Refractive Multifocal Intraocular Lens Research Articles

Stereopsis Following Implantation of Presbyopia-Correcting Intraocular Lenses: A Narrative Review.

Recent advancements in cataract surgery have broadened its scope from mere vision restoration to include correction of refractive errors and presbyopia. This evolution has introduced multifocal and extended depth-of-focus (EDOF) intraocular lenses (IOLs), allowing enhanced vision across multiple distances. However, the influence of these advanced IOLs on stereopsis remains controversial. Factors influencing stereopsis after surgery include visual acuity, interocular differences, residual astigmatism, and the type of IOL, etc. Binocular vision integration and neuroadaptation further affect stereopsis, especially in cases of presbyopia-correcting IOLs. It is widely acknowledged that bilateral implantation of presbyopia-correcting IOLs yield superior stereopsis compared to unilateral implantation. However, there remains no consensus on whether binocular implantation of multifocal or monofocal IOLs provides superior stereopsis. Most studies suggest no significant difference in stereopsis between these two types of implants. Among different types of multifocal IOLs, refractive multifocal IOLs may offer better stereopsis than diffractive multifocal IOLs when implanted bilaterally. Emerging EDOF and hybrid multifocal-EDOF IOLs also demonstrate promising postoperative stereopsis. Additionally, a mix-and-match strategy with different types of IOLs implanted in each eye may result in interocular differences in visual acuity at certain distances, potentially affecting stereopsis. Nevertheless, with appropriate selection, most patients can achieve satisfactory postoperative stereopsis. This review synthesizes current literature on the effects of presbyopia-correcting IOLs on postoperative stereopsis recovery following cataract surgery. Studies on stereopsis outcomes with different IOLs have yielded mixed results, urging further investigation for optimized surgical strategies and patient outcomes.

Optical Characterization of a Rotationally Asymmetric Refractive Multifocal Intraocular Lens Compared to a Standard Monofocal One

This study compares a standard monofocal intraocular lens (IOL) with two rotationally asymmetric refractive multifocal IOLs, analyzing power profiles and wavefront data across three nominal powers. Tested IOLs included monofocal Acunex AN6 and multifocal AN6V (addition +1.50 D) and AN6VM (addition +3.00 D) by Teleon Surgical, at powers +10.00 D, +20.00 D, and +30.00 D. Using NIMO TR1504, power profiles, spherical aberration, and coma were analyzed. Multifocal lenses displayed an asymmetrical design, with zones for far and near vision and a central notch for far power. The multifocal AN6V and AN6VM showed neutral spherical aberration in the center, increasing to positive values, and finally achieving negative values towards the periphery. The vertical coma coefficient [Z(3:−1)] remains almost stable for the monofocal IOLs. The lower-addition multifocal IOLs induce primary vertical coma of +0.11 microns at 3 mm away from the lens center compared to +0.21 microns obtained with the high-addition lens. We can conclude that the multifocal AN6V and AN6VM lenses display an asymmetrical design. The final addition provided by these lenses depends on its nominal power. The variation of SA with optic size is more pronounced for the monofocal model, and it is dependent on the nominal power.

Long-term Prevalence of Opacification of a Hydrophylic Acrylic Rotationally Asymmetric Refractive Multifocal Intraocular Lens.

To determine the prevalence of opacification of a hydrophylic intraocular lens (IOL) with hydrophobic coverage and the percentage of explantations required, determining possible risk factors associated with these opacifications. This ambispective study enrolled 575 eyes of 296 patients (age 36 to 87 years) that underwent cataract surgery between 2010 and 2017 with implantation of different models of Lentis Mplus IOLs: LS-312-MF30, LS-313-MF15, LS-313-MF30, LU-313-MF30, and LU-313-MF30T (Oculentis GmbH). Visual, refractive, and slit-lamp biomicroscopic changes were evaluated in a long-term follow-up. The percentage of cases with IOL opacification and the percentage of cases in which IOL explantation was required due to such opacifications were calculated at each visit. Five of the explanted IOLs from this series could be analyzed by scanning electron microscopy (SEM-EDX). IOL opacification developed in 63 eyes (11.0%). With 95% confidence, the prevalence of IOL opacification was between 842 and 1,401 cases per 10,000 eyes. The time elapsed between surgery and the presence of IOL opacification ranged between 0 and 9.3 years (mean: 4.7 ± 2.2 years). No significant differences in terms of IOL opacification rate were found according to gender (P = .378). No significant differences were found in arterial hypertension, diabetes, hypothyroidism, or hyperthyroidism rates between eyes with or without IOL opacification (P ≥ .053). IOL explantation was needed in 9 eyes (1.57%). SEM-EDX analysis confirmed the presence of rough areas on the IOL surface containing different components, such as calcium, phosphorous, copper, or nitrogen. The prevalence of opacification with time in Lentis Mplus IOLs is high, with no systemic risk factors associated with this complication, suggesting that it may be attributable to the material and/or the manufacturing process. [J Refract Surg. 2024;40(2):e98-e107.].

