Visual Outcomes and Patient Satisfaction After Bilateral Refractive Lens Exchange with a Trifocal Intraocular Lens in Patients with Presbyopia

Visual Performance and Patient Satisfaction of Bilaterally Implanted Extended Depth of Focus Intraocular Lens: Outcomes of a Multicenter Registry

PURPOSE

To evaluate visual performance, patient satisfaction, and spectacle independence in patients bilaterally implanted with AcrySof IQ Vivity intraocular lenses (IOLs) (Alcon Laboratories, Inc) during cataract or refractive lens exchange (RLE) surgery.

METHODS

This multicenter, ambispective, non-interventional registry study was conducted in Europe, Australia, and New Zealand. At the first follow-up visit, occurring between 3 and 6 months after IOL implantation, binocular uncorrected and corrected distance visual acuities at distance (UDVA/CDVA), intermediate (UIVA/DIVA 66 cm), and near (UNVA/DNVA 40 cm) were evaluated using the logarithm of the minimum angle of resolution (logMAR) chart. Patient satisfaction, spectacle independence, visual disturbances, and device deficiencies were also assessed.

RESULTS

The final analysis included 885 patients, with 790 (89.3%) and 82 (9.3%) patients who underwent cataract and RLE, respectively, where approximately 30% had one or more ocular comorbidity. Mean ± standard deviation logMAR (Snellen) UDVA, UIVA, and UNVA were 0.012 ± 0.102 (∼20/20), 0.088 ± 0.118 (∼20/25), and 0.256 ± 0.154 (∼20/40) for the cataract cohort and -0.005 ± 0.088 (∼20/20), 0.054 ± 0.141 (∼20/25), and 0.213 ± 0.151 (∼20/32) for the RLE cohort, respectively. The proportion of patients reporting spectacle independence at distance, intermediate, and near was 87.9%, 77.6%, and 46.1% for the cataract and 86.6%, 79.3%, and 59.8% for the RLE cohorts. The majority of patients among the cataract (92.1%) and RLE (85.4%) cohorts were satisfied with their postoperative sight, whereas 91.8% of the cataract and 84.1% of the RLE cohort reported no visual disturbances. No device deficiencies were reported.

CONCLUSIONS

In this real-world study, patients bilaterally implanted with AcrySof IQ Vivity IOLs demonstrated good visual performance and the majority reported spectacle independence for distance to intermediate, high visual satisfaction, and low levels of visual disturbances across both cohorts, despite approximately 30% who reported 1 or greater ocular comorbidity. [J Refract Surg. 2025;41(2):e131-e143.].

Visual training system 4: a promising adjuvant therapy for ocular accommodative function and visual acuity improvement in refractive amblyopia patients

OBJECTIVE

To evaluate the therapeutic effects of Visual Training System 4 (VTS4) as an adjunctive therapy for patients with refractive amblyopia.

METHOD

A total of 82 patients with refractive amblyopia (142 eyes) treated at the Zhongshan Ophthalmic Center of Sun Yat-sen University, were enrolled and divided into two groups based on the treatment protocol. The control group included 40 patients (68 eyes) who received conventional comprehensive treatment, while the observation group was comprised of 42 patients (74 eyes) treated with VTS4 in addition to conventional therapy. The therapeutic effects, best-corrected visual acuity (BCVA), spherical equivalent (SE), ocular accommodative function, and ocular convergence were compared between the two groups.

RESULTS

The total effective rate of visual improvement in the observation group was 86.49%, significantly higher than 66.18% in the control group. BCVA at 3 and 6 months was superior in the observation group compared to the control group (P < 0.05). At 6 months, the normal rate of binocular fusion images in the observation group was 94.59%, higher than 76.47% in the control group. The observation group showed greater improvement in accommodative flexibility and amplitude, and lower accommodative lag compared to the control group. Improvements in negative relative accommodation, positive relative accommodation, and near point of convergence were also more pronounced in the observation group (all P < 0.05). No significant differences were observed in SE, axial length, or corneal curvature within or between the groups before and after treatment (all P > 0.05).

CONCLUSION

VTS4, as an adjunctive therapy for refractive amblyopia, significantly improves visual acuity, enhances accommodative and convergence functions, and demonstrates strong clinical applicability.

