Refractive Lens Exchange Research Articles

Clinical Outcomes After Phacoemulsification With Implantation of Trifocal and Toric Trifocal Intraocular Lenses.

To evaluate the visual and refractive outcomes, visual quality, patient satisfaction, and spectacle independence after phacoemulsification with bilateral implantation of a diffractive trifocal intraocular lens (IOL). The study sample comprised 36 consecutive patients (72 eyes). Twenty-three (64%) patients underwent refractive lens exchange and 13 (36%) underwent cataract surgery. Exclusion criteria included previous ocular surgery, corneal higher order aberrations of greater than 0.4 µm, angle kappa of greater than 0.6 mm, and corneal astigmatism of greater than 5.00 diopters (D). All eyes were targeted for emmetropia. A toric IOL was used in 35 (48.6%%) eyes with corneal astigmatism of greater than 1.00 D. Uncorrected distance visual acuity (UDVA) and distance-corrected visual acuity were measured at 4 m and 80 and 40 cm. Patients underwent routine ophthalmic examination for 6 months postoperatively. Patient satisfaction was assessed with a subjective questionnaire at 6 months postoperatively. A P value of less than .05 was statistically significant. At 6 months postoperatively, the mean manifest refractive spherical equivalent was -0.01 ± 0.51 D. Binocular UDVA at 4 m and 80 and 40 cm was -0.02 ± 0.10, -0.07 ± 0.11, and 0.08 ± 0.10 logMAR, respectively. Binocular defocus curves presented two peaks of -0.07 and -0.02 logMAR for 0.00 and -2.00 D defocus, respectively. The Objective Scatter Index score decreased significantly in the cataract group and increased significantly in the refractive lens exchange group (P < .05, both cases). All patients were satisfied or very satisfied with the postoperative outcome. Bilateral implantation of a diffractive trifocal IOL resulted in good visual performance at all distances with high patient satisfaction and spectacle independence at 6 months postoperatively. [J Refract Surg. 2021;37(6):372-379.].

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.].

Long-Term Evaluation of Visual Outcomes and Patient Satisfaction after Binocular Implantation of a Bioanalogic Lens.

Purpose Long-term evaluation of the visual refractive outcomes and the quality of life after implantation of the WIOL-CF (Medicem, Czech Republic) in both eyes. Design retrospective, nonrandomized noncomparative case series. Methods 50 eyes of 25 patients, including 11 women (44%) and 14 men (56%). The age range of the patients was 38 to 77 years (mean age 55.48 ± 10.97 years). All patients underwent bilateral implantation of the WIOL-CF. Exclusion criteria were previous ocular surgeries except for cataract surgery and refractive lens exchange, irregular corneal astigmatism of >1.0 diopter, and ocular pathologies or corneal abnormalities. Postoperative examinations were performed at 14 days and 3, 6, 12 months of surgery; the last follow-up was between 24 and 36 months after the procedure. All exams included manifest refraction, monocular uncorrected visual acuity (UCVA) and distance-corrected visual acuity (DCVA) in 5 m (Snellen), monocular uncorrected visual acuity in 70 cm and 40 cm (Jeager) and binocular UCVA, DCVA in 5 m, 70 cm, and 40 cm, binocular contrast sensitivity (CS) under photopic conditions, binocular defocus curves, high-order aberrations, quality-of-vision VF-14 questionnaire, and spectacle independence. Results Significant improvement in monocular visual acuity at all distances was demonstrated; the mean postoperative spherical equivalent was 0.32 ± 0.45D. The postoperative means of binocular distance UCVA and BCVA were also improved (p < .001) and so were the mean uncorrected intermediate VA (2.053 ± 1.268) and near uncorrected VA (2.737 ± 1.447). There was a significant improvement in contrast sensitivity at all spatial frequencies and higher-order aberration, compared to preoperative results. Conclusions The evaluation of a WIOL-CF showed good distance, intermediate, and near visual acuity. Contrast sensitivity increased after surgery in all spatial frequencies. Patient satisfaction was high despite some optical phenomena. The rate of postoperative spectacle independence also turned out high. Financial Disclosure. No author has a financial or proprietary interest in any material or method mentioned.

