Retinal Image Quality Through an Operating Microscope With Wavefront Shaping Extended Depth of Focus Intraocular Lens in Model Eye

PURPOSE

To compare the quality of images of gratings placed in a model eye viewed through an extended depth of focus (EDoF) intraocular lens (IOL) to that of diffractive bifocal IOL or monofocal IOL.

DESIGN

Experimental laboratory investigation.

METHODS

Nondiffractive wavefront shaping EDoF (CNAET0, Alcon Laboratories), echelette-designed EDoF (ZXR00V, Johnson & Johnson Vision), diffractive bifocal IOL with low power addition (SV25T, Alcon Laboratories), or monofocal IOL (CNA0T0, Alcon Laboratories) was placed in a fluid-filled model eye. A United States Air Force Resolution Grating Target was glued to the posterior surface of the model eye and viewed through a flat or a wide-angle contact lens. The contrast of the gratings viewed through the EDoF or multifocal IOLs was compared to that through the monofocal IOL. A wavefront analyzer was used to measure the spherical power of the central 4.5 mm optics of the EDoF, multifocal, and monofocal IOLs. The distribution of the dioptric power and the dioptric power map were compared.

RESULTS

The gratings observed through the flat contact lens with CNAET0, ZXR00V, or SV25T were slightly blurred when viewed through the multifocal optics. The blurred area was in the circumferential area of CNAET0, the central area of SV25T, and the peripheral area of ZXR00V. The mean contrast was 0.258 ± 0.020 for CNAET0, 0.227 ± 0.025 for ZXR00V, and 0.221 ± 0.020 for SV25T for the 16.0 cyc/mm grating. The contrast was significantly lower for ZXR00V (P = .004) and SV25T (P = .004) than 0.303 ± 0.015 for CNA0T0 but the differences were not significant for CNAET0. For the wide-angle contact lens, the contrast for CNAET0 was 0.182 ± 0.009, for ZXR00V was 0.162 ± 0.011, and for SV25T was 0.163 ± 0.007 for the 16.0 cyc/mm grating, and none was significantly different from 0.188 ± 0.012 for CNA0T0. The dioptric variations of CNAET0 indicated a ring-shaped area of higher power corresponding to the circumferential blurred zone observed through the flat contact lens.

CONCLUSIONS

The wavefront shaping and echelette-designed EDoF-IOLs reduce the contrast of the grating more than the monofocal IOL when viewed through the flat contact lens. The degree of reduction depended on the design of the extended-focus optics. The difference was less through the wide-angle contact lens.

BCLA CLEAR Presbyopia: Definitions

Presbyopia is often the first sign of ageing experienced by humans. Standardising terminology and adopting it across the BCLA CLEAR Presbyopia reports, improves consistency in the communication of the evidence-based understanding of this universal physiological process. Presbyopia can be functionally and psychologically debilitating, especially for those with poor access to eyecare. Presbyopia was defined as occurring when the physiologically normal age-related reduction in the eye's focusing range reaches a point that, when optimally corrected for far vision, the clarity of vision at near is insufficient to satisfy an individual's requirements. Accommodation is the change in optical power of the eye due to a change in crystalline lens shape and position, whereas pseudo-accommodation is the attainment of functional near vision in an emmetropic or far-corrected eye without changing the refractive power of the eye. Other definitions specific to vision and lenses for presbyopia were also defined. It is recommended that these definitions be consistently adopted in order to standardise future research, clinical evaluations and education.

Clinical outcomes and optical performance of a new segmental refractive extended depth-of-focus intraocular lens

BACKGROUND

The visual performance and the optical quality of a segmental refractive extended depth-of-focus (EDoF) intraocular lens (IOL) were evaluated in a prospective, single-arm, single-center study.

METHODS

A total of 20 patients (40 eyes) after bilateral implantation of the refractive segmental EDoF Acunex Vario AN6V were included. Assessment procedure: refraction outcome, monocular and binocular uncorrected (UCVA) and distance-corrected visual acuity (DCVA), defocus curve, contrast sensitivity (CS), higher-order aberrations (HOAs) and patient satisfaction were evaluated 1 and 3 months after surgery.

RESULTS

At 3-month follow-up, mean spherical equivalent was - 0.23 ± 0.32 D. Binocular uncorrected distance visual acuity (VA) at distance, intermediate and near was - 0.08 ± 0.06 logMAR at 4 m, -0.03 ± 0.06 logMAR at 66 cm and 0.16 ± 0.06 logMAR at 40 cm, respectively. The binocular defocus curve showed a VA better than 0.20 logMAR over a range from + 1.50 to - 2.45 D. Contrast sensitivity aligned with monofocal lenses, highlighting the lens's clinical value. Aberrometry showed minimal changes in corneal aberrations. NEI-RQL-42-Questionnaire showed a high patient satisfaction for daily activities and revealed reduced dependence on glasses, particularly for near and intermediate vision. The Acunex Vario AN6V demonstrated minimal dysphotopsias, making it a promising option for those seeking spectacle independence.

CONCLUSION

This segmental refractive EDoF IOL provides a high degree of spectacle independence for far and intermediate distances with functional near VA. Although inducing residual coma aberrations, it showed subjectively good results with little dysphotopsias.

TRIAL REGISTRATION

This study protocol was reviewed and approved by ethics committee of Charité University, Berlin, Germany, with approval number EA4/126/20.

The tolerance of refractive errors of extended depth of focus intraocular lens in patients with previous corneal refractive surgery

PURPOSE

To evaluate the tolerance for refractive errors and visual outcomes of extended depth of focus intraocular lens (EDOF IOLs) in patients with previous corneal refractive surgery for myopia.

