Trifocal Intraocular Lens Research Articles

Comparison of Postoperative Outcomes of Trifocal Intraocular Lens with Enhanced Depth of Field and Diffractive Bifocal Intraocular Lens

Comparison of Postoperative Outcomes of Trifocal Intraocular Lens with Enhanced Depth of Field and Diffractive Bifocal Intraocular Lens

Prediction of Visual Acuity and Contrast Sensitivity From Optical Simulations With Multifocal Intraocular Lenses.

To evaluate whether the prediction of visual performance based on the modulation transfer function area (MTFa) calculated with optical simulations is better correlated with visual acuity or contrast sensitivity obtained from defocus curves in patients implanted with a trifocal intraocular lens. Biometric eye data from 43 patients were used to create a mean eye model. A trifocal intraocular lens with a power obtained from the mean of the eyes implanted was incorporated into the model and the MTFa was calculated at the 11 defocus planes corresponding the 11 defocus locations measured in clinical practice. Simulations were conducted for pupil diameters of 2.5, 3, 3.5, and 4 mm. The MTFa correlation with visual acuity and contrast sensitivity was evaluated with the mean obtained after stratification of the clinical sample in four groups according to the previous pupil diameters. A linear model predicted the visual acuity and contrast sensitivity from MTFa with similar accuracy to nonlinear models, with R2 approximately 0.50 for visual acuity and approximately 0.42 for contrast sensitivity. A change of -0.01 logMAR and -0.02 logC was produced per unit of MTFa for visual acuity and contrast sensitivity, respectively. The mean difference between the visual acuity and contrast sensitivity obtained from the model and that measured in clinical practice was close to zero, but the bias varied depending on the defocus lens used, with higher deviation at -0.50 and -3.00 diopters of defocus. The MTFa obtained from optical simulations can be used to predict the mean visual acuity and contrast sensitivity consistently, with contrast sensitivity being more sensitive but with higher bias. [J Refract Surg. 2019;35(12):789-795.].

Lens Surgery: Implantation of Multifocal Intraocular Lenses

Lens exchange surgery is the most common performed surgical ophthalmological procedure worldwide. The intraocular lens (IOL) is placed into the capsular bag. The power of the IOL decides whether afterwards the patient will be able to see objects in the far or near distance without glasses. Due to constant development of the IOL design in nowadays it is however possible to implant a lens which has multiple foci and consequently allows the patient to see in several distances. In this review article we summarize the most critical points which need to be considered when placement of a multifocal lens is planned in lens exchange surgery. Additionally, we present an overview of the currently available trifocal IOLs and IOLs with an extended depth of focus. We furthermore discuss the advantages and disadvantages of the multifocal IOLs as compared to monofocal IOLs.

Presbyopia Correction with Intraocular Lenses

Surgical correction of presbyopia can be performed by refractive lens exchange, replacing the lens with a monofocal, a multifocal or an extended-depth-of-focus (EDOF) intraocular lens (IOL). Option 1, a monofocal IOL, must be combined with monovision, otherwise presbyopia cannot be corrected. Monovision in this context means one eye for distance and one eye targeted for - 1.5 D. With this concept glasses are still required for near (30 - 40 cm) and for driving, but intermediate distances and everyday life is usually possible without glasses. Option 2, a multifocal IOL, results in spectacle independence. Current multifocal IOL typically use three foci and are therefore called trifocal IOL. Distance vision and near vision are typically good, intermediate vision still acceptable but lower than distance and near, resulting in occasional problems while working on a computer. Option 3, EDOF-IOL, provide good distance and intermediate vision without glasses but near vision typically requires reading glasses.

Visual And Refractive Outcomes In Hyperopic Pseudophakic Patients Implanted With A Trifocal Intraocular Lens.

