Trifocal Intraocular Lens Research Articles

Visual outcomes and safety after bilateral implantation of a trifocal presbyopia correcting intraocular lens in a Korean population: a prospective single-arm study

BackgroundTo investigate the 3-month postoperative performance and safety after implantation of a trifocal intraocular lens (IOL) in a Korean population.MethodsThis was a clinical, prospective, multicenter, single-arm study. Forty-four subjects (88 eyes) with bilateral cataract with expected postoperative corneal astigmatism of < 1.00 diopter (D) and no ocular disease or eye condition underwent bilateral implantation of the AcrySof IQ® PanOptix IOL (TFNT00). Postoperative examination at 3 months included binocular defocus curve; binocular best corrected distance visual acuity (BCDVA); monocular/binocular uncorrected VA (UCVA) at distance (4 m), intermediate (60 cm), and near (40 cm); contrast sensitivity under photopic conditions with/without glare; and subjective outcomes, including satisfaction and spectacle independence.ResultsBinocular defocus curve at 3 months after bilateral implantation showed VA of 0.1 logMAR or better from + 0.5 D through − 2.5 D. Binocular BCDVA mean ± SD at 4 m was − 0.05 ± 0.07 logMAR. Binocular and monocular UCVA was 0.03 ± 0.1 and 0.08 ± 0.12 logMAR (4 m), − 0.00 ± 0.11 and 0.05 ± 0.13 logMAR (60 cm), and 0.03 ± 0.12 and 0.09 ± 0.13 logMAR (40 cm), respectively. Contrast sensitivity with glare was 1.67 ± 0.13, 1.91 ± 0.17, 1.54 ± 0.21, and 1.14 ± 0.20 log units at 3, 6, 12, and 18 cycles/degree, respectively. At near and intermediate distances, 84 and 77% of subjects reported good/excellent satisfaction, and 84 and 91% of subjects reported spectacle independence, respectively.ConclusionsIn a Korean population, visual performance of the trifocal TFNT00 IOL 3 months postoperatively was < 0.1 logMAR for binocular UCVA at all distances, with high subject satisfaction and spectacle independence.Trial registrationwww.ClinicalTrials.gov (NCT03268746). Registered August 31, 2017.

Trifocal intraocular lenses versus bifocal intraocular lenses after cataract extraction among participants with presbyopia.

Presbyopia occurs when the lens of the eyes loses its elasticity leading to loss of accommodation. The lens may also progress to develop cataract, affecting visual acuity and contrast sensitivity. One option of care for individuals with presbyopia and cataract is the use of multifocal or extended depth of focus intraocular lens (IOL) after cataract surgery. Although trifocal and bifocal IOLs are designed to restore three and two focal points respectively, trifocal lens may be preferable because it restores near, intermediate, and far vision, and may also provide a greater range of useful vision and allow for greater spectacle independence in individuals with presbyopia. To assess the effectiveness and safety of implantation with trifocal versus bifocal IOLs during cataract surgery among participants with presbyopia. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 9); Ovid MEDLINE; Embase.com; PubMed; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 26 September 2019. We searched the reference lists of the retrieved articles and the abstracts from the Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO) for the years 2005 to 2015. We included randomized controlled trials that compared trifocal and bifocal IOLs among participants 30 years or older with presbyopia undergoing cataract surgery. We used standard Cochrane methodology. We identified five studies conducted in Europe with a total of 175 participants. All five studies assessed uncorrected distance visual acuity (primary outcome of the review), while some also examined our secondary outcomes including uncorrected near, intermediate, and best-corrected distance visual acuity, as well as contrast sensitivity. Study characteristics All participants had bilateral cataracts with no pre-existing ocular pathologies or ocular surgery. Participants' mean age ranged from 58 to 64 years. Only one study reported on gender of participants, and they were mostly women. We assessed all the included studies as being at unclear risk of bias for most domains. Two studies received financial support from manufacturers of lenses evaluated in this review, and at least one author of another study reported receiving payments for delivering lectures with lens manufacturers. Findings All studies compared trifocal versus bifocal IOL implantation on visual acuity outcomes measured on a LogMAR scale. At one year, trifocal IOL showed no evidence of effect on uncorrected distance visual acuity (mean difference (MD) 0.00, 95% confidence interval (CI) -0.04 to 0.04; I2 = 0%; 2 studies, 107 participants; low-certainty evidence) and uncorrected near visual acuity (MD 0.01, 95% CI -0.04 to 0.06; I2 = 0%; 2 studies, 107 participants; low-certainty evidence). Trifocal IOL implantation may improve uncorrected intermediate visual acuity at one year (MD -0.16, 95% CI -0.22 to -0.10; I2= 0%; 2 studies, 107 participants; low-certainty evidence), but showed no evidence of effect on best-corrected distance visual acuity at one year (MD 0.00, 95% CI -0.03 to 0.04; I2= 0%; 2 studies, 107 participants; low-certainty evidence). No study reported on contrast sensitivity or quality of life at one-year follow-up. Data from one study at three months suggest that contrast sensitivity did not differ between groups under photopic conditions, but may be worse in the trifocal group in one of the four frequencies under mesopic conditions (MD -0.19, 95% CI -0.33 to -0.05; 1 study; I2 = 0%, 25 participants; low-certainty evidence). In two studies, the investigators observed that participants' satisfaction or spectacle independence may be higher in the trifocal group at six months, although another study found no evidence of a difference in participant satisfaction or spectacle independence between groups. Adverse events Adverse events reporting varied among studies. Two studies reported information on adverse events at one year. One study reported that participants showed no intraoperative or postoperative complications, while the other study reported that four eyes (11.4%) in the bifocal and three eyes (7.5%) in the trifocal group developed significant posterior capsular opacification requiring YAG capsulotomy. The certainty of the evidence was low. There is low-certainty of evidence that compared to bifocal IOL, implantation of trifocal IOL may improve uncorrected intermediate visual acuity at one year. However, there is no evidence of a difference between trifocal and bifocal IOL for uncorrected distance visual acuity, uncorrected near visual acuity, and best-corrected visual acuity at one year. Future research should include the comparison of both trifocal IOL and specific bifocal IOLs that correct intermediate visual acuity to evaluate important outcomes such as contrast sensitivity and quality of life.