METHODS

Patients from Aier Eye Hospital of Wuhan University with previous myopia excimer laser correction underwent cataract surgery and implantation of an EDOF IOL. The follow-up period was three months. The uncorrected distance, intermediate, and near visual acuities (UDVA, UIVA, UNVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), defocus curve, optical quality, including modulation transfer functions (MTF) and Strehl ratio (SR), National Eye Institute Visual Functioning Questionnaire-14 for Chinese people (VF-14-CN), spectacle independence, and dysphotopsia were assessed.

RESULTS

At the final visit, UDVA, CDVA, UIVA, and UNVA (LogMAR) were 0.06 ± 0.09, 0.01 ± 0.06, 0.11 ± 0.08, 0.20 ± 0.10, respectively. The mean spherical equivalent (SE) was - 0.57 ± 0.58D, sphere and cylinder were - 0.24 ± 0.60D, - 0.70 ± 0.58D respectively. No statistical difference in UDVA between eyes with SE in ± 0.50 D and in ± 1.0 D (p > 0.05). Corneal astigmatism > 1.00D has no significant effect on postoperative visual acuity (p > 0.05). The defocus curve showed that visual acuity could reach 0.2 in the refractive range of + 0.50D ~ - 1.50D. SR and MTF values were all higher than before the surgery. In bilateral implantation patients, the VF-14-CN questionnaire score and visual quality were quite excellent.

CONCLUSION

The EDOF IOL have a certain tolerance for refractive errors and corneal astigmatism, and it's recommended for patients with prior myopia excimer laser surgery to achieve satisfactory visual performance.

Analysis of higher-order aberrations in relation to the clinical outcome of an enhanced monofocal IOL

PURPOSE

To analyse higher-order aberrations of an enhanced monofocal aspheric intraocular lens (IOL) in relation to the clinical outcome compared to a monofocal aspheric IOL.

SETTING

Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Germany.

DESIGN

Prospective, monocentric, controlled, non-randomized, two-armed study.

METHODS

After phacoemulsification, a total of 30 patients (60 eyes) were bilaterally implanted with either TECNIS Eyhance IOL model ICB00 (Johnson & Johnson Surgical Vision, Inc.) or TECNIS Monofocal 1-Piece IOL model ZCB00 (Johnson & Johnson Surgical Vision, Inc.) in 30 eyes each. Assessments were performed 1 and 3 months after surgery including refraction, uncorrected and best-corrected distance, intermediate and near visual acuity, defocus curves, contrast sensitivities under photopic, mesopic and mesopic conditions with glare, higher-order aberrations (HOAs) at pupil sizes of 5, 4, 3 and 2 mm and patient satisfaction.

RESULTS

At 3-month follow-up, measurements of HOAs revealed significant higher negative internal and ocular primary spherical aberrations in the ICB00 group at pupil sizes of 5, 4, 3 and 2 mm. The ICB00 showed significant better results in intermediate and near visual acuity, but no difference in distance visual acuity. No significant difference was found in contrast sensitivities at any condition or spatial frequency. Spectacle independence was significant better without significant higher rates of dysphotopsia in the ICB00 group.

CONCLUSIONS

Higher negative spherical aberrations in the ICB00 group at all measured pupil sizes appear to lead to a superior clinical outcome in intermediate and near vision compared to the ZCB00 group without compromising contrast sensitivity or distance visual acuity.

Comparison of visual performance between bifocal and extended-depth-of-focus intraocular lenses

We compared the visual performance of a bifocal intraocular lens (IOL) (ZMB00) and an extended-depth-of-focus (EDOF) IOL (ZXR00V) by evaluating postoperative parameters at 10 weeks after the last surgery in cataract patients who underwent bilateral ZMB00 or ZXR00V implantation between 2011 and 2020. The right and left lenses were implanted within 3 months of each other. The study enrolled 1536 eyes of 768 patients; the ZMB00 group comprised 1326 eyes of 663 patients (age: 67.0 ± 7.8 years; female/male, 518/145), and the ZXR00V group comprised 210 eyes of 105 patients (age: 67.8 ± 6.9 years; female/male, 39/66). A linear mixed-effects model using data for both eyes, with strict adjustments for sex, age, subjective refraction spherical equivalent, subjective refraction cylinder, corneal astigmatism, axial length, corneal higher-order aberrations and pupil diameter, ensured statistical validity. Uncorrected near visual acuity, corrected near visual acuity, and near spectacle independence were significantly better in the ZMB00 group (p<0.00068, Wald test) than in the ZXR00V group. Contrast sensitivity (visual angle of the test target: 4.0°/2.5°/1.6°/1.0°/0.7°) and contrast sensitivity with glare (4.0°/2.5°/1.6°/1.0°/0.7°) were significantly better in the ZXR00V group (p<0.00068, Wald test) than in the ZMB00 group. Uncorrected intermediate visual acuity, contrast sensitivity with glare (6.3°), and 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) scores for General Vision were slightly but significantly better in the ZXR00V group than in the ZMB00 group (p<0.05, Wald test). At high-performance levels, the two IOL groups had different characteristics regarding various visual performance parameters.

Comparison of dynamic defocus curve on cataract patients implanting extended depth of focus and monofocal intraocular lens

BACKGROUND

The aim of the study was to compare the dynamic defocus curve on patients post-implantation of the extended depth-of-focus (EDOF) and monofocal intraocular lens (IOL).

METHODS

A total of 62 age-related cataract patients receiving phacoemulsification with implantation of TECNIS Symfony (ZXR00) or monofocal IOLs were enrolled. The binocular static and dynamic defocus curves with corrected distance visual acuity were evaluated at one month postoperatively.