Bilateral Implantation of a New Refractive Multi-Segmented Multifocal Intraocular Lens in Cataract or Refractive Lens Exchange Patients.

PurposeTo evaluate the safety and efficacy of a new multi-segmented refractive multifocal intraocular lens (IOL) after phacoemulsification and refractive lens exchange (RLE).Patients and MethodsIn this prospective, multicenter clinical trial, 63 presbyopic subjects who had cataract or where RLE candidates were bilaterally implanted with the Precizon Presbyopia IOL (Ophtec BV, Groningen, the Netherlands) after phacoemulsification. The study was conducted at 6 clinical centers in Germany, the Netherlands, Belgium, Turkey and Spain. Subjects were evaluated at baseline and at 1 day, 1 week, 1 and 3 months postoperatively for monocular and binocular uncorrected (UDVA) and corrected distance visual acuity (CDVA), uncorrected (UIVA) and distance-corrected intermediate visual acuity (DCIVA), uncorrected (UNVA), corrected (CNVA) and distance-corrected near visual acuity (DCNVA), contrast sensitivity and quality of vision.ResultsThree months postoperatively, binocular UDVA and CDVA of ≥20/40 was achieved in 98.4% (60/61) and 100%, respectively. Binocular UIVA and DCIVA of ≥20/40 was achieved in 96.7% (59/61) and 93.4% (57/61) respectively. Binocular UNVA, CNVA and DCNVA of ≥20/40 was achieved in 93.4% (57/61), 98.4% (60/61) and 95% (57/60) subjects, respectively. Complete spectacle independence was achieved in 80% (49/61) patients; 93% of patients reported that they were quite or very satisfied with the outcomes of the procedure.ConclusionPrecizon Presbyopia IOL implantation is a safe and effective method to provide good visual acuity at all distances in presbyopic and cataract patients.

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.].

Refractive lens exchange on keratoconus patient: a case report

Introduction. Keratoconus is a vision disorder that occurs when the cornea becomes thin and irregularly (cone) shaped. Instead of being focused correctly on the retina, this abnormal shape causes the light entering the eye to improperly refracted and manifested as a distortion of vision. Refractive Lens Exchange is one type of Invasive therapy in Keratoconus. Here we describe a case of Keratoconus managed by the Refractive Lens Exchange procedure in our Center.Case Description. A male, 25 years old, visited the clinic due to blurry vision since ten years ago. Every six months or a year, he needs to adjust his lens power. Ophthalmology examination found visual acuity in the right eye was 2/60 PH 6/60, and if using S-9.00, visual acuity improved to 6/30. Meanwhile, visual acuity in the left eye was 1/60 PH 6/60 and if using S–11.75, visual acuity improved to 6/48. Corneal topography supports the finding of Keratoconus. Management for this patient was Refractive Lens Exchange + Intraocular Lens + Capsular Tension Ring. Initially, This advised was differ from the patient expectation, as he wanted a LASIK procedure. An important reminder was given, that Keratoconus is contraindicated for LASIK and any corneal surface ablation procedure. After series of procedure, the VA of the right eye was 6/15 PH 6/6, with C - 4.00 x 1800 VA became 6/6. VA left eye was 6/18 PH 6/9, with C - 4,00 x 1800 VA became 6/9. Binocular vision was 6/6. For near vision, S +3.00 was added for both eyes.Conclusions. Refractive Lens Exchange + Intraocular lens implantation is effective and safe procedures to treat high myopia in keratoconus cornea.