Comparison of the Polychromatic Image Quality of Two Refractive-Segmented and Two Diffractive Multifocal Intraocular Lenses.

Evaluating chromatic aberration for a multifocal intraocular lens (MIOL) in vitro is essential for studying its performance because it helps determine the most appropriate lens for each patient, enhancing surgical outcomes. While refractive MIOLs with angular power variation have shown positive clinical outcomes, studies of these MIOLs on optical benches primarily employed monochromatic green light, neglecting the impact of longitudinal chromatic aberration (LCA) on MIOL performance. To address this gap, we evaluated the through-focus modulation transfer function (TF-MTF) and the point spread function (PSF) of two refractive segmented extended depth of focus intraocular lenses (IOLs) (Femtis Comfort and Precizon Presbyopic), comparing the results with those obtained with two widely known diffractive multifocal intraocular lenses (AcrySof IQ ReSTOR and FineVision Pod F). Measurements of the TF-MTF were conducted using both monochromatic and polychromatic light in a customized optical bench. The refractive designs exhibited distinct haloes in the PSFs. When comparing the refractive and diffractive designs, opposite signs of LCA were observed at near foci. These findings emphasize the influence of the optical design of IOLs on their performance under polychromatic light, providing valuable information for vision care professionals when selecting the most suitable lens for each patient.

Stereoacuity and Multifocal Intraocular Lenses - a Systematic Review.

Among various visual functions, stereoacuity, or the ability to perceive depth, is the most sophisticated binocular function. Many publications discuss the influence of retinal image formation by multifocal intraocular lenses on glare and contrast sensitivity, but only a few present results of testing binocular vision in patients with multifocal intraocular lenses. This article is designed to review the results of testing binocular vision in patients with multifocal intraocular lenses implanted in cataract surgery. This article was performed based on a literature review and Internet search through scientific databases such as PubMed, Scopus, Web of Science, and Google Scholar. Some reports found that patients implanted with the monofocal lens, when measured with a near addition, presented statistically significant better stereoacuity scores than those implanted with any of the multifocal intraocular lens types. When the TNO test was used for measurement, statistically significant better stereoacuity was disclosed with the refractive multifocal intraocular lens than with the diffractive-based multifocal intraocular lens design. Stereoacuity scores, even within the same types of lenses, were significantly better with the Titmus test than with the TNO test. Stereoacuity is not affected by multifocality-induced retinal blur as it is by other causes of image degradation such as small residual refractive error very early opacification of ocular media or dry eye. Multifocal intraocular lenses do not cause more functional aniseikonia than would be expected with a monofocal intraocular lens. Since stereoacuity is compromised with unilateral multifocal intraocular lens implantation bilateral implantation should be attempted.

Comparative analysis of visual quality between unilateral implantation of a trifocal intraocular lens and a rotationally asymmetric refractive multifocal intraocular lens.

To compare visual quality after unilateral cataract surgery with implantation of trifocal intraocular lens (IOL) and asymmetric refractive multifocal IOL. The prospective nonrandom, comparative study consisted of 60 eyes of 60 patients suffering unilateral cataract surgery with implantation of two different IOLs: AT LISA tri 839MP (30 eyes; Carl Zeiss Meditec, Germany) and LS-313 MF30 (30 eyes; Oculentis GmbH, Germany). Visual acuity, refractive outcome, contrast sensitivity, defocus curves, quality of vision, and optical phenomena were evaluated at 3mo postoperatively. There were no statistical differences between groups in uncorrected distance visual acuity (P=0.13) and uncorrected near visual acuity (P=0.54). In contrast, uncorrected intermediate visual acuity was better in trifocal group compared to the refractive multifocal group (P=0.02). No significant statistical between-group difference was detected in cylinder (P=0.43). Compared to trifocal group, spherical refraction and spherical equivalent in refractive multi focal group were more myopic (P<0.01). Under photopic conditions, no significant statistical differences were found between groups in contrast sensitivity at 3 and 6 cycles per degree (cpd). The refractive multifocal group performed better at 12 and 18 cpd than the trifocal group (P=0.01, P=0.034, respectively). The questionnaires of quality of vision and optical phenomena showed no differences between groups. Trifocal IOL is superior to refractive multifocal IOL in intermediate visual acuity. Rotationally asymmetric refractive multifocal IOL is more myopic in automated refraction and significantly better for the photopic contrast sensitivity at high frequency.