RESULTS

The ZXR00 group achieved significantly better intermediate (P = 0.044) and near (P = 0.017) visual acuity (VA) than the monofocal group. Two groups had similar uncorrected and corrected distance VA (P > 0.05, respectively). The dynamic defocus curve revealed a smoother decline from 0.0 D to - 2.0 D in the ZXR00 group. Defocused dynamic VA in the ZXR00 group was significantly better (P < 0.05) except at 0.0 D (P = 0.724) and - 0.5 D (P = 0.176). The area under the curve (P = 0.002) and corrected dynamic vision accommodation (P = 0.001) derived from the dynamic defocus curves were better in the ZXR00 group. A positive correlation was observed between defocused dynamic and static VA in both groups (P < 0.001). Multiple linear regression analysis indicated that defocused static VA and corrected dynamic vision accommodation were significant influential factors for the defocused dynamic VA from - 1.0 D to - 3.0 D (P < 0.05).

CONCLUSIONS

The EDOF IOL provided similar distance vision, better intermediate and near vision, and a better overall dynamic defocus curve than the monofocal IOL. The dynamic defocus curve may be comprehensively applied to evaluate the all-distance dynamic visual performance post-cataract surgery.

Partial monovision achieved by unilateral implantation of a multifocal add-on lens with bilateral pseudophakia: evaluation and results

PURPOSE

To assess the results of partial monovision (PMV) in comparison to a bilateral monofocal implantation (MMV).

METHODS

The PMV group was treated bilaterally with a monofocal intraocular lens (IOL) implantation, followed 3 months later by the implantation of a multifocal AddOn® lens (+ 3.00 D) into the non-dominant eye. The MMV group received a bilateral monofocal IOL implantation intending to achieve a slight anisometropia (0.0 D/ - 0.50 D). The near visual acuity (UNVA), intermediate visual acuity (UIVA), distance visual acuity (UDVA), defocus curve, and Lang-Stereotest II were conducted uncorrected, binocular, and minimum 3 months after the last operation. For the contrast sensitivity test, the patients were refractively corrected. The Quality of Vision Questionnaire (QoV), Visual Function Questionnaire (VF-14), spectacle independence, and general satisfaction were also assessed.

RESULTS

A total of 27 PMV patients and 28 MMV patients without ocular diseases relevant to visual acuity were examined. The PMV group was significantly better at UNVA (0.11 ± 0.08 logMAR vs 0.56 ± 0.16 logMAR) and between - 2.00 and - 4.00 D in the defocus curve (p < 0.001). At the UIVA, the PMV group was slightly better (0.11 ± 0.10 logMAR vs 0.20 ± 0.18 logMAR) but not significant (p = 0.054). The UDVA (- 0.13 ± 0.09 logMAR vs - 0.09 ± 0.14 logMAR) (p = 0.315) and contrast sensitivity (p = 0.667) revealed no differences between the groups. The stereo vision was in favor of PMV (p = 0.008). Spectacle independence was statistically better for PMV at distance, intermediate, and near (distance p = 0.012; intermediate p < 0.001; near p < 0.001). In the VF-14 Questionnaire, the PMV was statistically superior (p < 0.001). The QoV Questionnaire showed no differences regarding frequency and severity of visual disturbances. Both groups were highly satisfied (p = 0.509).

CONCLUSION

Patients with PMV are more independent of glasses and are able to read without disadvantages in distance vision, due to halos and glare. The concept of PMV is well suited for the desire of eyeglass independence, without optical side effects.

Clinical outcomes with a low add multifocal and an extended depth of focus intraocular lenses both implanted with mini-monovision

OBJECTIVES

To compare the visual acuity, contrast sensitivity (CS), spectacle needs, photic phenomena, and quality of life parameters of patients bilaterally implanted with a low add multifocal (MIOL) or an extended depth of focus (EDOF) intraocular lens (IOL), both with intended mini-monovision.

METHODS

In this prospective, randomized, comparative study, patients were randomized to receive either Tecnis +2.75 D (ZKB00) (MIOL Group, n = 15) or Tecnis Symfony (ZXR00) (EDOF Group, n = 14) for bilateral implantation with mini-monovision (-0.50 D). Binocular logMAR uncorrected visual acuities (UVA), monocular defocus curves, CS with CSV 1000-E, and Pelli-Robson Test (PRT), spectacle needs and quality of life parameters with NEI RQL-42 questionnaire were evaluated at postoperative 1, 3, and 6 months.

RESULTS

Results of MIOL and EDOF Groups at postoperative month 6 are as follows: distance (6 m) UVA -0.03 ± 0.05 and -0.05 ± 0.06 (p = 0.938), intermediate (60 cm) UVA, 0.04 ± 0.08 and -0.03 ± 0.07 (p = 0.046); near (40 cm) UVA, 0.22 ± 0.08 and 0.15 ± 0.07 (p = 0.046); near spectacle needs, 26.7% and 14.3% (p > 0.05), respectively. Better visual acuity was achieved in the EDOF Group between the defocus range of -0.50 and -1.75 D (p < 0.05). No significant difference was found regarding photic phenomena and CS evaluated with CSV 1000-E between the two IOL groups at 6 months after surgery (otherwise there are differences at 1 and 3 months in favor of EDOF). However, EDOF Group performed better in mesopic CS evaluated with PRT (p < 0.05).

CONCLUSIONS

When implanted with mini-monovision better binocular uncorrected visual performance at intermediate and near distances achieved with EDOF than low add MIOL.

The effects of premium intraocular lenses on presbyopia treatments

Background

Presbyopia has become a global disease affecting the world's aging population. Among various treatments, cataract extraction and intraocular lens (IOL) implantation have become the most popular and common methods of presbyopia correction. During the twentieth century, IOLs have underwent significant innovation and advancements to meet the patients' high demands for functional vision at all distances.