Comparison of trifocal or hybrid multifocal-extended depth of focus intraocular lenses: a systematic review and meta-analysis

This meta-analysis aimed to evaluate the clinical outcomes following implantation of trifocal intraocular lenses (IOLs) or a hybrid multifocal-extended depth of focus (EDOF) IOL in cataract or refractive lens exchange surgeries. We examined 13 comparative studies with bilateral implantation of trifocal (898 eyes) or hybrid multifocal-EDOF (624 eyes) IOLs published through 1 March 2020. Better uncorrected and corrected near visual acuity (VA) were observed in the trifocal group (MD: − 0.143, 95% CI: − 0.192 to − 0.010, P < 0.001 and MD: − 0.149, 95% CI: − 0.217 to − 0.082, P < 0.001, respectively), while the hybrid multifocal-EDOF group presented better uncorrected intermediate VA (MD: 0.055, 95% CI: 0.016 to 0.093, P = 0.005). Trifocal IOLs were more likely to achieve spectacle independence at near distance (RR: 1.103, 95% CI: 1.036 to 1.152, P = 0.002). The halo photic effect was generated more frequently by the trifocal IOLs (RR: 1.318, 95% CI: 1.025 to 1.696, P = 0.031). Contrast sensitivity and subjective visual quality yielded comparable results between groups. Trifocal IOLs demonstrated better performance at near distance but apparently led to more photic disturbances. Our findings provided the most up-to-date and comprehensive evidence by comparing the benefits of advanced IOLs in clinical practice.

Femtosecond Laser-assisted Lens Surgery with Low-energy Pulse versus Conventional Phacoemulsification for Presbyopia Correction: An Intraindividual Study

Background: Lens surgery with multifocal IOL implantation for presbyopia correction is performed by femtosecond laser-assisted lens surgery or conventional phacoemulsification. Objective: To compare the clinical results of femtosecond laser-assisted with low-energy pulse conventional phacoemulsification lens surgery for presbyopia correction intraindividually. Methods: Charts from patients who underwent Refractive Lens Exchange (RLE) for presbyopia correction in a single center, with Femtosecond Laser-Assisted Lens Surgery (FLALS) in one eye and Conventional Phacoemulsification (CP) in the other, were retrospectively reviewed. All eyes had the same multifocal Intraocular Lens (IOL) implanted. The clinical outcomes and the results of the level of satisfaction questionnaire were compared between the two groups according to the technique employed (FLALS vs. CP) for a period of up to four years. Stability, efficacy and safety indices were also assessed. Results: This study comprised a total of 56 eyes of 28 patients randomly assigned FLALS in one eye and CP in the other. No statistically significant difference was observed between the two techniques regarding postoperative visual acuities, duration of surgical procedure, efficacy or safety indexes (p&gt;0.05). Refraction was stable in all FLALS eyes, whereas a change occurred in 2 eyes (7.1%) operated with CP upon 6 months postoperatively, but without statistical significance (p˃0.05). Satisfaction was slightly better with FLALS but not statistically significant (p=0.134). No immediate myosis or other adverse events after the femtosecond laser were registered. Conclusion: The parameters assessed showed no significant differences between the two techniques, in spite of a difference of refraction stability upon 6 months postoperatively.

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%).

Transepithelial Photorefractive Keratektomy after a Clear Lens Exchange.

Purpose: We evaluated the refractive visual outcomes and efficacy of Transepithelial Photorefractive Keratectomy (TransPRK) using Smart Pulse Technology with static and dynamic cyclotorsion and the AMARIS 1050 Hz RS laser platform from Schwind in the eyes after a refractive lens exchange. Setting/Venue: Aurelios Augenlaserzentrum, Recklinghausen. Methods: We retrospectively evaluated the data of 552 consecutive eyes treated with refractive lens exchange between 2016 and 2019. A total of 47 eyes (8.5%) required a touch up after the clear lens exchange. From 43 eyes of 43 patients, we obtained a minimum follow up of 3 months. In all cases, we performed a TransPRK with a minimum optical zone of 7.2 mm, centering the ablation on the vertex of the cornea. Results: The average age of the treated eyes was 57 years old, with a range between 48 and 68 years. The mean treated sphere was 0.42 diopters (D), with a range between −1.0 and +1.75 D. The mean astigmatism was 1.06 D. Postoperatively, after laser vision correction, we reduced the sphere to a mean of 0.11 D (range −0.5 to +0.75 D), and, postoperatively, the mean astigmatism was 0.25 D (range −0.75 to 0 D). The predictability for a spheric equivalent (SEQ) of 0.5 D was 91%, and for 1 D it was 100% of the cases. No eye lost more than one Snellen line. Conclusions: TransPRK with smart pulse was predictable for correcting ametropia after Clear Lens Surgery.