Laboratory Evaluation of Halos and Through-Focus Performance of Three Different Multifocal Intraocular Lenses.

To compare the halo features and through-focus performance of three different multifocal intraocular lenses (MIOLs) that provide distance, intermediate, and near vision in a clinical trial. A trifocal diffractive MIOL (AT LISA tri 839MP; Carl Zeiss Meditec), a diffractive extended depth-of-focus MIOL (TECNIS Symfony ZXR00; Abbott Laboratories, Inc), and a rotational asymmetric refractive MIOL (SBL-3; Lenstec, Inc) were assessed in a modified International Organization for Standardization eye model. The modulation transfer function (MTF) at the IOLs' foci was obtained using aperture sizes of 3 and 4.5 mm. Through-focus MTF curves were compared among all MIOLs. Images of the slit pattern were used to assess halo formation and characteristics. The AT LISA tri and Symfony IOLs showed symmetric halos. The halos of the AT LISA tri IOL were larger but weaker in distance and near foci, whereas the halos of the Symfony IOL were smaller and fainter in intermediate focus. The halos of the SBL-3 IOL were asymmetric and appeared as tangentially downward weaker halos. The optical performance of diffractive MIOLs gradually deteriorated as the aperture increased. The distance foci of the AT LISA tri and SBL-3 IOLs were of similar superior optical quality, the intermediate focus of the Symfony IOL showed the best optical quality, and the near focus of the SBL-3 IOL outperformed the near foci of the remaining IOLs. The differences in the design of the MIOLs translate to differences in optical performance at their foci, through-focus expressions, and halo features, which can provide further information to surgeons when selecting what IOL to implant. [J Refract Surg. 2022;38(9):552-558.].

Enhanced Stereopsis of Rotationally Asymmetric Multifocal Intraocular Lens With + 1.5 Diopters Near Addition.