Long-term objective and subjective outcomes following bilateral implantation of diffractive bifocal or trifocal intraocular lenses.

To evaluate and compare the objective and subjective outcomes after the bilateral implantation of a diffractive bifocal and trifocal intraocular lens. This is a case-control, single-center observational study which included 27 patients; 16 patients were implanted bilaterally with the bifocal AcrySof IQ ReSTOR+3.0D and 11 patients with the trifocal AT LISA tri 839MP. Uncorrected visual acuity at distance, intermediate, and near under mesopic and photopic conditions using ETDRS charts with 10% and 100% contrast, corrected distance visual acuity, and binocular defocus curve in photopic conditions; binocular contrast sensitivity under mesopic and photopic conditions for far and near distances were assessed. The Visual Function Questionnaire-25 questionnaire was used to assess patients' satisfaction. All the measurements were performed 6-24 months after cataract surgery. The ReSTOR group had better binocular uncorrected near visual acuity in photopic conditions with low and high contrast charts (p = 0.040 and p = 0.033, respectively), as well as in far contrast sensitivity measurement under mesopic conditions with a spatial frequency of 3 cycles per degree (p = 0.034). There was not a significant difference between the two study groups in uncorrected near, intermediate or distance vision under mesopic conditions. The AT LISA tri study group had better subjective outcomes. Both intraocular lenses restore visual acuity after cataract surgery. The ReSTOR intraocular lens provides better objective outcomes than the AT LISA tri, although the latter provides better subjective outcomes. The relevance of this study is the evaluation of both objective and subjective outcomes.

Visual Outcomes and Subjective Experience After Combined Implantation of Extended Depth of Focus and Trifocal IOLs.

To evaluate postoperative visual performance and patient-reported outcomes following combined implantation of an extended depth of focus (EDOF) intraocular lens (IOL) and a trifocal IOL. The study enrolled consecutive patients undergoing refractive lens extraction or cataract surgery with combined implantation of an EDOF IOL (dominant eye) and a trifocal IOL in the nondominant eye. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, uncorrected intermediate (UIVA) and near (UNVA) visual acuities, defocus curves, and subjective questionnaires were evaluated 1 month postoperatively. The study enrolled 100 consecutive patients (200 eyes). The postoperative mean binocular UDVA, UIVA, and UNVA were -0.08 ± 0.07, 0.13 ± 0.12, and 0.17 ± 0.11 logMAR, respectively. The percentage of eyes within ±0.50 and ±1.00 diopters of the refractive target was 65% and 96% with EDOF IOLs, and 76% and 99% with trifocal IOLs, respectively. Of all patients, 91% were satisfied or more than satisfied with the procedure, and 87% of patients were spectacle free for near vision. On a scale from 0 (not at all) to 3 (very), mean scores of 0.52 ± 0.83, 0.71 ± 0.83, and 0.34 ± 0.73 were reported for glare, halos, and starbursts. The mean daytime and nighttime Quality of Vision scores were 9.13 ± 0.91 and 7.96 ± 1.57, respectively. The combination of an EDOF IOL and a trifocal IOL provides good unaided visual acuity for distance and near. This IOL combination provides high postoperative satisfaction and functional vision, but some early visual side effects were reported. [J Refract Surg. 2020;36(5):326-333.].