Unilateral acute macular edema with serous macular detachment after bilateral phacoemulsification

Two cases of unilateral macular edema with serous macular detachment occurring 1 day after uneventful bilateral phacoemulsification procedures are reported. Both patients underwent sequential bilateral phacoemulsification for refractive lens exchange. On postoperative day 1, corrected distance visual acuity (CDVA) was recorded between 6/24 and 6/48 in the affected eyes of cases 1 and 2, respectively. In both cases, optical coherence tomography showed serous macular detachment with significant intraretinal fluid accumulation. Central foveal thickness (CFT) was recorded as 583 μm in case 1 and 822 μm in case 2. In case 1, the fluid was completely resorbed by postoperative day 3 with no additional treatment. Final CDVA and CFT in case 1 were 6/6 and 292 μm, respectively. Resolution of edema was more prolonged in case 2 and occurred by postoperative day 8, after the addition of nepafenac 0.1% on day 2. Final CDVA and CFT in case 2 were 6/6 and 299 μm, respectively.

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.

Visual Outcomes, Patient Satisfaction, and Light Distortion Analysis After Blended Implantation of Rotationally Asymmetric Multifocal Intraocular Lenses.

To evaluate the visual outcomes and patient satisfaction after blended implantation of rotationally asymmetric multifocal intraocular lenses (IOLs) (LENTIS Mplus LS-313 +3.00 and +1.50 diopters [D], Oculentis GmbH). This was an interventional prospective study that included 40 eyes of 20 patients who underwent uneventful refractive lens exchange. Patients were implanted with the LENTIS Mplus LS-313 +3.00 D IOL in the non-dominant eye and the +1.50 D IOL in the dominant eye. Twelve months after surgery, binocular and monocular uncorrected and corrected near, intermediate, and distance visual acuity, defocus curve, contrast sensitivity, and light distortion analysis (LDA) were evaluated. Monocular total ocular aberrometry with a pyramidal wavefront sensor (Osiris; CSO) and patient satisfaction was evaluated with the 10-item Near Activity Vision Questionnaire (NAVQ-10). There was a statistically significant improvement in the uncorrected distance visual acuity in both eyes after surgery (P < .001), with good uncorrected near and intermediate distance visual acuity (0.18 and 0.38 logMAR, respectively). The binocular defocus curve showed good levels of visual acuity for the most important ranges of vision. Contrast sensitivity and LDA had significantly better results when measured binocularly than monocularly. Higher order aberrations were significantly higher in the +3.00 D eye (P < .001). The mean Rasch score for the NAVQ-10 questionnaire was 26.9 ± 27.66. Visual outcomes, defocus curve, LDA, and contrast sensitivity were significantly better binocularly than monocularly. The implantation of a blended IOL combination with different near addition complements the advantages of each IOL, improving binocular visual outcomes and providing good patient satisfaction. [J Refract Surg. 2020;36(12):796-803.].

The Impact of Eye Exercises on High Myopia and Visual Acuity in Patients Aged (15-30) Years

High myopia is a state in which the spherical equivalent objective refractive error is ≤ -5.00 Diopters (D) in either eye. Currently, there are several treatment options to correct high myopia including laser eye surgery, refractive lens exchange, pharmaceutical treatment, and others. This study focuses on physiotherapy treatment and aims to evaluate the potential advantage of applying new physical exercises for the eyes of patients aged between 15-30 years, was applied on 50 patients with a known case of high myopia who were recruited through criteria based purposive sampling, they visit the optical clinic routinely at the Medical Technical University. The optometrist assessed the refractive errors and visual acuity of subjects using a Snellen’s chart and an auto refractometer, then the eye exercises treatment was done by the specialist physician. The effect of physical exercises on the eyes was determined by comparing the visual acuity of patients before and after the treatment through the SPSS program, and the result was found to be significant with a P-value = 0.0281<0.05. Therefore, eye exercises provide an enhancement in visual acuity, ocular health, and correct the refractive error of high myopia resulting in better vision.