Main Text

To meet the increasing needs for excellent near and intermediate vision for daily activities, some premium IOLs with more than one focus have been developed, for example, the refractive MfIOLs, diffractive MfIOLs, extended depth of field (EDOF) IOLs, and accommodating IOLs (AIOLs) were introduced to meet this need. In addition, the add-on MfIOLs have been explored as promising supplementary IOLs for pseudophakic presbyopia. When selecting the MfIOLs, the IOLs' features, patients' characteristics, preoperative eye conditions, and treatment expectations should be considered.

Conclusions

In this review, we focus on the multifocal IOLs (MfIOLs) commonly used for presbyopia correction and systematically summarized their optical designs and clinical outcomes. More evidence-based studies are required to provide guidelines for MfIOL selection, provide maximum visual benefits, and develop personalized visual solutions in the future.

Comparison Between an Intraocular Lens With Extended Depth of Focus (Tecnis Symfony ZXR00) and a New Monofocal Intraocular Lens With Enhanced Intermediate Vision (Tecnis Eyhance ICB00)

PURPOSE

This study compared the extended depth of focus (EDOF) intraocular lens (IOL) (ZXR00; Tecnis Symfony, Johnson & Johnson Vision, Santa Ana, CA, US) to a novel, higher-order aspheric monofocal IOL (ICB00; Tecnis Eyhance, Johnson & Johnson Vision, Santa Ana, CA, US) which uses the same platform and material.

METHODS

Medical records of patients undergoing cataract surgery with ZXR00 or ICB00 implantation between March 2020 and January 2021 and with the data available for the 3-month visit were reviewed. The uncorrected near, intermediate, and distance visual acuity (VA); corrected distance VA; and optical quality parameters were the main outcome measures.

RESULTS

Among the 174 enrolled patients, 72 and 102 received the ZXR00 and ICB00, respectively. The average patient ages were 59.6 ± 10.6 (range: 49 to 70) and 65.2 ± 8.2 (range: 45 to 82) years in the ZXR00 and ICB00 groups, respectively, with significantly older patients in the ICB00 group. The other baseline parameters were not different for the 2 groups. Compared to the ICB00 group, the ZXR00 group showed markedly superior near VA (P < 0.05) at 3 months postoperatively. In terms of optical quality, ICB00 was, statistically, significantly superior to ZXR00.

CONCLUSIONS

The ZXR00 showed remarkable near vision and defocus curve smoothness, while the ICB00 achieved better optical quality. The 2 IOLs had comparable distance and intermediate vision.

Visual outcome and optical quality of a wavefront-engineered extended depth-of-focus intraocular lens

PURPOSE

To evaluate visual performance and optical quality of an extended depth-of-focus intraocular lens (EDoF IOL) compared with a monofocal aspheric IOL.

SETTING

Department of Ophthalmology, Charité-Medical University Berlin, Germany.

DESIGN

Prospective case series.

METHODS

After phacoemulsification, a total of 28 patients (56 eyes) underwent bilateral implantation of either the Mini Well (EDoF IOL) or the Mini 4 (monofocal IOL). Assessments including refraction, distance, intermediate and near visual acuity, defocus curves, contrast sensitivity, glare disability, higher-order aberrations (HOAs), and patient satisfaction were performed at 1 month and 3 months postoperatively.

RESULTS

Both study groups comprised 14 patients (28 eyes) each. At 3-month follow-up, the EDoF IOL showed better results in monocular uncorrected intermediate visual acuity (-0.04 vs 0.10 logMAR, P = .000) and in uncorrected near visual acuity (0.13 vs 0.36 logMAR, P = .000), whereas no statistically significant difference was found between groups in monocular uncorrected distance visual acuity (0.04 vs 0.00 logMAR, P = .110). The monocular depth of focus was 0.8 D greater in the Mini Well IOL group. Measurements of internal HOAs revealed a greater negative primary spherical aberration in the EDoF group at pupil sizes of 2.0 to 5.0 mm. At 5.0 mm, total internal HOAs did not differ statistically significantly (0.376 vs 0.340 μm root mean square, P = .068).

CONCLUSIONS

The Mini Well IOL provided greater depth of focus with superior outcomes at intermediate and near distances and comparable outcomes at far distance. Although inducing higher amounts of spherical aberration, it showed good results under low lighting conditions with little subjective dysphotopsia.

Clinical Outcomes With a New Continuous Range of Vision Presbyopia-Correcting Intraocular Lens

PURPOSE

To evaluate the clinical outcomes including patient-reported outcome measures in a sample of eyes undergoing bilateral cataract surgery with implantation of a new model of presbyopia-correcting intraocular lens (IOL).

METHODS

This non-randomized prospective case series enrolled 206 eyes of 103 patients undergoing phacoemulsification cataract surgery with bilateral implantation of the TECNIS Synergy IOL (Johnson & Johnson Vision). High and low contrast visual acuity, refractive, defocus curve, and patient-reported visual performance (Catquest-9SF questionnaire) outcomes were evaluated during a 3-month follow-up.

RESULTS

A total of 96.1% (99 of 103) and 91.3% (94 of 103) of patients achieved binocular postoperative uncorrected distance (UDVA) and near visual acuity (UNVA) of 0.00 logMAR (20/20), respectively. Mean postoperative mesopic UNVA for both eyes was 0.14 ± 0.03 logMAR. Likewise, mean binocular UDVA and UNVA were 0.00 ± 0.03 and 0.04 ± 0.02 logMAR. An almost flat mean defocus curve was obtained, with visual acuities between 0.00 and 0.10 logMAR for most defocus levels in both eyes. A reduction of contrast led to a limited but statistically significant change in UNVA in both eyes (P < .001). The Rasch calibrated scoring of item 2 and the Rasch calibrated mean score of the Catquest-9SF questionnaire increased significantly with surgery (P < .001).