To the Editor: Stereopsis is the highest level of binocular vision and contributes to the determination of depth and distance in solid object recognition. Currently, multi-focal intraocular lenses (IOLs) with various added powers are selected based on patient preferences and lifestyles. The European Society of Cataract and Refractive Surgery (ESCRS) Functional Vision Working Group report1 emphasized the importance of the postoperative functionality of near and intermediate vision, which are necessary for everyday activities. Conventional multifocal IOLs with 2 distinct foci provide patients with good far and near vision, but unsatisfactory intermediate vision. The use of low-addition multifocal IOLs (low-add IOLs) can improve intermediate vision.2 Herein, we discussed the stereopsis from far to near in patients implanted with low-add IOLs. Twenty-one patients bilaterally implanted with the low-add IOL (Lentis Comfort LS-313MF15 IOL, Santen Pharmaceutical) (69.7 ± 5.2 years, Low-add group) and 22 with the aspheric monofocal IOL (Tecnis ZCB00 V, Johnson & Johnson Surgical Vision) (69.7 ± 5.2 years, Monofocal group) were examined. All surgeries were performed using a standard technique of sutureless phacoemulsification under topical anesthesia by the same experienced surgeon. The low-add IOL was a foldable plate-haptic, rotationally asymmetric, refractive multifocal IOL, combining an aspheric distance vision zone and a sector-shaped near vision zone with an add power of + 1.5 diopters (D) on the lens plane, that was positioned inferiorly. Inclusion criteria were: 1) having postoperative distance-corrected visual acuity (DCVA) of Snellen 20/25 or better in both eyes, 2) refraction difference of < 2.0 D between both eyes, and 3) without manifest strabismus. DCVA and stereoacuity were measured at far (5 m, 2 m), intermediate (1 m, 70 cm, 50 cm), and near (30 cm) using a Binoptometer 4 P (Oculus Optikgeräte GmbH) at 2 months postoperatively. Significantly better distance-corrected intermediate visual acuity, and distance-corrected near visual acuity were attained in the Low-add group than in the Monofocal group (P < 0.001 for 50 cm and 70 cm; P < 0.01 for 30 cm and 1 m) (Supplemental Digital Content Fig. 1A, http://links.lww.com/APJO/A122) Stereoacuity at 30 cm and 50 cm was significantly better in the Low-add group than in the Monofocal group (Supplemental Digital Content Fig. 1B, http://links.lww.com/APJO/A122). The rates of normal range3 (≤ 100 seconds of arc for 5 m, 2 m, 1 m, 70 cm, 50 cm, and 30 cm) were 85%, 77%, 81%, 58%, 53%, and 24% in the Low-add group, while they were 82%, 64%, 59%, 37%, 18%, and 0% in the Monofocal group. The rates of normal range at 30 cm (P = 0.002) and 50 cm (P = 0.017) in the Low-add group were significantly higher than those in the Monofocal group. Consistent with a previous study,4 a low-add IOL provided good postoperative far and intermediate visual acuity. Unlike the double-peak curve pattern observed with conventional far/near bifocal IOLs, the DCVA showed a gradual decrease from far to near. The Titmus stereoscopic test is the most common test measured at a standardized distance (40 cm) as near ster-eoacuity. The current study measured ster-eoacuity under binocular natural viewing conditions at several distances to assess stereopsis similar to those experienced in everyday life. In the Monofocal group, the DCVA and the rates of the normal range of stereoacuity decreased with a shorter target distance. At a distance of 30 cm, no patient showed a normal range of stereoacuity. The effects of optical blur on stereopsis5 have been reported and are comparable to the results in the Monofocal group. In contrast, a normal range of stereoacuity was attained for 1 m to 5 m in approximately 80% of patients in the Low-add group. The Cat-quest-9SF QoL questionnaire6 for assessing intermediate vision1 should have been utilized; however, its validated Japanese version is not currently available. In summary, the rotationally asymmetric multifocal IOLs with + 1.5 D near addition provided enhanced stereoacuity and vision at near and intermediate levels compared with monofocal IOLs. It may be an option for enhanced functional vision, leading to better overall patient satisfaction.

Comparison of Anterior Capsule Polishing on the Rate of Neodymium: YAG Laser Capsulotomy After Two Multifocal Intraocular Lens Implantation.

PurposeTo compare the impact of anterior capsule polishing (ACP) during cataract surgery on the rate of neodymium: YAG (Nd: YAG) laser capsulotomy in pseudophakic eyes with two multifocal intraocular lenses (MIOLs).MethodsData were collected on patients who underwent cataract surgery and implanted segmental refractive MIOLs (SBL-3, Lenstec) or diffracted MIOLs (AT LISA tri 839MP, Carl Zeiss Meditec). The participants were divided into ACP and non-ACP groups based on whether the anterior capsule was polished. The primary outcome measure was whether Nd: YAG capsulotomy was performed during the 3 years follow-up. We used Kaplan–Meier survival curves to determine the time from IOL implantation to Nd: YAG laser capsulotomy.ResultsACP and non-ACP groups comprised 70 and 60 eyes, respectively. One year postoperatively, 7.14% of ACP group eyes and 8.33% of non-ACP group required Nd: YAG laser capsulotomy (P > 0.99). After 2 years, it was 24.29 and 18.33%, respectively (P = 0.52), while after 3 years, it reached 30.0 and 28.33% (P = 0.85). No distinct difference existed in the probability of using Nd: YAG laser in both groups evaluated using Kaplan-Meier survival curves (P = 0.81). Patients with diffractive MIOLs (AT LISA tri 839MP) implantation were more likely to require Nd: YAG laser capsulotomy (P < 0.01).ConclusionPolishing the anterior capsule had no remarkable effect on reducing the rate of Nd: YAG laser capsulotomy following phacoemulsification in MIOLs. Patients with diffractive MIOLs implantation had a high probability of requiring Nd: YAG laser capsulotomy.

Nd:YAG Capsulotomy Rates with Two Multifocal Intraocular Lenses.