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.

Duet procedure to achieve reversible trifocality

Funktionelle Ergebnisse und das Auftreten von Nebenwirkungen (insbesondere photischer Phänomene) können beim Einsatz multifokaler Intraokularlinsen (IOL) schwer vorhergesagt werden. Des Weiteren können Patienten im Laufe des Lebens Erkrankungen entwickeln, bei denen eine multifokale Optik von Nachteil sein kann. In diesen Fällen ist ein Austausch der IOL die einzige Therapieoption. Die Implantation einer monofokalen oder monofokal-torischen IOL in den Kapselsack und einer additiven trifokalen IOL in den Sulcus ciliaris in einer als Duett-Verfahren bezeichneten Operation ermöglicht Trifokalität, die bei Bedarf vergleichsweise einfach wieder rückgängig gemacht werden kann.Video onlineDie Online-Version dieses Beitrags (10.1007/s00347-020-01096-4) enthält ein Video.

Automated refraction after trifocal and trifocal toric intraocular lens implantation.

To analyze the correlation between automated refraction and manifest refraction after implantation of a trifocal intraocular lens or its toric version. This cross-sectional study involved 105 eyes of 105 patients. Subjects were divided in two groups: 62 with trifocal (AcrySof PanOptix) and 43 with trifocal toric (AcrySof PanOptix Toric) intraocular lenses. Automated refraction was employed as starting point for obtaining the manifest refraction. Automated refraction and manifest refraction measurements were analyzed and compared using the vector analysis 3 months after the surgery. In both groups, the higher differences between automated refraction and manifest refraction measurements were found for the cylinder and the spherical equivalent (M). Cylinder values for PanOptix were: -0.60 ± 0.36 D with automated refraction and -0.17 ± 38 D with manifest refraction (p < 0.001); for PanOptix Toric, the values were: -0.49 ± 0.31 D with automated refraction and -0.05 ± 0.21 D with manifest refraction (p < 0.001). M values for PanOptix were: -0.23 ± 0.31 D with automated refraction and -0.03 ± 0.16 D with manifest refraction (p < 0.001); for PanOptix Toric, the values were: -0.13 ± 0.40 D with automated refraction and 0.01 ± 0.12 D with manifest refraction (p < 0.001). For the PanOptix group, intraclass correlation coefficients were: 0.51 (sphere), 0.64 (cylinder), 0.42 (M), 0.62 (J0), and 0.37 (J45). For the PanOptix Toric group, the intraclass correlation coefficients were: 0.39 (sphere), 0.61 (cylinder), 0.39 (M), 0.53 (J0), and 0.09 (J45). The results of this study suggest that patients implanted with the trifocal and the trifocal toric intraocular lens under study showed similar automated refraction results between them, with a slight trend to more negative amounts of cylinder and M. Nevertheless, clinicians should carefully confirm all parameters of the refraction with manifest refraction.

Spectacle Independence for Pseudophakic Patients - Experience with a Trifocal Supplementary Add-on Intraocular Lens.