Refractive Lens Exchange: A Review

In recent decades, technical advancements in lens surgery have considerably improved safety and refractive outcomes. This has led to a much broader range of indications for refractive lens exchange (RLE). Effective restoration of uncorrected distance and near visual acuity is possible with modern presbyopia correcting intraocular lenses (IOLs). Hyperopic patients who are fully presbyopic were identified as ideal candidates for RLE. For myopic patients, an increased risk of retinal detachment has been reported, which leads to a higher threshold to perform RLE in this patient group. The most frequent postoperative complications include posterior capsular opacification, deviation from the target refraction and cystoid macular edema. Thus, adequate planning of surgery, careful patient selection, as well as comprehensive counseling are crucial for successful RLE.

Visual performance, safety, and patient satisfaction after binocular clear lens extraction and trifocal intraocular lens implantation in Chinese presbyopic patients

BACKGROUND

Addressing presbyopia in the aging population, particularly in non-cataractous patients, remains a challenge. This study evaluates the outcomes of refractive lens exchange (RLE) with AT LISA tri 839MP trifocal intraocular lens (IOL) implantation in a Chinese presbyopic population without cataracts.

METHODS

The study included 164 eyes from 82 patients undergoing bilateral RLE at Peking Union Medical College Hospital. Comprehensive evaluations encompassed visual acuities, refraction, ocular aberrometry, and subjective outcomes via the VF-14 questionnaire. The focus was on postoperative visual performance, refractive outcomes, safety, objective optical quality, and patient satisfaction.

RESULTS

100%, 90.2%, and 89.0% of patients achieved binocular UDVA, UNVA, and UIVA of logMAR 0.1 or better at 6 months postoperatively. 97.6% of eyes were within ± 1.00 D of emmetropia postoperatively. Optical quality assessments showed increases in modulation transfer function and Strehl ratios (p < 0.05). High-order aberrations decreased significantly (p < 0.05). Despite the high incidence of posterior capsule opacification (83.2%), managed with early Nd: YAG capsulotomy, no other severe complications were reported. Patient-reported outcomes indicated high satisfaction, with an average VF-14 score of 94.3 ± 10.2 and 93.5% achieving complete spectacle independence. Halo (66.2%) was the most commonly reported optical phenomena, followed by glare (18.2%), and starburst (7.8%) after surgery.

CONCLUSIONS

Bilateral RLE with trifocal IOLs in presbyopic patients without cataracts significantly improves visual acuity and reduces ocular aberrations in presbyopic patients. The procedure offers high patient satisfaction and spectacle independence, though it requires careful patient selection and management of expectations regarding potential photic phenomena.

Clinical and Patient Reported Outcomes of an Optimized Trifocal Intraocular Lens

Background/Objectives: To evaluate the clinical and patient-reported outcomes (PROMs) obtained with an optimized version of a previously investigated trifocal IOL. Methods: Prospective non-comparative single-center study enrolling 29 patients (55-71 years) undergoing bilateral cataract surgery with implantation of the trifocal diffractive IOL Liberty 677CMY (Medicontur Medical Engineering Ltd., Zsámbék, Hungary). Visual and refractive outcomes as well as PROMs were evaluated during a 3-month follow-up: measurement of uncorrected and corrected distance (UDVA, CDVA), intermediate (UIVA, DCIVA) and near visual acuities (UNVA, DCNVA), defocus curve, patient satisfaction, photic phenomena perception, spectacle independence, and difficulty in performing some vision-related activities. Results: A total of 100%, 92%, and 80% of patients achieved a postoperative binocular UDVA, UIVA, and UNVA of 20/25 or better, respectively. Likewise, 100%, 80%, and 84% of patients achieved a postoperative binocular CDVA, DCIVA, and DCNVA of 20/25 or better, respectively. In the defocus curve, all mean visual acuity values were better than 0.15 logMAR for all defocus levels. A total of 95.8%, 95.8%, and 91.7% of patients referred to be satisfied with their distance, intermediate, and near visual vision, respectively. Mean overall Catquest Rasch calibrated score was -3.12 ± 0.98. Most of the patients were spectacle independent: far (95.8%), intermediate (95.8%) or near vision (91.7%). No bothersome or minimal to moderately bothersome halo, starburst, and glare was perceived by 83.3%, 83.4%, and 83.3% of patients, respectively. Conclusions: The trifocal IOL evaluated provides a visual acuity improvement, with high levels of spectacle independence, patient satisfaction, and perceived visual quality associated.

Visual Outcomes and Patient Satisfaction After Bilateral Refractive Lens Exchange With a Trifocal Intraocular Lens in 5,226 Patients With Presbyopia

PURPOSE

To assess visual and refractive outcomes and visual function after bilateral RayOne Trifocal toric and nontoric intraocular lens (IOL) (Rayner) implantation in patients with presbyopia.