CONCLUSIONS

This new presbyopia-correcting IOL provides a continuous range of functional focus, with a limited deterioration under mesopic conditions, which is perceived as a satisfactory outcome by the patient if proper patient selection is performed. [J Refract Surg. 2021;37(4):256-262.].

Measures of visual disturbance in patients receiving extended depth-of-focus or trifocal intraocular lenses

The degree of visual disturbance associated with a particular model of intraocular lens (IOL) depends on several factors, including IOL optic, material, and mechanics. Characterization of visual disturbance profiles is paramount for informing clinical IOL selection. Although many studies evaluating presbyopia-correcting IOLs include subjective assessment of visual symptoms, the types of patient-reported outcome measures (PROMs) used to capture these outcomes are inconsistent across studies, complicating data contextualization. Furthermore, some tools produce more meaningful results than others. This review presents a discussion on the scientific literature published on the subjective and semiobjective (halo and glare simulator, light-distortion analyzer, vision monitor, and halometers) methods used to assess visual disturbances in patients implanted with trifocal or extended depth-of-focus IOLs, highlighting their advantages and limitations. It underscores the importance of between-study comparisons and the need for standardized PROMs in clinical IOL research to provide more accurate information for IOL selection.

Quality of view through extended depth of focus intraocular lens in a model eye

PURPOSE

To compare the quality of images viewed through an extended depth of focus (EDF) intraocular lens (IOL) to that through multifocal or monofocal IOL.

STUDY DESIGN

Experimental study METHODS: EDF IOL (Symfony^®, ZXR00V, Johnson & Johnson Vision), diffractive multifocal (ZLB00, + 3.25D or ZMB00, + 4.0D), or monofocal (ZCB00V) IOL with a spherical power of + 20.0 diopter (D) was placed in a fluid-filled model eye with corneal aberrations similar to those of human eyes. A United States Air Force Resolution Grating Target was glued to the posterior surface of the model eye and viewed through a flat contact lens, a 60D or 128D wide-angle non-contact lens (Resight^®) or wide-angle contact lens (MiniQuad^®). The contrast of the grating images recorded with the EDF and multifocal IOLs were compared to those through the monofocal IOL.

RESULTS

The grating images viewed through the flat contact lens were slightly blurred when viewed through the EDF IOL but clearer than those through the multifocal IOLs with very blurred images in the periphery. The contrast of the images viewed through the EDF and multifocal IOLs through the flat contact lens was significantly lower than through the monofocal IOL (P < 0.02). The contrast of the images viewed through the EDF IOL with 60D or 128D wide-angle non-contact lens was significantly lower than through the monofocal IOL (P < 0.05) but not with wide-angle contact lens.

CONCLUSION

Our results suggest that vitreous surgeons can accomplish a clearer view during vitrectomy in EDF IOL-implanted eyes with a wide-angle viewing contact lens and a flat contact lens than in multifocal IOL-implanted eyes.

Optical aberrations in three different intraocular lens designs of a same platform

PURPOSE:

To compare internal optical aberrations between three different intraocular lenses (IOL) of the same Tecnis platform: monofocal ZCB00, multifocal ZMB00, and enlarged depth-of-focus (EDoF) Symfony ZXR00.

METHODS:

We included in this study 236 eyes of 118 patients who had been bilaterally implanted either with the monofocal, the multifocal, or the EDoF IOL. They were examined with the K1-RW wavefront analyzer (Topcon Medical Systems) 2 months after surgery. Patients with any ocular pathology were excluded from the study. Only high-order aberrations (HOA) of the third and fourth orders of the Zernike polynomials were considered.

RESULTS:

Forty-three patients (86 eyes) were implanted with the monofocal IOL, 45 patients (90 eyes) with the ZMB00 IOL, and 30 patients (60 eyes) with the EDoF Symfony IOL. Mean age was 62.42 ± 7.38, 63.60 ± 6.01, and 64.74 ± 5.84 years, respectively. Mean axial length was 23.37 ± 1.00, 23.49 ± 1.00, and 23.54 ± 0.73 mm, respectively. For a 6-mm pupil, internal total HOA in the monofocal group was 1.01 ± 1.75 μm; in the bifocal group was 1.35 ± 2.12 μm; and in the Symfony group was 0.72 ± 0.63 μm. No optical aberration differences were found among the three groups (P > 0.05).

CONCLUSION:

There are no differences regarding internal optical aberrations between these three IOLs when analyzing them with optical aberrometry. Patients’ pupil size should be considered for the selection of the most appropriate IOL to be implanted, because despite a same optical platform, every IOL implies a different increase of HOA with larger pupil sizes.

Straylight in Different Types of Intraocular Lenses

Purpose

To show the importance of measuring the angular distribution of straylight as an in vitro test for intraocular lenses (IOLs).

Methods

The optical integration method was implemented to measure the point spread function, up to 5.1°, of IOLs immersed in a wet cell. The straylight parameter was calculated as the product of the point spread function by the squared angle. The effect of the scattered light is shown in extended images of a target surrounded by headlamps as glare sources. Three different IOLs were tested: (1) AcrySof IQ SN60WF, monofocal, (2) AcrySof IQ PanOptix, trifocal, and (3) Tecnis Symfony ZRX00, bifocal with extended depth of focus. Measurements were compared to previously reported clinical studies where the same IOL models were implanted.

Results

The mean amount of scattered light, between 1.0° and 5.1°, generated by each IOLs were, in deg²sr^{- 1} units: (1) 1.2, (2) 12.1, and (3) 33.4. Lens (3) present a high amount of straylight related to a halo of an approximate diameter of 2°.