PurposeTo evaluate the refractive and functional outcomes of the trifocal 1stQ AddOn® (Medicontur) supplementary intraocular lenses (IOLs) designed for implantation into the ciliary sulcus.Patients and MethodsThe study included 18 eyes of 11 pseudophakic patients with uncomplicated previous implantation of monofocal capsular bag IOLs. These patients had a desire for spectacle independence. Distance, intermediate and near visual acuities were measured, and defocus curves were plotted over a period of 6 months following implantation of the add-on IOLs. Intraocular pressure (IOP), endothelial cell density measurements and biomicroscopic evaluation were also performed.ResultsIn this study, 83.3% of eyes had spherical refractions within ±0.5 D from emetropia and 100% of eyes had spherical equivalent refractions that were within ±1.0 D of the target refraction. Visual acuities and defocus curves clearly confirmed trifocal optical performance (UDVA=0.03 ±0.05; UIVA=0.21 ±0.04; UNVA=0.12 ±0.04 logMAR; expressed as mean ±SD). Depth of focus showed identical results (DOF=0.486 D) compared to a trifocal capsular bag IOL, while the defocus curve was found to be superior in the intermediate and near ranges when compared to a trifocal capsular bag IOL. All patients achieved spectacle independence at all distances. All add-on IOLs were well positioned in the ciliary sulcus. No negative changes were noted in connection with endothelial cell counts, IOPs, the angle structure during surgery and during the follow-up period.ConclusionThe supplementary trifocal add-on IOL seems to be a safe, efficient and stable solution for achieving spectacle independence in pseudophakic patients with monofocal primary IOLs.

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.

Implantation of a Trifocal Intraocular Lens in High Myopic Eyes with Nasal-Inferior Staphyloma.

PurposeTo assess visual outcomes in high myopic eyes with nasal-inferior staphyloma implanted with a pseudophakic trifocal intraocular lens (IOL).MethodsWe retrospectively analyzed the visual outcomes of 50 eyes of 45 patients who had cataract surgery after AT LISA trifocal IOL implantation. Twenty-five eyes diagnosed with posterior staphyloma (nasal-inferior, type IV and V), and 25 eyes as long eyes. Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) values were used to assess the efficacy and safety of the surgery. Refraction and defocus curves were also evaluated at 6 months.ResultsNo intra- or post-operative problems occurred during the 6 months of follow-up. After the surgery, the mean Snellen decimal UDVA ranged from 0.50 to 1.00, and CDVA from 0.60 to 1.00 for both groups. CDVA was 0.91 and 0.74 for the long eye and nasal-inferior staphyloma groups, respectively. Efficacy and safety indexes were 1.22 and 1.32 for the long eye, and 1.26 and 1.43 for the nasal-inferior staphyloma group, respectively. All eyes of both groups showed a postoperative spherical equivalent within ±1.00D. The long eye group showed the highest percentage of spherical equivalent between −0.13D and +0.13D (56%) and the nasal-inferior staphyloma group was between −0.51D and −0.14D (40%).ConclusionThe outcomes of the present study show that a trifocal IOL provides good visual acuity in high myopic eyes, being worse for nasal-inferior staphyloma eyes. The degree of tilt of the macular plane is related with the expected visual acuity.

Influence of angle κ on visual and refractive outcomes after implantation of a diffractive trifocal intraocular lens.

To evaluate changes in angle κ after the implantation of a trifocal intraocular lens (IOL) and to assess the postoperative outcomes of patients with different angle κ values. IOA Madrid Innova Ocular, Madrid, Spain. Prospective trial. Sixty-three eyes from 63 patients who had bilateral implantation of a diffractive trifocal IOL (POD F, PhysIOL) were included. Pupil offset was used as the best estimate of angle κ and was measured using Pentacam (Oculus) preoperatively and at 3 months postoperatively. Postoperative refractive outcomes (sphere, cylinder, and manifest refraction spherical equivalent) and visual outcomes at far, intermediate, and near distance were assessed and compared between eyes with small pupil offset and eyes with large pupil offset. Quality of vision was assessed using a subjective questionnaire. There was a significant decrease in pupil offset values postoperatively (mean: 0.197 ± 0.12 mm) compared with those preoperatively (mean: 0.239 ± 0.12 mm), with a mean decrease of -0.042 mm (P = .0002). The same significant decrease was found for both right and left eyes, when analyzed separately. No statistically significant difference was found in any of the refractive and visual acuity outcomes between eyes with small pupil offset and eyes with large pupil offset. The majority of patients (14 of 16) complaining of significant halos had eyes with small pupil offset. Large pupil offset did not negatively affect visual and refractive outcomes. The tolerance to larger pupil offset might be due to the IOL optical design, with the first diffractive ring being larger than other commonly used multifocal IOLs. More studies comparing various diffractive IOL models would be useful to confirm such hypothesis.

A novel standardized test system to evaluate dynamic visual acuity post trifocal or monofocal intraocular lens implantation: a multicenter study.