PurposeTo assess visual and refractive results after bilateral implantation of a trifocal intraocular lens (IOL) in patients with hyperopia.MethodsIn a retrospective nonrandomized study, 196 eyes of 98 patients had bilateral implantation of a trifocal IOL. The Barrett Universal II formula was used for IOL power calculation. Eyes were divided into two groups for their analysis: low-moderate, with IOL power ranging from 22 to 26 D, and high, with IOL power ranging from 25 to 34 D. Refractive error was used to assess predictability, and corrected distance visual acuity (CDVA) and uncorrected distance visual acuity values were used to assess efficacy and safety of the surgery.ResultsSix months postoperatively, our results revealed a Snellen decimal CDVA of 0.97±0.05 and 0.94±0.09, for the low-moderate and high groups, respectively. The low-moderate hyperopia group showed a 75.23% of eyes with 20/20 of CDVA and 100% of eyes with 20/25 of CDVA, and the high hyperopia group showed 60.95% and 94.29% for these values of visual acuity, respectively. The mean postoperative spherical equivalent was −0.25±0.36D and −0.24±0.42D for low-moderate and high hyperopia groups, respectively. In the case of low-moderate hyperopia group, 81% of eyes were within ±0.50D and 99% within ±1.00D. These values were 78% and 95%, respectively, for the high hyperopic eyes.ConclusionBilateral implantation of a trifocal IOL in hyperopic eyes provided good visual and refractive outcomes. The Barrett Universal II formula was accurate in predicting the IOL power in hyperopic eyes.

Patient selection to optimize near vision performance with a low-addition trifocal lens

PurposeTo assess the impact of ocular biometric variables on the visual performance achieved with a low addition trifocal intraocular lens (MIOL). MethodsRetrospective observational study including 34 eyes. Preoperative measured variables included mean corneal power (Km), corneal regular astigmatism (RA), anterior chamber depth (ACD), axial length (AXL), total irregular astigmatism (IA), spherical aberration (SA) and distance from pupil center to vertex normal (µ). Same variables were retrieved from the three month visit follow-up in addition to the actual lens position (ALP), the calculated effective addition (EA), the IOL centration from vertex normal (d), and the visual acuity defocus curve. The area under the defocus curve was computed along the total curve (TAUC) and ranges for far (FAUC), intermediate (IAUC) and near vision (NAUC). The sample was split in two groups of 17 eyes with TAUCs above and below the mean, and the differences among groups for different ocular parameters were assessed. ResultsThe group of eyes above TAUC of 2.03 logMAR*m-1 showed significantly lower Km and greater AXL and SA. Km was negatively correlated with TAUC and NAUC. NAUC was negatively correlated with IA and positively with d. A multiple lineal regression model including Km, d, and IA predicted NAUC (r-square = 34%). No significant differences between IA and SA were found between preoperative and postoperative values but µ significantly decreased after surgery. ConclusionsThe mean corneal power, irregular astigmatism, and centration from vertex normal should be considered for optimizing the near visual performance with this MIOL.

Early outcomes of vision and objective visual quality analysis after cataract surgery with trifocal intraocular lens implantation.

To investigate the early outcomes of vision, objective visual quality and their correlation after cataract surgery with trifocal intraocular lens implantation. The visual examination and objective visual quality analysis using Optical Quality Analysis System (OQAS) at 1mo and 3mo, and defocus curve examination at 3mo were performed in 20 patients (27 eyes) after phacoemulsification combined with trifocal intraocular lens implantation surgery. The uncorrected distant (UD), intermediate and near visual acuity (VA) were significantly improved after surgery (P<0.001). UDVA at 1mo after the surgery was slightly better than that after 3mo (P=0.026). The defocus curve after 3mo indicated that the peak of distant vision was close to 0 logMAR, and UDVA was lower than 0.3 logMAR in the range of -1.5 D to -3.0 D. The modulation transfer function (MTF) cutoff frequency, strehl ratio (SR), Optical Quality Analysis System values (OVs), includes OV100, OV20 and OV9 after the surgery were significantly better than before surgery (P<0.001), but the objective scattering index (OSI) was significantly decreased (P<0.001). UDVA at 3mo after the surgery had correlations with MTF cutoff, OSI, OV100 and OV20 (r=-0.400, 0.431, -0.437, -0.411, P=0.039, 0.025, 0.023, 0.033). The uncorrected intermediate VA after 3mo of the surgery had correlations with OSI and OV100 (r=0.478, -0.411, P=0.012, 0.033). Trifocal intraocular lens implantation can provide good distant, intermediate and near VA, and the vision shows a well correlation with objective visual quality during early surgery.