PurposeTo investigate the incidence of Nd:YAG capsulotomy after implantation of two types of multifocal intraocular lenses (MIOLs).MethodsThis retrospective analysis included patients who had undergone cataract extraction and implanted diffractive MIOL (Acri. LISA tri 839M) or asymmetric refractive MIOL (SBL-3) from May 2016 to September 2018. They were followed up for at least 3 years. During the follow-up period, the relevant data of patients were kept by special person in the hospital. The rates of Nd:YAG capsulotomy and the Kaplan–Meier survival curve were used to analyze the two groups.ResultsThe Asymmetric Refractive MIOL group was comprised of 98 patients (121 eyes), while the Diffractive MIOL group was comprised of 99 patients (120 eyes). There were no significant differences in age, sex, or IOL power between the two groups. The Nd:YAG rate of the asymmetric refractive MIOL group and the diffractive MIOL group was 3.3% and 7.5% respectively (P = 0.15) in the first year, 14.88% and 22.5% respectively (P = 0.129) in the second year, and 21.49% and 34.17% respectively (P = 0.028) in the third year. In the first 7 months of follow-up, the two groups showed the same performance in the Nd:YAG rate. After that, there was a difference between the two groups, and the difference gradually increased. Until the 27th month of follow-up, the difference was significant (P < 0.05). What is more, there were significant differences in survival (without Nd:YAG capsulotomy)/failure (with Nd:YAG capsulotomy) functions (P = 0.0035).ConclusionThe incidence of Nd:YAG laser capsulotomy in patients with diffractive MIOLs was higher than that in patients with asymmetric refractive MIOLs.

Comparing prediction accuracy between total keratometry and conventional keratometry in cataract surgery with refractive multifocal intraocular lens implantation

We aimed to compare refractive outcomes between total keratometry using a swept-source optical biometer and conventional keratometry in cataract surgery with refractive multifocal intraocular lens (IOL) implantation. We included patients who underwent cataract surgery with refractive multifocal IOL implantation. The IOL power was calculated using conventional formulas (Haigis, SRK/T, Holladay 2, and Barrett Universal II) as well as a new formula (Barrett TK Universal II). The refractive mean error, mean absolute error, and median absolute error were compared, as were the proportions of eyes within ± 0.25 diopters (D), ± 0.50 D, and ± 1.00 D of prediction error. In total 543 eyes of 543 patients, the absolute prediction error of total keratometry was significantly higher than that of conventional keratometry using the SRK/T (P = 0.034) and Barrett Universal II (P = 0.003). The proportion of eyes within ± 0.50 D of the prediction error using the SRK/T and Barrett Universal II was also significantly higher when using conventional keratometry than total keratometry (P = 0.010 for SRK/T and P = 0.005 for Barrett Universal II). Prediction accuracy of conventional keratometry was higher than that of total keratometry in cataract surgery with refractive multifocal IOL implantation.

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.

Comparison of the visual performance between Oculentis MF30 and Tecnis ZMB00 multifocal intraocular lenses

BackgroundTo compare the visual performance of MF30 asymmetric refractive multifocal intraocular lenses (MIOLs) with ZMB00 all optic zone diffractive MIOLs.MethodsThis is a prospective study. Patients that underwent phacoemulsification were divided into two groups according to the type of MIOLs used: 35 patients were implanted with asymmetric refractive MIOLs and 35 patients with all optic zone diffractive MIOLs. Visual acuity (VA), refraction, defocus curves, objective optical quality, and a questionnaire evaluating quality of life were measured at 3 months postoperatively.ResultsThere were no significant differences between the two groups in uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), best-corrected distance visual acuity (BCDVA), or distance-corrected near visual acuity (DCNVA). However, the uncorrected intermediate VA was 0.24±0.10 in the refractive group and 0.31±0.13 in the diffractive group (P<0.05), and the distance-corrected intermediate VA was 0.22±0.09 in the refractive group and 0.31±0.14 in the diffractive group (P<0.05). Defocus curves showed two peaks of maximum vision in both groups. However, the curve between the two peaks in the refractive group was smoother than that of the diffractive group. The modulated transfer function cut-off frequency was 22.74±12.29 c/d in the refractive group and 30.50±10.04 c/d in the diffractive group (P<0.05). The Optical Quality Analysis System (OQAS) values 100% (OV100%) was 0.75±0.41 in the refractive group and 1.02±0.34 in the diffractive group (P<0.05), while the OV20% was 0.52±0.34 in the refractive group and 0.71±0.25 in the diffractive group (P<0.05). There was no significant difference between the two groups in overall satisfaction, spectacle independence ratio, or visual interference phenomenon.ConclusionsBoth MIOLs achieve good VA at distance and near vision. Oculentis MF30 showed better intermediate VA, and Tecnis ZMB00 appears to have better objective visual quality.Trial registrationNCT02234635 (http://www.clinicaltrials.gov).

