective case series. Setting: Private refractive surgery clinics. Patients/Study Population: Patients who underwent refractive lens exchange between July 1, 2014, and June 30, 2016. Intervention/Observation Procedures: All AEs recorded in the electronic medical record were extracted and retrospectively reviewed. The total incidence of AEs and serious AEs was calculated. Loss of 2 or more lines of corrected distance visual acuity (CDVA) was calculated for the entire cohort of patients that attended a minimum of 3months follow-up. AEs. The total number of patients included was 10,206 (18,689 eyes). A multifocal intraocular lens (IOL) was implanted in 84.3% of eyes; 15.7% of eyes received a monofocal IOL. A total of 1164 AEs were recorded (1112 eyes of 1039 patients, incidence 6.0% of eyes, 1:17 eyes). The most common AE was posterior capsular opacification (PCO; 748 eyes, incidence 4.0%). Of all AEs, 171 events (occurring in 165 eyes of 151 patients, incidence 0.9%, 1:113 eyes) were classified as serious, potentially sight threatening. Loss of 2 or more lines of CDVA was 0.56% when excluding eyes where the loss of CDVA was due to PCO; the majority of these were due to macular causes. The incidence of sight-threatening AEs and significant loss of CDVA in elective refractive lens exchange surgery was low. Other than PCO, postoperative macular issues were the most common cause of vision loss in this cohort.

Refractive correction with multifocal intraocular lenses after radial keratotomy.

To assess visual and refractive results of multifocal intraocular lens (IOLs) implantation for refractive correction after radial keratotomy (RK). In a retrospective non-comparative interventional case series, we analyzed the outcomes of multifocal IOL implantation performed in the context of cataract or refractive lens exchange surgery following RK. A total of 17 eyes from nine patients were included in the study. IOL power calculation was done using the Double-K formula. Refractive error was used to assess predictability, and distance-corrected visual acuity (DCVA) and uncorrected distance visual acuity (UDVA) values were used to assess the surgical procedure's efficacy and safety. Distance-corrected near visual acuity (DCNVA) was also determined. Phacoemulsification and multifocal IOL implantation was successful in all cases, with neither complications nor adverse events. At 6 months postoperatively, monocular UDVA, DCVA, and DCNVA were 0.51 ± 0.39, 0.20 ± 0.30, and 0.11 ± 0.11, respectively (logMAR scale). More specifically, 35.29% of the eyes had DCVA ≥20/20 and 52.94% showed DCVA ≥20/25. Regarding pre- vs. post-operative changes, 52.94% had lost one line of DCVA, 23.53% showed no changes, 11.76% had gained one line of DCVA, 5.88% had gained two lines, and 5.88% had gained three or more lines. The efficacy and safety indexes were 0.56 and 0.98, respectively. As for near vision surgical outcomes, 29.41% of the eyes had DCNVA ≥20/20 and 64.71% had DCNVA ≥20/25. As for surgical accuracy, 29% of the eyes were within ±0.50 D of the target refraction, whereas 65% were within ±1.00 D. Multifocal IOL implantation following radial keratotomy (RK) does not result in good distance visual performance, at least after 6 months of follow-up. Thus, this surgical approach has to be considered with only limited expectations.

The Effect of Anterior Corneal Astigmatism Orientation on Toric Intraocular Lens Outcomes

Background: It is unclear whether post-operative errors after toric intraocular lens implantation would be more amenable to pre-operative correction with a fixed adjustment or a correction ratio that scales with the magnitude of pre-operative astigmatism. Purpose: To investigate the effect of pre-operative anterior corneal astigmatism orientation on outcomes of toric intraocular lens implantation in a large population. Methods: A retrospective cohort study of 625 patients undergoing refractive lens exchange through a superior clear corneal incision with Oculentis M-Plus toric intraocular lens implantation at an Optical Express, Inc. located in the United Kingdom and Ireland. Patients were stratified by axis of astigmatism on automated keratometry as with-the-rule, against-the-rule, or oblique. Analysis of visual acuity and refractive outcomes was performed using American National Standards Institute (ANSI) guidelines on astigmatic corrections with non-vector as well as vector analyses. Analysis was limited to one eye per patient. Results: Patients who had with-the-rule (WTR) astigmatism, compared with oblique and against-the-rule (ATR), had higher vector magnitudes of surgically induced refractive correction (2.89D, 2.55D, 2.42D; p < 0.001), and larger correction ratios (1.18, 1.02, 1.07; p < 0.001). This created a change of astigmatic axis in the with-the-rule cohort from WTR pre-operative astigmatism to an average ATR post-operative astigmatism. The overcorrection in the WTR cohort averaged 0.30D. We found that the absolute dioptric overcorrection among WTR patients did not differ significantly with magnitude of corneal astigmatism, but the correction ratio was lower among those with higher baseline cylindrical errors (p = 0.93 and 0.0002, respectively). Conclusions: Refractive lens exchange surgery using toric intraocular lenses overcorrected patients who had with-the-rule astigmatism. Degree of overcorrection did not vary with severity of pre-operative astigmatism. Incorporation of axis of astigmatism in lens selection and reduction of astigmatic correction among with-the-rule patients by an absolute value of 0.25D - 0.35D, rather than proportional adjustments, may reduce cylindrical over-correction.

Validity of automated refraction after segmented refractive multifocal intraocular lens implantation.

To evaluate the clinical utility of automated refraction (AR) and keratometry (KR) compared with subjective or manifest refraction (MR) after cataract or refractive lens exchange surgery with implantation of Lentis Mplus X (Oculentis GmbH) refractive multifocal intraocular lens (IOL). Eighty-six eyes implanted with the Lentis Mplus X multifocal IOL were included. MR was performed in all patients followed by three consecutive AR measurements using the Topcon KR-8000 autorefractor. Assessment of repeatability of consecutive AR before and after dilation with phenylephrine 10%, and comparison of the AR and KR with MR using vector analysis were performed at 3mo follow-up. Analysis showed excellent repeatability of the AR measurements. Linear regression of AR versus MR showed good correlation for sphere and spherical equivalent, whereas the correlation for astigmatism was low. The mean difference AR-MR was -1.28±0.29 diopters (D) for sphere. Astigmatism showed better correlation between KR and MR. We suggest AR sphere plus 1.25 D and the KR cylinder as the starting point for MR in eyes with a Lentis Mplus X multifocal IOL. If AR measurements are equal to MR, decentration of the IOL should be suspected.