Acute clouding of a trifocal intraocular lens with spontaneous resolution: a case report

BackgroundOpacification of hydrophobic and hydrophilic intraocular lenses (IOLs) has been reported. Herein, we report a case of spontaneous resolution of opacification following acute clouding of a trifocal IOL, which consisted of hydrophilic acrylic material (25%) with hydrophobic surface properties, occurring in a cold region in the winter season.Case presentationA young adult with bilateral radiation cataract underwent phacoemulsification using a femtosecond laser and implantation of a trifocal IOL. The trifocal IOL was delivered to the operating theatre 30 min before the surgery. The outside temperature was approximately − 7 °C. The IOL package was warmed using a radiator at approximately 35 °C for 15 min. After the optical region was implanted in the eye, cloudiness was observed, which persisted throughout the operation. Complete clearing of the IOL was apparent after three postoperative hours.ConclusionIn this case, rapid opacification and clearing of the IOL suggested an acute and transient process. IOLs should be stored and shipped at a constant temperature, and sudden temperature fluctuations should be avoided, especially in the colder seasons.

Visual quality and patient satisfaction with a trifocal intraocular lens and its new toric version

To assess and compare the visual quality and subjective outcomes of a trifocal spherical intraocular lens (IOL) and its new toric version. Clínica Rementería, Madrid, Spain. Prospective case series. Patients had bilateral implantation of the AcrySof IQ PanOptix spherical or toric IOL. Three months postoperatively, monocular and the binocular uncorrected and corrected distance, intermediate, and near visual acuities; binocular defocus curves; and binocular contrast sensitivity function (CSF) were assessed. Patient satisfaction was evaluated with the Catquest 9SF questionnaire. The study comprised 250 eyes (166 with spherical IOL; 84 with toric IOL) of 125 patients. Both groups had good monocular visual acuity at all distances with no statistically significant differences between groups. The mean monocular uncorrected acuity in the spherical group was 0.06 logarithm of the minimum angle of resolution (logMAR)±0.07 (SD), 0.20±0.10 logMAR, and 0.05±0.07 logMAR for far, intermediate, and near, respectively, and in the toric group, 0.07±0.10 logMAR, 0.23±0.20 logMAR, and 0.07±0.12 logMAR, respectively. Defocus curves showed a visual acuity of 0.1 logMAR or better between -2.5 diopters (D) and +0.5 D with no differences between groups. The CSF values were within normal ranges with both IOLs. The questionnaire showed high rates of patient satisfaction with no differences between groups. The visual outcomes with the 2 IOLs were similar. With optimum implantation and alignment, the trifocal toric IOL seems to provide visual quality and patient satisfaction that is equivalent to that with the nontoric version with the same platform.

Subjective and objective depth of field measures in pseudophakic eyes: comparison between extended depth of focus, trifocal and bifocal intraocular lenses

To evaluate different intraocular lens (IOL) designs and to determine whether extended depth of focus (EDOF) lenses provide a higher depth of field (DOF) than the rest considering both subjective and objective measurements. A total of 100 eyes undergoing cataract surgery were divided into six groups depending on the IOL implanted: bifocal designs were Tecnis ZMB and ZLB (Abbott Laboratories, Illinois, USA), trifocal designs were Finevision (PhysIOL, Liège, Belgium) and AT LISA Tri (Carl Zeiss Meditec., Jena, Germany) and EDOF designs were Symfony (Abbott Laboratories, Illinois, USA) and MiniWell (SIFI MedTech, Catania, Italy). Subjective DOF was obtained from defocus curves for the range of vergences which provide a VA over 0.1 LogMAR and 0.2 LogMAR. Aberrometry was measured and Visual Strehl Optical Transference Function (90%) was used to quantify objectively the DOF. Symfony IOL group showed better subjective and objective DOF compared to the rest of IOL groups, with statistically significant differences (p < 0.001). Comparison between subjective and objective DOF showed that subjective measures were higher for all IOLs, being these differences statistically significant for all groups when compared with objective measures (p < 0.001). Objective and subjective measures of DOF are not comparable due to differences in methodologies and criterions to define the level of degradation acceptance. Nevertheless, both objective and subjective measures demonstrate a greater DOF for EDOF designs compared to bifocal and trifocal IOLs, being the Symfony IOL the one providing higher levels of subjective and objective DOF.