Refractive Lens Exchange in Hyperopic Presbyopes with the Acrysof IQ Panoptix Intraocular Lens: One-Year Results and Analysis of the Literature.

PurposeTo assess the functional and refractive outcomes in hyperopia and presbyopia correction by clear lens exchange with the intraocular trifocal artificial lens (IOL) Acrysof IQ Panoptix implant at 1 year.Materials and MethodsA number of 128 eyes (64 patients) underwent clear lens exchange with placement of the trifocal IOL Acrysof IQ Panoptix implant for hyperopia and presbyopia. Prior to the surgery the patients had a complete ocular examination. In all cases the artificial lens was implanted in the bag without any intraoperative complications. Visual acuity (VA) at distance, intermediate and near and ocular refraction were evaluated at 4 weeks, 6 and 12 months postoperatively.ResultsThe mean age was 53.49 ±7.377 years old (range 40–73 years). As high as 51.57% of the patients were males and 48.43% were females. The mean achieved refraction was 0.26 ± 0.73D. Almost 60.93% of patients were within ±0.25D of the target refraction, with 82.03% eyes within ±0.50D of the planned correction. At 1 year after surgery, 96.45% of eyes had a stable refraction (p >0.05). At 1 year, a total of 92.25%, 89.92% and 91.47% achieved a monocular uncorrected distance, intermediate and near visual acuity of 0.2 logarithm of the minimum angle of resolution or better, respectively. At the same time point, a total of 95.35%, 91.47% and 93.80% achieved a binocular uncorrected distance, intermediate and near visual acuity of 0.2 logarithm of the minimum angle of resolution or better, respectively. There was no statistically significant difference (p>0.05) between the postoperative uncorrected and best corrected VA (distance, intermediate, near) at 6 months and postoperative uncorrected and best corrected VA (distance, intermediate, near) at 12 months. None of our patients had any intraoperative complications. Two cases (1.56%) developed posterior capsule opacification. Twelve patients (18.75%) complained about photic phenomena such as glare and haloes, but this symptom disappeared after 6 months postoperatively. As high as93.56% of patients had a high satisfaction with the outcomes of the surgery. Spectacle independence was obtained in 97.65% eyes.ConclusionThe Acrysof Panoptix trifocal artificial lens offers a good vision at distance, intermediate and near, with a good quality of vision and refraction.

A Comparative Evaluation of Diffractive Trifocal and New Refractive/Extended Depth of Focus Intraocular Lenses for Refractive Lens Exchange

ABSTRACT Purpose To evaluate and compare the visual performance and quality of life (QOL) associated with refractive/extended depth of focus (EDOF) intraocular lenses (IOLs) and diffractive trifocal IOLs in refractive lens exchange patients. Materials and methods This was a comparative interventional study of patients undergoing implantation of Lucidis (Swiss Advanced Vision, SAV‑IOL SA, Neuchâtel, Switzerland) or AT LISA tri 839MP (Carl Zeiss Meditec AG, Germany) IOLs. Near, intermediate, and distance best corrected and uncorrected visual acuities were collected at 1 and 3 months postoperatively. The vision-related QOL was evaluated 1 and 3 months after surgery, using the National Eye Institute Visual Function Questionnaire-14 (VF-14 QOL questionnaire). Results A total of 74 patients underwent refractive lens exchange and IOL implantation, with 38 patients in the EDOF group and 36 in the trifocal group. Among all visual acuities, uncorrected near visual acuity was statistically significantly better with the Lucidis IOL at the first month (p = .02) and diminished at the third-month visit (p = .16). When we compared the VF-14 QOL questionnaire scores, reading small print, reading a newspaper or book, and driving at night were statistically significantly better in the Lucidis group at the first month (p = .00, for each). That difference persisted only in driving at night at the third-month visit (p = .04). Reading small print, driving at night, and doing fine handwork were the most difficult tasks in the AT LISA group at the first month, and only driving at night remained so at the third-month visit. Conclusions The refractive results and visual outcomes at all distances of EDOF and trifocal IOLs were highly satisfactory. However, the EDOF design in the Lucidis IOL achieves lower rates of glare in the early period after refractive lens exchange.