Conclusions

In vitro measurements of the angular distribution of the point spread function of different types of IOLs showed important aspects related to their manufacturing quality. These results are in line with previous clinical findings where glare sensitivity was tested in the same angular range.

Translational Relevance

In vitro measurement of angular dependence of straylight in IOLs, regardless their design, provides a valuable feedback to improve their optical quality. The minimization of the amounts of straylight positively impacts the recurrence of photic phenomena.

Comparison of the Visual Performance after Implantation of Three Aberration-correcting Aspherical Intraocular Lens

PURPOSE

To compare the visual performance after implantation of three aberration-correcting aspherical intraocular lens (IOL).

MATERIALS AND METHODS

Seventy-seven eyes of 77 cataract patients were divided into three groups: 26 eyes implanted with a non-constant aberration IOL (LUCIA 601P IOL, Zeiss Company, Germany); 26 eyes implanted with a spherical aberration -0.18μm IOL (CT ASPHINA 509M, Zeiss Company, Germany) and 27 eyes implanted with a spherical aberration -0.27μm IOL (AMO Tecnis ZCB00, Johnson & Johnson Surgical Vision, USA). Three months after operation, the distance visual acuity, wavefront aberrometry, contrast sensitivity, intraocular stray light, IOL decentration, and tilt were evaluated.

RESULTS

Three months postoperatively, no statistically significant differences were found in uncorrected distance visual acuity and corrected distance visual acuity (p≥.83). The RMS for total ocular coma was statistically significantly lower in the Lucia group (p=.03) and spherical aberration was statistically significantly lower in the Tecnis group (p<.01). No statistically significant differences were observed among the three lenses in higher order aberration (p=.85) and in contrast sensitivity under both photopic and mesopic lighting conditions (p≥.05). The intraocular stray light was statistically significantly better in the Lucia group (p=.04). No statistically significant differences were observed with respect to IOL decentration (p=.75) and tilt (p=.89).

CONCLUSIONS

Cataract surgery with non-constant aberration IOL resulted in lower coma and better intraocular stray light than with the spherical aberration -0.18μm and -0.27μm IOLs despite equivalent postoperative levels of visual acuity and contrast sensitivity.

Comparison of two extended depth of focus intraocular lenses with a monofocal lens: a multi-centre randomised trial

Purpose

The AT LARA 829MP is a next-generation extended depth of focus (EDOF) intraocular lens (IOL) providing continuous vision over a range of distances. The aim of this prospective multi-centre randomised trial was to compare two EDOF IOLs and one monofocal IOL.

Methods

Cataract patients between 50 and 80 years were randomised for bilateral implantation with either the AT LARA 829MP (EDOF), the TECNIS Symfony (EDOF) or the CT ASPHINA 409MP (monofocal). Follow-up was at 1 to 2 weeks, 1 month and 4 to 6 months.

Results

A total of 211 patients were randomised and included in the final analysis. Monocular depth of focus was significantly better for AT LARA 829MP eyes compared with that for TECNIS Symfony at all thresholds (p = 0.024, 0.001 and 0.006, for 0.1, 0.2 and 0.3 logMAR respectively) with no significant difference for binocular depth of focus. LARA eyes had significantly better monocular depth of focus at all levels compared with ASPHINA eyes (all p < 0.0001), while there was no significant difference between Symfony and ASPHINA eyes at 0.1 logMAR and 0.2 logMAR. Both EDOF IOLs were significantly better than the monofocal ASPHINA at all levels for binocular depth of focus (LARA: all p < 0.0001; Symfony: all p = 0.002). Distance visual acuity was similar for all IOLs at 6 months; intermediate and near visual acuity were significantly better for the EDOF IOLs than for the monofocal (p < 0.0001). Refraction improved in all groups relative to baseline. Contrast sensitivity was higher with the CT ASPHINA 409MP but both EDOF lenses had a better spectacle independence rate. At 6 months, all IOLs were well centred with no cases of tilt. No general safety issues were raised for any of the groups.

Conclusion

The two EDOF intraocular lenses investigated provided good visual outcomes with comparable visual acuity at all distances. The AT LARA 829MP provided the widest monocular depth of focus at 0.1 and 0.2 logMAR, with a clear superiority compared with the monofocal IOL. TECNIS Symfony was superior to the monofocal control at 0.3 logMAR. Spectacle independence and patient satisfaction were comparable.

Trial registration

Trial registered on https://clinicaltrials.gov/ under the identification NCT03172351 (date of registration 1 June May 2017).

Comparison of reading performance with low add bifocal and extended depth of focus intraocular lenses implanted with mini-monovision

PURPOSE

To evaluate reading performance, preferred reading distance, and spectacle independence in patients implanted with a low add multifocal or an extended depth of focus (EDOF) intraocular lens (IOL) after phacoemulsification.

METHODS

In this prospective study, patients were randomized into two groups: the diffractive multifocal Tecnis + 2.75 D (ZKB00) IOL (Tecnis + 2.75 group; 15 patients) or the EDOF Tecnis Symfony (ZXR00) IOL (Symfony group; 14 patients) for bilateral implantation with mini-monovision. Reading performance parameters (reading acuity [RA], critical print size [CPS], and maximum reading speed [MRS]) were evaluated with MNREAD acuity charts at 40 cm, and preferred reading distances and spectacle independence for near activities were assessed preoperatively and at the postoperative 1st, 3rd, and 6th months.