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

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

Presbyopic refractive lens exchange with trifocal intraocular lens implantation after corneal laser vision correction: Refractive results and biometry analysis

To evaluate the refractive and biometry results of presbyopic refractive lens exchange (RLE) with trifocal intraocular lens (IOL) implantation in eyes with previous myopic or hyperopic corneal laser vision correction (LVC). Memira AS, Norway, Sweden, and Denmark. Retrospective case series. The refractive results included the manifest refraction spherical equivalent, uncorrected near (UNVA) and distance (UDVA) visual acuities, corrected distance visual acuity, safety, efficacy, and precision. The biometry analysis included the refractive prediction error (RPE), median absolute error (MedAE), and percentage of eyes within a certain RPE range for the formulas from the American Society of Cataract and Refractive Surgery (ASCRS) online calculator. The study comprised 241 eyes. Six months postoperatively, 60.0% of eyes were within ±0.25 diopter (D), 80.9% within ±0.50 D, and 97.9% within ±1.00 D of emmetropia. There were no statistical differences in the mean monocular UDVA (0.87 ± 0.20 [SD]), safety index (0.98 ± 0.09), or efficacy index (0.81 ± 0.18) between the myopic ablation group and hyperopic ablation group. Binocularly, 85% of patients had simultaneous UDVA and UNVA of 0.9 or better and Jaeger 3, respectively. The ASCRS online calculator formulas gave different performances for previous myopic and hyperopic ablation profiles. Using optimized constants and nomogram for correcting the mean RPE improved the MedAE. Presbyopic RLE was safe and effective in selected cases with a history of LVC. The use of optimized IOL constants and nomograms can improve the refractive precision of lens-based refractive surgery.

Visual Function after Implantation of a Presbyopia-Correcting Trifocal Intraocular Lens

Purpose: To evaluate distance, intermediate, and near visual performance in patients implanted with a trifocal aspheric presbyopia-correcting intraocular lens (IOL). Methods: Forty patients were bilaterally implanted with the AcrySofIQ PanOptix IOL after femtosecond laser-assisted lens surgery. Binocular best corrected distance visual acuity (CDVA) (4 m), best distance-corrected near visual acuity (DCNVA) (40 and 30 cm), best corrected distance intermediate visual acuity (DCIVA) (70, 60, and 50 cm), binocular distance contrast sensitivity under photopic conditions (85 cd/m²), and defocus curves were evaluated at 6-months. Results: Six months postoperatively, the mean binocular Snellen decimal CDVA and DCNVA were 0.94 ± 0.10 (ranging from 0.70 to 1.25) and 0.85 ± 0.13 (ranging from 0.63 to 1.00), respectively. At a distance, all patients showed a cumulative binocular distance-corrected visual acuity of 0.8 or better, and about 80% (n = 31) of the patients had a value of 1.0 (20/20). At near and intermediate distances, all patients showed a cumulative distance-corrected visual acuity of 0.5 (20/40) or better at 30, 40, 50, 60, and 70 cm. Specifically, 50 cm showed the highest percentage of patients with larger values of visual acuity (60% [n = 26] with 20/20). Defocus curve showed a wide range of useful vision with two peaks of best visual acuity at distance and at 50 cm, and the binocular distance contrast sensitivity was within normal limits. Conclusions: The outcomes of the present study show that the visual performance obtained with bilateral implantation of the trifocal aspheric AcrySofIQ PanOptix IOL is good at far, intermediate, and near distances.

Predictability of different calculators in the minimization of postoperative astigmatism after implantation of a toric intraocular lens.

PurposeTo assess the efficacy of five calculators for toric intraocular lenses (IOL).MethodsRetrospective comparative case series in cataract patients undergoing implantation of trifocal toric IOLs (PhysIOL FineVision POD FT). Inclusion criteria were age-related cataract and a corneal astigmatism between 0.90D and 4.50D. Refractive astigmatism predictability of five different toric calculators or calculation methods were compared. Furthermore, two groups were differentiated according to the type of astigmatism. The mean absolute error and the centroid errors in the predicted residual astigmatism from each calculator were evaluated.ResultsFifty-one eyes of 43 patients were included in the study. For the standard toric calculator using anterior keratometry values only, the centroid prediction error was 0.39D±0.41@166º, which was reduced by the application of the PhysIOL toric calculator that includes the Abulafia-Koch regression formula and adjustment for the effective lens position (0.05D±0.34@167º), and also by the application of the Barrett toric calculator (0.07D±0.28@160º). Regarding the techniques that directly evaluate posterior corneal surface, the Holladay toric calculator, using total corneal power provided by a color-LED topographer, generated better results (0.10D±0.44@156º) than those using Scheimpflug camera data (0.23D±0.56@158º). Similar results were found for both types of astigmatism.ConclusionThe PhysIOL and the Barrett toric calculators taking into account the posterior corneal astigmatism by mathematical models, yielded lower astigmatic prediction errors compared to a standard toric calculator based on anterior keratometry data only. When total corneal power measurements were used, prediction errors were lower with color-LED than with Scheimpflug based topography.