Unilateral Versus Bilateral Refractive Lens Exchange With a Trifocal Intraocular Lens in Emmetropic Presbyopic Patients

PurposeTo compare visual outcomes and patient satisfaction between unilateral and bilateral trifocal diffractive intraocular lens (IOL) implantation in emmetropic patients with presbyopia. DesignRetrospective observational case series. MethodsThis is a multicenter, multisurgeon study of emmetropic presbyopes who underwent refractive lens exchange (RLE) followed by an implantation of FineVision IOL (PhysIOL). Inclusion criteria were emmetropic eyes, with a sphere between –0.25 and +0.50 diopters (D), cylinder of less than 0.75 D and spherical equivalent (SE) between –0.25 and +0.25 D. In addition, uncorrected distance visual acuity (UDVA) had to be Snellen >0.9 in each eye. A total of 171 eyes of 122 patients were evaluated. This sample was divided into 2 groups depending on whether they have been operated monocularly or binocularly. Visual and refractive performance, patient satisfaction, and spectacle independence were evaluated. ResultsUDVA and corrected distance visual acuity (CDVA) remained almost unchanged after monocular and binocular surgery. Binocular uncorrected intermediate (UIVA) and near visual acuity (UNVA) were better in those operated binocularly (0.3±0.12 vs 0.22±0.06, P < .063, and 0.09±0.08 vs 0.04±0.05, P < .027, respectively). Predictability and efficacy were higher in the binocular group, whereas safety was better in the monocular group. Visual dysphotopsia was worse and spectacle independence for all distances was higher in binocular group. ConclusionsOur research shows that RLE with binocular implantation of a trifocal diffractive IOL in presbyopic emmetropic patients is more successful in UNVA than monocular implantation. However, no significant differences were observed in UDVA, UIVA, and patient satisfaction.

Standard Results and Contrast Sensitivity Reestablishment after Implantation of a Trifocal Intraocular Lens

ABSTRACT Purpose/Aim To assess, following the standards, the results of safety, efficacy and predictability for a trifocal intraocular lens and to evaluate contrast sensitivity and visual acuity defocus curve. Materials and Methods Fifty subjects operated on cataract surgery or refractive lens exchange with a trifocal intraocular lens have been recruited for the study. The monocular uncorrected visual acuity (VA) at far, intermediate (67 cm) and near (40 cm) distances in addition to corrected VA at far and near distances was evaluated at 1 week, 1 month and 3 months after surgery. Postoperative refraction, binocular contrast sensitivity function (CSF) and binocular defocus curves were also collected at the 3-month follow-up visit. Results Mean uncorrected VA was 0.10, 0.07 and 0.05 logMAR at far, intermediate and near distances. Corrected distance VA at far and near distances was 0.04 and 0.02 logMAR. Ninety percent and 100% achieved a spherical equivalent in ±0.50 D and ±1.00 D, respectively. CSF was above normal range for 12 and 18 cycles per degree (cpd) in all the conditions, inside the normal range in 1.5, 3 and 6 cpd and only decreased below normal range for 1.5 and 3 cpd in mesopic vision without glare. Conclusions The procedure achieved a safety, efficacy and predictability similar to those reported by previous studies. The CSF was generally enhanced after the procedure in comparison to those reported in non-operated subjects above 60 years old. Previous studies might underestimate the effective distance of the intermediate and near foci.

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.

Update on Laser Vision Correction Versus Intraocular Lens Options

In this article, we review the current surgical options for refractive error and presbyopia, including laser refractive surgery and intraocular lens surgery. A wide range of surgical treatments are available for treating refractive error. Refractive surgeons today can correct higher levels of ametropia and presbyopia more safely and predictably. Laser vision correction has been established as a safe and effective method for treating refractive error; however, the potential benefits of a wider range of procedures including refractive lens exchange and phakic intraocular implants are potentially useful in selected patients. Refractive surgeons are able to provide patients with many options for the correction of refractive error. Selecting the safest and most appropriate technique for each individual patient is critical. This article discusses the various options available and specific considerations to take into account for myopia, hyperopia, astigmatism and presbyopia in turn.