Prospective assessment of plate-haptic rotationally asymmetric multifocal toric intraocular lens with near addition of +\u20091.5 diopters

BackgroundTo prospectively evaluate surgical results following implantation of rotationally asymmetric, plate-haptic, refractive segmented multifocal toric intraocular lenses (IOLs) with near addition of + 1.5 diopters (D) (Lentis Comfort LS-313 MF15T, Oculentis GmbH).MethodsIn 59 eyes of 41 patients, ocular examinations were conducted before and 1 day, 1 week, 1, 3, and 6 months after surgery. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuity at 70 cm, and uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity at 30 cm were tested. A defocus curve was drawn, and the degree of disturbing photic phenomena were questioned.ResultsThe IOL showed excellent rotational stability; the average absolute rotation was 1.66 ± 1.17 degrees from 1 day 1 to 6 months postoperatively, and 98.1 and 100% of eyes yielded rotation of less than 5 and 10 degrees, respectively. Postoperative distance and intermediate visual acuity were highly satisfactory; UDVA, CDVA, UIVA, and DCIVA were about 20/20, 20/16, 20/25, 20/25, respectively. Near visual acuity was suboptimal; UNVA and DCNVA were at approximately 20/60. The defocus curve analysis showed that 20/25 and 20/40 uncorrected visual acuity was attained at as close as 60 and 40 cm, respectively. Contrast sensitivity was within a normal range, and subjective photic phenomena were minimum.ConclusionsThe refractive segmented, rotationally asymmetric multifocal toric IOLs with + 1.5 D near addition showed superb rotational stability and highly satisfactory distance and intermediate vision. Contrast sensitivity was high and incidence of photic symptoms was very low.Trial registrationThis study was registered at JAPIC Clinical Trials Information, ID: JapicCTI-183,877, https://www.clinicaltrials.jp/cti-user/trial/Search.jsp (February 5, 2018).

Comparison of Nd:YAG Laser Capsulotomy Rates Between Refractive Segmented Multifocal and Multifocal Toric Intraocular Lenses

To investigate the early incidence of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy according to intraocular lens (IOL) type (nontoric vs toric) and surgical techniques (femtosecond laser-assisted cataract surgery vs conventional phacoemulsification) in eyes with refractive multifocal IOLs. Retrospective case-control study. Nine hundred thirteen eyes from 483 patients implanted with Lentis Mplus LS-313 MF20 (767 eyes) or Lentis Mplus Toric LU-313 MF20T (146 eyes) IOLs (Oculentis GmbH, Berlin, Germany) were enrolled. We compared the incidence of Nd:YAG laser capsulotomy between the nontoric and toric groups. In addition, the incidence of Nd:YAG laser capsulotomy was also evaluated according to the surgical technique used. The overall incidence of Nd:YAG laser capsulotomy was 10.2% (93/913 eyes). The Nd:YAG laser capsulotomy rate was significantly higher in the toric group (24/146; 16.4%) than in the nontoric group (69/767; 9.0%; P= .007). Of the 913 enrolled eyes, 448 eyes (49.1%) underwent femtosecond laser-assisted cataract surgery and 465 eyes (50.9%) underwent conventional phacoemulsification cataract surgery. There was no significant difference in the incidence of Nd:YAG laser capsulotomy between eyes with femtosecond laser-assisted cataract surgery and eyes with conventional phacoemulsification cataract surgery. Patients with refractive multifocal toric IOLs had higher early incidence rates of Nd:YAG laser capsulotomy when compared to those with refractive multifocal nontoric IOLs. Furthermore, femtosecond laser-assisted cataract surgery could not reduce the early incidence of Nd:YAG laser capsulotomy in this study.

Suitability of Different Observational Lenses for Viewing the Macular Area Through Multifocal Intraocular Lenses in a Model of the Human Eye.