To compare the dynamic visual acuity (DVA) following implantation of trifocal with monofocal intraocular lenses (IOL) and using a novel test system. The present research was a retrospective, multicenter clinical study. Two hundred and ten eyes of 149 patients that underwent cataract phacoemulsification and IOL implantation were enrolled. One hundred and ten eyes of patients received trifocal (AT LISA tri839MP, Carl Zeiss Meditec, Germany) and 100 eyes received monofocal (Tecnis ZCB00, Abbott, United States) lenses and were evaluated 3 months after implantation. Outcome measures included monocular uncorrected distance (UDVA), intermediate (UIVA) and near (UNVA) visual acuity and best corrected distance visual acuity (BCDVA; logMAR units); contrast sensitivity under photopic, mesopic, with glare conditions; and dynamic visual acuity using a self-developed system. There was no statistically significant difference in baseline characteristics between groups. Monocular UDVA, UIVA, and UNVA were significantly better (all p < 0.001) in the trifocal IOL group, but not BCDVA. The trifocal IOL group showed better contrast sensitivity under photopic, mesopic, with or without glare conditions (p < 0.05) and statistically significantly better dynamic vision at 15, 30, 60, and 90 degrees per second (dps) compared with the monofocal group (all p < 0.001). The strength of positive association only between UIVA and dynamic visual acuity increased as the velocity increased, but not UDVA or UNVA. Diffractive trifocal IOL provides better postoperative full range vision acuity, contrast sensitivity, and dynamic vision compared with monofocal IOLs. And intermediate visual acuity is increasingly associated with DVA as the velocity increasing.

Ray propagation imaging and optical quality evaluation of different intraocular lens models.

PurposeRay propagation visualization and optical performance analysis of four different intraocular lenses (IOLs)MethodsIn this laboratory study, four IOLs with different optical designs were assessed: a monofocal AcrySof IQ SN60WF [Alcon], a diffractive-refractive bifocal AcrySof IQ Restor SN6AD1 [Alcon], a diffractive trifocal AcrySof IQ PanOptix TFNT00 [Alcon], and a diffractive extended-depth-of-focus (EDOF) Symfony ZXR00 [Johnson&Johnson]. An experimental set-up with a water bath containing 0.01% fluorescein solution and monochromatic green laser light (532 nm) was used to visualize the propagation of light rays. Also, the optical performance of the IOLs was evaluated by measuring the modulation transfer function (MTF) values at a pupil sizes of 3.0 and 4.5 mm on the optical bench OptiSpheric® IOL PRO II (Trioptics GmbH, Germany).ResultsBoth the diffractive-refractive bifocal IOL and the EDOF IOL showed two defined foci for distance and near vision. In the diffractive trifocal IOL, three distinct foci for distance, intermediate, and near vision could be visualized.ConclusionsThe ray propagation visualization technique allows a qualitative assessment and comparison of light energy distribution between different IOL models. The measured Through-Focus Response (TFR) quantitatively confirmed the evaluated ray propagation behavior.

Comparison of visual and refractive outcomes of 2 trifocal intraocular lenses.

To compare clinical outcomes after cataract surgery and bilateral implantation of 2 diffractive trifocal toric intraocular lenses (IOLs). Hospital da Luz, Lisbon, Portugal. Double-arm, randomized, prospective case series. A total of 60 patients were randomly allocated to receive bilateral implantation of either the FineVision Pod FT toric IOL (PhysIOL) or the AcrySof IQ PanOptix toric IOL (Alcon). Visual and refractive outcomes, contrast sensitivity, IOL misalignment, and quality of vision outcomes (QoV questionnaire) were evaluated at 3 months postoperatively. Surgically induced astigmatic changes were evaluated by vector analysis. Each group (FineVision toric and AcrySof IQ PanOptix toric) comprised 30 patients (60 eyes). No significant differences between groups were found regarding uncorrected and corrected distance and near visual outcomes (P ≥ .333). Mean postoperative distance-corrected intermediate visual acuity at 60 cm was 0.04 ± 0.09 logarithm of the minimum angle of resolution (logMAR) and 0.09 ± 0.11 logMAR in the PanOptix and Pod FT group, respectively (P = .032). Mean IOL axis misalignment was 1.59 degrees ± 2.15 degrees (PanOptix group) and 1.89 degrees ± 3.31 degrees (Pod FT group) (P = .821). Mean magnitude of error of astigmatic correction was -0.09 diopters (D) and -0.11 D in the PanOptix group and Pod FT group, respectively (P = .333). Contrast sensitivity, QoV scores for the presence of photic phenomena, and the level of spectacle independence were similar in both groups (P > .05). Both trifocal toric IOLs allowed complete patient visual restoration, and good spectacle independence and good visual quality outcomes. The PanOptix IOL provided superior intermediate visual acuity for distances around 60 cm.