RESULTS

At the postoperative 6th month, binocular logMAR UNVA and DCNVA were significantly better in the Symfony group than in the Tecnis + 2.75 group (UNVA: 0.15 ± 0.07 vs. 0.22 ± 0.08, p = 0.046; DCNVA: 0.21 ± 0.05 vs. 0.28 ± 0.07, p = 0.043; respectively). There was no significant difference in reading performance parameters between the groups; however, the Symfony group preferred significantly closer reading distance than the Tecnis + 2.75 group (42.00 ± 4.67 cm; 45.87 ± 5.32 cm, respectively, p = 0.030). At the postoperative 6th month, 14.3% and 26.7% of patients reported that they needed spectacles, rarely or occasionally, for near activities in the Symfony and Tecnis + 2.75 groups, respectively (p > 0.05).

CONCLUSIONS

When implanted with mini-monovision, although functional near visual acuity and a high degree of spectacle independence at near distances were achieved with both IOLs, patients implanted with the EDOF IOL preferred closer reading distance than those implanted with the low add diffractive multifocal IOL.

Initial Clinical Outcomes of a New Extended Depth of Focus Intraocular Lens

PURPOSE

To evaluate clinical and patient-reported outcomes of a new extended depth of focus intraocular lens (IOL).

METHODS

Data of patients treated between September 2017 and September 2018 who underwent a refractive lens exchange/cataract surgery with an implantation of the AT LARA 829MP IOL (Carl Zeiss Meditec AG, Jena, Germany) and attended the 1-week, 1-month, and 3-month follow-up visit were reviewed.

RESULTS

At 3 months, the percentage of eyes within ±0.50 diopters (D) of emmetropia was 86.7%. The mean binocular uncorrected distance visual acuity was -0.05 ± 0.09 logMAR and the mean binocular unaided near vision was 0.26 ± 0.14 logMAR. Of all patients, 90.3% were satisfied with their vision. The percentage of patients spectacle-free for near and distance vision was 83.6% and 95.4%, respectively. On a scale from 1 (no difficulty) to 7 (severe difficulty), there was an average 1.2 to 1.4 units increase in glare, halo, and starburst between the preoperative and 1-month visit, and a decrease of 0.2 to 0.3 units between the 1- and 3-month visit.

CONCLUSIONS

The new extended depth of focus IOL provided reasonable unaided near and distance vision, as well as spectacle independence and patient satisfaction. Some optical side effects were reported in the early postoperative period. [J Refract Surg. 2019;35(7):426-433.].

Retrospective analysis on the visual outcomes and photic phenomena following bilateral extended depth of focus intraocular lens implants

OBJECTIVE

To evaluate binocular visual outcomes and presence of photic phenomena in patients with bilateral extended depth of focus (EDF) intraocular lens (IOL) implants.

DESIGN

Retrospective consecutive case series.

PARTICIPANTS

Patients above the age of 18 years without prior ocular pathology or surgery with bilateral EDF IOL implants (ZXR00; Johnson & Johnson Vision) between January 2015 and December 2017 in Canadian ophthalmology centres.

METHODS

Patient charts were retrospectively evaluated for binocular uncorrected distance visual acuity (UCDVA), binocular corrected distance visual acuity (CDVA), binocular uncorrected near visual acuity (UCNVA), photic phenomena (glare, halos, or dysphotopsia), complications, or reoperations. Subgroup analysis investigated the effect of monovision on the above outcomes.

RESULTS

In total, 87 individuals with bilateral EDF IOL implants were included in the analysis. Median logMAR pre-operative CDVA was 0.18 (0.1-0.3). The median logMAR postoperative bilateral UCDVA was 0.14 (0.00-0.18), median CDVA was 0.00 (0.00-0.10), and median UCNVA was 0.10 (0.10-0.20). Overall, 16 (18.4%) cases self-reported the presence of photic phenomena, the most common of which were halos (13.8%). Subgroup analysis determined that there was no significant difference in visual outcomes or presence of photic phenomena when stratifying patients based on the degree of postoperative monovision (p = 0.31-0.57).

CONCLUSIONS

Overall, the Tecnis Symfony EDF IOL provided a reasonable range of binocular distance and near vision. Approximately 12.6% of patients self-reported any postoperative photic phenomena; however, all cases were subjectively considered mild and tolerable. Monovision had no effect on visual outcomes or the presence of photic phenomena.

Comparison of the Clinical Outcomes between Echelette Extended Range of Vision and Diffractive Bifocal Intraocular Lenses

Purpose

To compare the clinical outcomes of echelette extended range of vision (ERV) and diffractive bifocal intraocular lenses (IOLs).

Methods

This is a prospective, consecutive, nonrandomized clinical trial. Seventy-three eligible patients (109 eyes) received the implantation of echelette ERV IOL (Tecnis Symfony ZXR00) or diffractive bifocal IOL (Tecnis ZMB00). 1 week, 1 month, and 3 months after surgery, visual acuities at different distances were examined. At 3 months, defocus curves, contrast sensitivities (CSs) with and without glare, optic path difference (OPD) scans, and questionnaires were evaluated. Regression analyses were applied to discover influence factors on postoperative vision.

Results

ZXR00 showed better distance (P < 0.05) and intermediate (P < 0.001) visual acuities, while ZMB00 was better at distance-corrected near visual acuity (P < 0.001). Multivariate analyses indicated that worse intermediate (P < 0.001) and near vision (P=0.013) of ZMB00 might occur in patients with longer axial length. ZXR00 demonstrated smoother defocus curve and higher CSs. Superior modulation transfer function (MTF) and higher Strehl ratio (P < 0.05) were shown in ZXR00. In questionnaire evaluation, ZXR00 received better outcomes in self-reported vision, Visual Function-14 (VF-14) questionnaire, Quality of Vision (QoV) questionnaire, satisfaction, and recommendation grades. Spectacle dependence did not differ between ZXR00 and ZMB00 statistically.