Comparison of visual outcomes after bilateral implantation of two intraocular lenses with distinct diffractive optics.

PurposeThe aim of this study was to compare the visual outcomes and subjective visual quality between bilateral implantation of an extended depth of focus intraocular lens, J&J Vision Tecnis Symfony® ZXR00 (Group A) and bilateral implantation of a diffractive trifocal intraocular lens, Alcon Acrysof IQ PanOptix® TNFT00 (Group B).MethodsThis prospective, nonrandomized, comparative study of consecutive cases assessed 52 eyes of 26 patients operated on by the same surgeon (WTH) and binocularly implanted with multifocal intraocular lenses between May 2016 and July 2018. Binocular visual acuity for far, intermediate and near was tested in all cases. Ophthalmological evaluation included the measurement of binocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA) at 40 cm, uncorrected intermediate visual acuity (UIVA) at 70 cm, monocular visual defocus curve and the quality of life (QoL) questionnaire, National Eye Institute Visual Functioning Questionnaire - 25 ( NEI-VFQ 25).ResultsPostoperative UDVA was 0.00 and 0.09 logMAR (P<0.001), UIVA was 0.20 and 0.39 logMAR (P<0.001) and UNVA was 0.16 and −0.01 logMAR (P<0.001) in groups A and B, respectively; postoperative CDVA was −0.05 and 0.06 logMAR (P<0.001) in groups A and B, respectively.ConclusionBoth groups reported good subjective quality of vision regarding long, intermediate and short distances. Group A had a better performance for binocular UDVA, UIVA at 70 cm and CDVA, while regarding the monocular defocus curve, Group A outperformed Group B for long distances. Furthermore, Group B surpassed it in the short to very short distances, between the range of ≥2.00 D to 5.00 D of vergence. While Group A had a better performance regarding the vergences between 0.00 and 1.00 D (P<0.05) and at the vergence of +2.50 D (P=0.007). Group B outran Group A for UNVA at 40 cm.

Influence of trifocal intraocular lenses on standard autorefraction and aberrometer-based autorefraction

To study the agreement between manifest refraction and objective refraction measured with two autorefractor models and an aberrometer in eyes implanted with a trifocal diffractive intraocular lens (IOL). IOA Madrid Innova Ocular, Madrid, Spain. Prospective comparative cohort study. An autorefractor keratometer (KR-8800), based on a Scheiner double pinhole, and a 3-dimension wavefront topography aberrometer system (OPD-Scan III), based on the scanning-slit retinoscopy principle, were used to obtain objective refraction readings. In addition, lower-order Zernike coefficients (Z) were used to calculate objective refraction. A set of 7 different results was obtained in power vector notation (spherical equivalent [SE], Jackson cross-cylinder, axes at 180 degrees and 90 degrees [J0] and Jackson cross-cylinder, axes at 45 degrees and 135 degrees [J45]) for 7 different methods: manifest refraction, autorefraction obtained with the autorefractor keratometer, WF-P (Z-based objective refraction for the photopic pupil), WF-M (Z-based objective refraction for the mesopic pupil), WF-4 (Z-based objective refraction for a 4.0mm pupil), OPD-C (autorefraction measured with the 3-dimension wavefront topography aberrometer system under photopic conditions), and OPD-M (autorefraction measured with the 3-dimension wavefront topography aberrometer system under mesopic conditions). The study comprised 102 eyes from 51 cataract patients who underwent binocular implantation of a diffractive trifocal IOL (FineVision POD F). All 6 objective methods yielded more negative SE values than manifest refraction (P<.001). As for the astigmatism components (J0 and J45), only autorefraction (P=.003) and OPD-M (P<.001) differed significantly from manifest refraction. The best and worst correlation for the SE component were intraclass correlation coefficient (ICC)=0.70 (for WF-M) and ICC=0.48 (for WF-4). Objective methods tend to yield more negative sphere values than manifest refraction.