Refractive and Visual Outcomes After Bilateral Implantation of a Trifocal Intraocular Lens in a Large Population.

PurposeTo review refractive, visual acuity, defocus curve and contrast sensitivity results after bilateral implantation of a trifocal intraocular lens (IOL) in a large population.SettingOne site in Santiago, Chile.DesignSingle arm, non-randomized retrospective chart review.MethodsThis was a single-arm retrospective chart review of clinical outcomes after bilateral implantation of a trifocal IOL (Panoptix®), both toric and non-toric versions. Binocular visual acuity at 4 m, 60 cm and 40 cm was tested. Other tests included refraction, mesopic and photopic contrast sensitivity, and defocus curve measurement.ResultsThe review included 500 eyes of 250 patients implanted with the trifocal IOL and 200 eyes of 100 patients implanted with the trifocal toric IOL, with no clinically significant differences between groups. Ninety-six percent of all eyes were within 0.50D of the intended spherical equivalent correction. In the toric group, 94% of eyes (187/200) had a residual refractive cylinder ≤0.50D, compared to 81% of eyes (406/500) in the non-toric group. Four out of five patients (80.6%, 282/350) had a binocular uncorrected VA of 0.1 logMAR (20/25) at all test distances. Mean defocus was 0.1 logMAR or better from vergences from 0.00 to −3.00 D (corresponding to vision from distance to about 33 cm). With a cutoff of 0.2 logMAR, 96% of patients had a range of vision 2.5 D or greater. Contrast sensitivity was similar between the toric and non-toric lenses, and similar to age-matched normal results.ConclusionThe non-toric and toric trifocal IOLs provided good distance, intermediate and near vision to patients, with a wide range of vision and good contrast sensitivity.

Quality of life of patients after phacoemulsification with implantation of trifocal intraocular lens

To study the QoL of patients with trifocal and monofocal intraocular lenses 1 year after cataract surgery. The study included 44 patients divided into two groups: in group 1 - after bilateral implantation of trifocal intraocular lenses, in group 2 - after bilateral implantation of monofocal intraocular lenses. The quality of life of patients in these groups was studied using the VF-14 questionnaire. Additionally, the NAVQ-10 questionnaire was used to study the QoL depending on near vision, satisfaction with the surgery outcome, and the presence and frequency of dysphotopsias. The quality of life of the patients with trifocal intraocular lenses is significantly higher than with monofocal intraocular lenses according to the VF-14 questionnaire (92.61±7.57 in group 1 and 60.96±3.99 in group 2, p<0.001). Using the NAVQ-10 questionnaire, 68.1% of patients with trifocal lenses were found to have no problems with near vision, 82% of them had high satisfaction with the operation result. 4.5% of patients had intensive dysphotopsias in the dark, 41.0% of patients reported light haloes around light sources during the dark hours and night-time, and 54.5% have not reported any dysphotopsias. Trifocal intraocular lenses ensure higher quality of life for patients after phacoemulsification when compared with monofocal lenses. Dysphotopsias have some effect on the QoL of patients with multifocal correction, but 82% of them are highly satisfied with the surgery outcome.

Refractive results, visual quality and patient satisfaction with a new trifocal intraocular lens design

Aim: To evaluate the outcomes after bilateral implantation of a new trifocal intraocular lens (IOL).Materials and Methods: The study included patients with visually significant cataract that underwent bilateral implantation of the Acriva Trinova Sinusoidal Trifocal IOL. The preoperative corrected distance visual acuity (CDVA) and postoperative uncorrected distance visual acuity (UDVA), CDVA, uncorrected intermediate (UIVA) and near visual acuities (UNVA) along with manifest refractions were assessed at 1 month and 6 months after cataract surgery. The defocus curve and contrast sensitivity (CS) were evaluated at the 6th month visit. Patient satisfaction and incidence of dysphotopic symptoms were assessed. Results: The study enrolled a total of 60 eyes of 30 patients, 10 males and 20 females aged 61.78± 8.73 years (range, 45 to 78 years). 90% of the patients (n: 27) achieved a binocular UIVA of 0.1 LogMAR or better at the 6-month visit while, 96.7% (n:29) patients had a binocular UNVA of 0.1 LogMAR or better in the same postoperative visit. The CS results were within the the range of normality at 6 months post-surgery. 6.7% of patients reported marked halo around light sources and 3.3% reported glare that interferes with nighttime driving. 96.6% of the patients reported spectacle independence for all distances and rated their visual function and quality satisfactory at all distances. Conclusion: Bilateral implantation of the Acriva Trinova Sinusoidal Trifocal IOL seems to provide effective restoration of visual function at all distances after cataract surgery in the majority of patients. Contrast sensitivity results and low incidence of dysphotopic phenomena might be associated with high patient satisfaction.