Conclusion

ZXR00 proved to be remarkable in distance and intermediate vision, defocus curve smoothness, CSs, and visual comfort, while ZMB00 achieved better near vision. ZXR00 may attain better near vision if postoperative SE remains slightly negative. Patients with relatively longer axial length might receive less favorable intermediate and near vision after ZMB00 implantation. This trial is registered with ChiCTR-ONC-17011119.

Efficacy and safety of extended depth of focus intraocular lenses in cataract surgery: a systematic review and meta-analysis

Background

This study aims to evaluate the efficacy and safety of extended depth of focus (EDOF) intraocular lenes (IOLs) in cataract surgery.

Methods

All comparative clinical trials that involved bilaterally implanting EDOF IOLs in patients with cataract were retrieved from the literature database. We used random effects models to pool weighted mean differences (WMD) and risk ratio (RR) for continuous and dichotomous variables, respectively.

Results

Nine studies with a total of 1336 eyes were identified. The subgroup analysis was conducted according to the type of IOLs used in the control group. Compared with monofocal IOLs, EDOF IOLs produced better uncorrected intermediate visual acuity (WMD: -0.17, 95% CI: − 0.26 to − 0.08, P = 0.0001) and uncorrected near visual acuity (WMD: -0.17, 95% CI: − 0.21 to − 0.12, P < 0.00001). EDOF IOLs resulted in reduced contrast sensitivity, more frequent halos, however, higher spectacle independence (RR: 2.81, 95% CI: 1.06 to 7.46, P = 0.04) than monofocal IOLs. Compared with trifocal IOLs, EDOF IOLs produced worse near visual acuity (MD: 0.10, 95% CI: 0.07 to 0.13, P < 0.0001). EDOF IOLs performed better than trifocal IOls in contrast sensitivity, and there were no significant difference in halos and spectacle independence. Serious postoperative complications were rare, with no adverse events were reported in most studies.

Conclusions

Increasing the risk of contrast reduction and more frequent halos, EDOF IOLs provided better intermediate and near VAs than monofocal IOLs. At the expense of near vision, patients receiving EDOF IOLs have better contrast sensitivity than those receiving trifocal IOLs. Halo incidence and spectacle independence of EDOF IOLs were similar to those of trifocal IOLs.

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

Purpose

The 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).

Methods

This 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).

Results

Postoperative 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.

Conclusion

Both 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.

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.

Visual Performance after a Unilateral or Bilateral Implantation of Enlarged Depth-of-Focus Intraocular Lens in Patients with Cataract: A Prospective Clinical Trial

Purpose

To investigate visual performances after a unilateral or bilateral implantation of enlarged depth-of-focus intraocular lens in patients with cataract.

Methods

In this prospective study, uneventful phacoemulsification and TECNIS® Symfony intraocular lens implantation were performed in 20 eyes of 17 patients. At postoperative 1, 4, and 12 weeks, the logarithm of the minimal angle of resolution visual acuity at far, intermediate, and near distances and the spherical equivalent in manifest refraction and automated refraction were measured. A questionnaire was used to investigate glare, spectacle dependency, and satisfaction at 12 weeks. The mean numerical error and mean absolute error were compared between intraocular lens formulas to assess the best-fit formula.

Results

The logarithm of the minimal angle of resolution visual acuity significantly improved to 0.02 at far, 0.02 at intermediate, and 0.27 at near distances at 12 weeks (p < 0.05). Spherical equivalent was −0.79 D on automated refraction and was significantly lower than −0.26 D measured on manifest refraction. Patients' satisfaction score was 9.06, 8.94, and 6.65 for far, intermediate, and near distances, respectively. Near glasses were required in 5 patients and 2 patients complained of photic phenomenon. Visual performances were not significantly different between bilateral and unilateral implanted patients. No patients reported bilateral imbalance due to unilateral surgery. The mean numerical error was closest to 0 D using the Barrett Universal II formula. The mean absolute error was not significantly different between these formulas.

Conclusion

Unilateral or bilateral implantation of the enlarged depth-of-focus intraocular lens seems to be equally effective in improving visual performances in patients with cataract.

Monocular Clinical Outcomes and Range of Near Vision following Cataract Surgery with Implantation of an Extended Depth of Focus Intraocular Lens

Importance

A full range of near and intermediate vision has not been clinically evaluated for the Symfony extended depth of focus intraocular lens (EDOF IOL).

Background

To evaluate the monocular range of near visual acuity with an EDOF IOL.

Design

Retrospective case series.

Participants

Consecutive patients of a single surgeon from January 2017 through March 2018.

Methods

Phacoemulsification with implantation of an EDOF IOL.

Main Outcome Measures

Uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), distance-corrected near visual acuity (DCNVA), range of DCNVA, and optimal near focal length.

Results

Seventy-six eyes of 48 patients (34 or 71% female, mean age: 68 years) were included with a mean follow-up of 68 days. Mean values were as follows: logarithm of the minimum angle of resolution (logMAR) UDVA 0.02 ± 0.09, logMAR UNVA 0.12 ± 0.09 at a mean distance of 51 cm, logMAR CDVA -0.05 ± 0.07, logMAR DCNVA 0.08 ± 0.07 at a mean distance of 51 cm, and a spherical equivalent of -0.16 diopters ±0.35. Percentage of eyes achieving DCNVA of 20/30 were 84% at 36 cm, 92% at 41 cm, 99% at 51 cm, 93% at 61 cm, and 74% at 71 cm. DCNVA of 20/40 or better was achieved in nearly 100% of eyes over a range of 35 cm.

Conclusions and Relevance

The Symfony EDOF IOL achieved excellent distance visual acuity while providing a 35 cm range of near visual acuity at levels useful for many tasks in nearly all patients.