Trial to Investigate the Safety and Efficacy of a Trifocal Intraocular Lens (IOL) POD L GF in Comparison With a Multifocal and a Monofocal IOL

Trial to Investigate the Safety and Efficacy of a Trifocal Intraocular Lens (IOL) POD L GF in Comparison With a Multifocal and a Monofocal IOL

AcrySof IQ PanOptix Intraocular Lens Versus Extended Depth of Focus Intraocular Lens and Trifocal Intraocular Lens: A Clinical Overview.

AcrySof IQ PanOptix Model TFNT00 (Alcon Laboratories, Fort Worth, TX) is a 1-piece aspheric hydrophobic presbyopia-correcting intraocular lens (IOL) launched in 2015. Unlike traditional trifocal IOLs that usually have an intermediate focal point of 80 cm, the PanOptix IOL is designed to have an intermediate focal point of 60 cm (arms-length), a more natural and comfortable working distance to perform functional tasks on computers, laptops, mobiles, among others. The non-apodized PanOptix IOL uses the ENhanced LIGHT ENergy (ENLIGHTEN; Alcon Laboratories, Fort Worth, TX) optical technology that provides high (88%) utilization of light energy, low dependence on pupil size in all lighting conditions, and a more comfortable near-to-intermediate range of vision than traditional trifocal IOLs. This review provides an overview of the clinical performance of the PanOptix IOL and discusses it in the context of other commercially available trifocal IOLs, FineVision Micro F (PhysIOL, Liege, Belgium), the AT LISA tri 839MP (Carl Zeiss Meditec AG, Jena, Germany) and the extended depth of focus IOL, TECNIS Symfony (Abbott Medical Optics, Santa Ana, CA). A literature search was performed in the PubMed database to identify studies that have assessed the visual and other clinical outcomes with the PanOptix IOL. In total, 12 studies were included in this review article. Overall, the clinical evidence suggests that in general good visual outcomes, along with a high degree of spectacle independence, are achieved in patients implanted with the PanOptix, FineVision, AT LISA and Symfony IOLs. However, every MIOL has its benefits and limitations, which along with patient's needs and clinical conditions are important factors to consider while selecting an IOL to achieve best possible post-operative outcomes.

Dissatisfaction After Trifocal IOL Implantation and Its Improvement by Selective Wavefront-Guided LASIK.

To evaluate a substantially improved wavefront acquisition technique (Peramis; SCHWIND eye-tech-solutions, Kleinostheim, Germany) for selective wavefront-guided aberration correction to improve satisfaction after implantation of trifocal intraocular lenses (IOLs). Of 213 eyes from 108 consecutive patients receiving cataract surgery with multifocal IOL implantation (FineVision; PhysIOL, Liége, Belgium), 56 eyes (26%) of 42 dissatisfied patients were treated with selective wavefront-guided laser in situ keratomileusis (LASIK) (Amaris 1050; SCHWIND eye-tech-solutions) free of cost with a follow-up of 12 months. Selective wavefront-guided ablation corrected for all aberrations except spherical aberrations to preserve the apodization and therefore to enhance the multifocal effect. The degree of satisfaction after trifocal IOL implantation, its increase after selective wavefront-guided LASIK, and the refractive error (spherical equivalent, refractive astigmatism) before and after selective wavefront-guided LASIK were evaluated. Refractive astigmatism of greater than 0.50 diopters (D) was the most frequent residual refractive error (63%), followed by myopia (45%), hyperopia (20%), and increased ocular higher order aberrations (13%). After selective wavefront-guided LASIK, the refractive target (±0.50 D) was achieved in 98% and refractive astigmatism was 0.50 D or less in 93% of the eyes operated on. The overall satisfaction score in dissatisfied patients increased from 2.1 ± 0.8 preoperatively to 3.6 ± 0.8 (out of 4). Eighty-eight percent of initially dissatisfied patients would choose this procedure again. Selective wavefront-guided LASIK reduced refractive errors and significantly increased spectacle independence and satisfaction, which may lead to a better acceptance of trifocal IOLs. [J Refract Surg. 2019;35(6):346-352.].

Femtosecond laser-assisted cataract surgery combined with trifocal intraocular lens implantation

Femtosecond laser-assisted cataract surgery combined with trifocal intraocular lens implantation