Visual and subjective outcomes following trifocal intraocular lens implantation in Iranian cataractous patients.

BACKGROUND:The aim of this study was to evaluate visual and refractive outcomes and quality of vision after implantation of the AT LISA tri 839MP intraocular lens (IOL).PATIENTS AND METHODS:This interventional clinical trial comprised 46 cataractous eyes of patients who underwent phacoemulsification with IOL implantation (mean age of 58.08 ± 11.01 years; range: 36–76 years old). Spherical equivalent (SE), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), corrected intermediate visual acuity (CIVA), uncorrected near visual acuity (UNVA), and corrected near visual acuity (CNVA) were measured 1, 3, and 6 months after surgery. Contrast sensitivity (CS) was measured at 6 months. Subjective quality of vision and presence of dysphotopsia by a short questionnaire were evaluated postoperatively.RESULTS:At 6 months, the mean visual acuity was 0.08 ± 0.11, 0.03 ± 0.08, 0.07 ± 0.09, 0.02 ± 0.08, 0.05 ± 0.09, and 0.02 ± 0.08 LogMAR for UDVA, CDVA, UIVA, CIVA, UNVA, and CNVA, respectively. The mean values of SE were − 0.4728 ± 0.32D. These variables improved over time, yet significant changes were detected in UDVA (P = 0.009) and SE (P = 0.0001). The mean CS value was 1.74 ± 0.08. The mean scores (0% = no symptoms; 100% = strong symptoms/unable to perform activities) for glare and halos were 7.07 ± 0.22% and 8.70 ± 0.23%, respectively. These items were reduced over time. Patients’ level of satisfaction mean score for performing activities was 96.66%.CONCLUSIONS:The AT LISA tri 839MP IOL provides excellent uncorrected distance, intermediate and near vision, and CS. This IOL showed a minimal level of photic phenomena and a high level of patient satisfaction.

Comparative analysis of the functional results after implantation of various diffractive trifocal intraocular lenses

To compare visual outcomes after implantation of two models of diffractive trifocal IOLs using various vision assessment systems. The study included 25 patients (25 eyes) who were implanted with AcrySof IQ PanOptix (TFN) and 25 patients (25 eyes) implanted with AT LISA tri 839 MP (TRI). Postoperative examination at 1 year included assessment of monocular visual acuity for far, intermediate and near distance using decimal scale, as well as LogMAR and an interactive computer program (ICP). Contrast sensitivity was assessed with the Optec 6500 device. A questionnaire was used to evaluate subjective quality of vision and the intensity of optical phenomena. Uncorrected visual acuity (UCVA) at distance, intermediate and near was better in the TFN group in comparison with the TRI group as measured with decimal scale, ICP and LogMAR. Under photopic and mesopic conditions with and without glare, at all spatial frequencies the contrast sensitivity function (CSF) was higher after implantation of TFN in comparison with TRI. The average VF-14 score was 97.2 after implantation of TFN and 96.7 after implantation of TRI. The amount of patients who required spectacle correction after the surgery was 5.5% less in the TFN group compared to the TRI group. High visual outcomes at all distances were observed in patients after implantation of both trifocal IOLs with TFN showing a slight advantage. Evaluation of the visual outcomes using various systems showed the benefits of the ICP assessment. The CSF had typical configuration with maximum value in the mid-range region and a decrease in the high-frequency range after implantation of both IOLs, however the indicators were better in the TFN group. The postoperative period was characterized by high levels of patient satisfaction and spectacle independence in both groups.

Efficacy of trifocal intraocular lens: visual outcomes and patient satisfaction

Efficacy of trifocal intraocular lens: visual outcomes and patient satisfaction