PurposeMultifocal intraocular lenses (IOLs) can potentially affect the intraoperative view of the retina. We investigated the suitability of different lenses for viewing the macular area through two multifocal intraocular lenses in a human eye model.MethodsThis study compared the image quality of graduated index (0.1 mm) in a model eye when viewed through refractive or diffractive multifocal IOLs with a meniscus or flat contact lens, and a wide field 60 diopter non-contact lens or wide field contact lens (Super Macula®).ResultsImages acquired through the meniscus contact lens or flat contact lens via the central optical zone of the refractive multifocal IOL or the diffractive multifocal IOL were well focused. However, images viewed through these lenses near the center were warped and out of focus. All images viewed through a wide-field 60 diopter non-contact lens at the central optical zone and near the center were slightly out of focus. All images viewed through the Super Macula at the central optical zone and near the center were well focused.ConclusionA wide field contact lens (Super Macula®) made it possible to obtain clear images of the macular area at multiple focal points through refractive or diffractive multifocal IOLs.

Design and Evaluation of Refractive Multifocal Intraocular Lenses Implanted within the Human Eye

In this paper, optimum design of three classic model have been proposed, for refractive multifocal intraocular lenses (singlet, doublet, triplet-MIOLs) implanted within human eye (Liou & Brennan model). The analysis were carried out with ZEMAX-EE optical software through the polychromatic functions; MTF, PSF, spot diagram and (longitudinal-, Sphero-) chromatic aberration in addition to comparison with healthy eye. Due to good biocompatibility, AR40N Allergan and AcrySof SA60AT were used to design refractive MIOLs in unique and / or dual combination. Correction of the spherical aberration and longitudinal chromatic aberration (LCA) within 5° of visual field and 4 mm of pupil diameter were performed over the spectral region (455-655 nm). Result indicate that for all MIOLs proposed design (pseudophakic eye) sharp vision was achieved for a set of distances within range (25-108cm) but still much less than in healthy eye and pseudophakic eye with triplet-MIOLs implanted was the best model.

Efficacy of Oculentis refractive segmented multifocal intraocular lens implantation

Objective To evaluate the efficacy of Oculentis refractive segmented multifocal intraocular lens implantation. Methods The data of 120 eyes of 80 cases with cataract from Jan.2017 to Jan.2018 were analyzed retrospectively. All cases were divided into two group randomly. The trial group, 60 eyes of 40 cases, underwent phacoemulsification combined with Oculentis refractive segmented multifocal intraocular lens implantation. The control group, 60 eyes of 40 cases, underwent phacoemulsification combined with single focal lens implantation. The followed-up time was 1 year. Results At 1 year after operation, the difference of uncorrected distance visual acuity was not statistically significant (t=1.85, P=0.55). The difference of uncorrected near visual acuity and refractive condition were statistically significant between the two groups(t=14.85, 0.13; P=0.048, 0.027). The contrast sensivity in the trial group was better than that in the control group. The difference of contrast sensitivity was not statistically significant between the two groups(t=0.62, P=0.38). No comlication occurred in the trial group. Posterior capsule opacification occurred in 2 cases in control group. Conclusion The Oculentis refractive segmented multifcal intraocular lens implantation can provide good uncorrected visual acuity. Key words: Lens, intraocular, multifocal, Oculentis refractive segmented; Phacoemulsification; Cataract

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.

Clinical Results of Diffractive, Refractive, Hybrid Multifocal, and Monofocal Intraocular Lenses.

Purpose To present the outcomes of hybrid multifocal and monofocal intraocular lenses (IOLs) and to compare with refractive and diffractive multifocal IOLs (MFIOLs). Methods Three hundred twenty eyes (160 patients) underwent cataract surgery with randomized IOLs bilateral implantation. Changes in uncorrected and distance-corrected logMAR distance, intermediate and near (UNVA and DCNVA) visual acuity (VA), contrast sensitivity (CS), presence of dysphotopsia, spectacle independence, and patient satisfaction were analyzed. Results Postoperative VA in the hybrid (OptiVis) group was improved in all distances (p < 0.001). OptiVis acted superiorly to monofocal IOLs in UNVA and DCNVA (p < 0.001 for both) and to refractive ones in DCNVA (p < 0.005). Distance, mesopic, without glare CS in OptiVis was lower than in the monofocal group and similar to other MFIOLs. No differences in dysphotopsia pre- and postoperatively and spectacle independence in near for OptiVis and refractive MFIOLs were detected. OptiVis patients were more satisfied than those with monofocal IOLs (p=0.015). Conclusions After cataract surgery, patients with OptiVis improved VA in all distances. Near and intermediate VA was better than monofocal, and DCNVA was better than the refractive group. CS was lower in OptiVis than in the monofocal group, but there was no difference between MFIOLs. Patient satisfaction was higher in OptiVis than in the monofocal group. This trial is registered with NCT03512626.