METHODS

Charts of patients with presbyopia who underwent refractive lens exchange with bilateral implantation of the RayOne Trifocal IOL (toric and non-toric) were retrospectively reviewed. Visual and refractive outcomes were evaluated at 3 months. Patient satisfaction, spectacle independence, and visual disturbance profile were assessed by questionnaires.

RESULTS

A total of 5,226 patients were assigned to one of two groups: 1,010 patients had toric IOL implantation (toric group) and 4,216 patients received the non-toric model (non-toric group). Mean ± standard deviation visual acuity at 3 months for the toric group was binocular uncorrected distance visual acuity (UDVA) of 0.07 ± 0.11 logMAR, monocular corrected distance visual acuity (CDVA) of 0.05 ± 0.07 logMAR, binocular uncorrected near visual acuity (UNVA) at 40 cm of 0.10 ± 0.09 logMAR, binocular uncorrected intermediate visual acuity (UIVA) at 40 cm of 0.13 ± 0.12 logMAR, postoperative spherical equivalent (SE) of -0.21 ± 0.47 diopters (D), and cylinder of -0.34 ± 0.40 D. The non-toric group had binocular UDVA of 0.04 ± 0.08 logMAR, monocular CDVA of 0.05 ± 0.07 logMAR, binocular UNVA of 0.10 ± 0.08 logMAR, binocular UIVA of 0.13 ± 0.11 logMAR, SE of -0.08 ± 0.38 D, and cylinder of -0.28 ± 0.34 D. No statistically significant differences were found in achieving spectacle independence and there were high levels of satisfaction in both groups.

CONCLUSIONS

In this retrospective analysis with more than 5,000 patients, both the toric and non-toric RayOne Trifocal IOL models provided good visual performance at all distances, resulting in excellent levels of spectacle independence and patient satisfaction. [J Refract Surg. 2024;40(7):e468-e479.].

Refractive lens exchange: What are the red lines?

Practical advancements in phacoemulsification techniques and intraocular lenses and the wide availability of phacoemulsification machines have led refractive lens exchange (RLE) to increase in popularity. Ethical boundaries in RLE have subsequently been pushed to include patients at higher risk of complications. In this editorial, we consider RLE outcomes and complications per type of refractive error, together with preoperative, intraoperative and postoperative ethical obligations for refractive surgeons. In the conclusions section, we propose an algorithm for ethics-guided indications to RLE.

Bilateral Femtosecond Laser-Assisted Clear Lens Extraction with Trifocal Intraocular Lens Implantation for Presbyopia Correction: A Short-Term Observational Study in Chinese Adults

Purpose

To observe the outcome of bilateral femtosecond laser-assisted clear lens extraction with trifocal intraocular lens (IOL) implantation for presbyopia correction and evaluate its feasibility in early presbyopic adults.

Methods

Prospective case series of eyes with clear crystalline lenses that underwent femtosecond laser-assisted lens extraction and trifocal IOL (Acrysof IQ PanOptix, Model TFNT00, Alcon) implantation between 2021 and 2023 were followed up for at least 3 months after surgery. Outcome measures included monocular uncorrected visual acuity at near (UNVA, 40 cm), intermediate (UIVA, 60 cm), and distance (UDVA, 5 m), monocular manifest refraction, corrected distance visual acuity (CDVA), defocus curve assessment, and spectacle independence at both near and distance.

Results

A total of 60 eyes from 30 consecutive patients were included, and their mean age was 50.4±6.5 years. After surgery, the mean UNVA (LogMAR) increased from 0.28±0.16 to 0.08±0.07, UIVA increased from 0.25±0.12 to 0.09±0.06, and UDVA increased from 0.27±0.21 to 0.01±0.08. The enhancements of UNVA, UIVA and UDVA were all significant (P < 0.05). The optometric results showed that the mean postoperative spherical equivalent (SE) was -0.21±0.24 D, and the mean postoperative CDVA (LogMAR) was -0.00±0.06. The preoperative spectacle independences at near and distance were 46.7% (14/30) and 56.7% (17/30), respectively, and both increased to 100% at 3 months after surgery.

Conclusion

Satisfactory visual outcomes and safe surgical procedures were observed in this study, which demonstrate that bilateral femtosecond laser-assisted clear lens extraction with PanOptix IOL implantation could be a feasible approach for presbyopia correction in working-age Chinese patients.