Influence of extended depth of focus intraocular lenses on visual field sensitivity

Efficacy and safety of the enhanced monofocal intraocular lens in glaucoma of varying severity

This study evaluates the safety and visual outcomes of enhanced monofocal intraocular lenses compared to standard monofocal intraocular lenses in patients with varying severities of glaucoma. Utilizing data from surgeries performed in 2021, the study involved patients aged 40 and older with visually significant cataracts and diagnosed glaucoma or glaucoma suspects. The findings indicate that both enhanced and standard monofocal lenses lead to significant improvements in best-corrected visual acuity, visual field index, mean deviation, and retinal nerve fiber layer thickness postoperatively. No significant differences were observed between the two groups in the extent of these improvements, suggesting that enhanced monofocal lenses may offer a viable alternative for patients with glaucoma, providing significant visual benefits and potentially better intermediate vision while preserving overall visual function.

Outcomes of a non-diffractive extended depth of focus intraocular lens in patients with well-controlled glaucoma and ocular hypertension

AIM

To assess visual outcomes and satisfaction of a non-diffractive extended depth of focus (EDOF) intraocular lens (IOL) in individuals with ocular hypertension (OHT) and well-controlled mild glaucoma undergoing cataract surgery.

METHODS

An investigator-initiated, single-center, prospective, interventional, noncomparative study conducted in Montreal, Canada. The study enrolled 31 patients (55 eyes) with OHT or mild glaucoma who received a non-diffractive EDOF IOL (Acrysof IQ Vivity). Participants underwent sequential cataract surgery with the Vivity IOL. Follow-up evaluations occurred at 1d, 1, and 3mo postoperatively, assessing uncorrected distance, intermediate, and near visual acuity. Questionnaires (QUVID: Questionnaire for visual disturbances and IOLSAT: Intraocular lens satisfaction) were administered pre and post-operatively to measure visual disturbances and spectacle independence in various lighting. Safety parameters included intraocular pressure (IOP), glaucoma medications, spherical equivalence, mean deviation and pattern standard deviation or square root of lost variance on Octopus visual field.

RESULTS

At 1 and 3mo postoperatively, significant improvements were observed in uncorrected distance and intermediate visual acuity. Spectacle independence was enhanced for distance and intermediate vision, especially in bright light settings. Spectacle-free intermediate vision was improved even in dim lighting. Visual disturbances, particularly glare symptoms, were reduced, and there was a notable decrease in IOP and glaucoma medication burden at 3mo. There was more hazy vision postoperatively with no impact on visual acuity and visual satisfaction.

CONCLUSION

The non-diffractive EDOF lens improves distance and intermediate spectacle-free visual function in patients with OHT and well-controlled glaucoma. The findings highlight significant improvements in visual acuity, reduced glare, enhanced spectacle independence, and improved visual performance in different lighting conditions.

Clinical outcomes of an extended depth-of-focus intraocular lens in patients with glaucoma

PURPOSE

to evaluate the clinical outcomes of a hybrid refractive/extended depth-of-focus intraocular lens (Lucidis; Swiss Advanced Vision, SAV-IOL SA, Neuchâtel, Switzerland) in glaucoma patients and to compare the contrast sensitivity results as regards to method of glaucoma control.

METHODS

This retrospective multicenter study included 28 patients with visually impairing cataract and controlled early to moderate primary open angle glaucoma who underwent phacoemulsification and Lucidis intraocular lens implantation during the period from June 2021 to July 2023. Medical records were reviewed for baseline characteristics, severity, adequacy and method of control of glaucoma, details of cataract surgery and postoperative findings. Clinical outcomes were analysed at 3 months postoperatively and included uncorrected and best corrected near, intermediate and distance visual acuities, manifest refraction, contrast sensitivity, and patient satisfaction (adapted from the Catquest-9SF questionnaire).

RESULTS

42 eyes of 28 patients were included, with a male to female ratio of 1:1.8. There was a highly significant improvement in postoperative uncorrected and best corrected near, intermediate, and distance visual acuities (p < 0.001). Mean postoperative contrast sensitivity was 1.56 ± 0.11 log and there was no significant difference between medically and surgically controlled glaucoma (P = 0.08). There was a highly significant correlation between preoperative mean deviation and postoperative contrast sensitivity (p < 0.001). 26 (92.9%) patients were very satisfied. One (2.4%) eye developed dysphotopsia and no serious complications occurred throughout the study.

CONCLUSIONS

Lucidis IOL is effective and safe in patients with cataract and early to moderate POAG requesting spectacle independence. Adequate glaucoma control, regardless the method of control, and better preoperative mean deviation ensure good clinical outcomes.

TRIAL REGISTRATION

ZU-IRB#11,295-28-11-2023, 28/11/2023 'retrospectively registered'.

Visual Function after Implantation of Diffractive Extended Depth-of-Focus Intraocular Lenses in Eyes with Primary Open-Angle Glaucoma

INTRODUCTION

The aim of this prospective study was to compare the visual functions of extended depth-of-focus intraocular lenses (EDOF IOLs) and monofocal IOLs in eyes with mild to moderate primary open-angle glaucoma (POAG).

METHODS

Cataractous eyes with POAG controlled using medical treatments, no central visual field defects, and mean deviation (MD) values of -10 dB or better on the 30-2 test grid of the Swedish Interactive Threshold Algorithm standard program were included. Twenty-two eyes of 22 patients received EDOF IOLs (ZXR00V and ZXV150-375; J&J), whereas 24 eyes of 24 patients received monofocal IOLs (ZCB00V and ZCV150-375; J&J). MD values, corrected distance visual acuity (CDVA), and photopic contrast sensitivity were measured at 3 months after surgery. Noninferiority of CDVA and contrast sensitivity in eyes with EDOF IOLs to eyes with monofocal IOLs were examined.

RESULTS

The postoperative mean MDs of eyes with EDOF and monofocal IOLs were -2.76 dB and -4.21 dB with no significant difference. The CDVA of eyes with EDOF IOLs was noninferior to that of eyes with monofocal IOLs (P = 0.02). There were no inferiority in contrast sensitivity at any spatial frequency (P < 0.001).

CONCLUSIONS

The visual function of EDOF IOLs in eyes with mild-to-moderate POAG was not inferior to that of monofocal IOLs.

TRIAL REGISTRATION

Registered in the Japan Registry for Clinical Research (identifier: jRCTs032200218).

Comparison of the Visual Outcomes of Enhanced and Standard Monofocal Intraocular Lens Implantations in Eyes with Early Glaucoma

This study aimed to compare the efficacies and safety of enhanced and standard monofocal intraocular lenses (IOLs) in eyes with early glaucoma. Patients with concurrent cataracts and open-angle glaucoma (OAG) were enrolled. They underwent cataract surgery with IOL implantation. The comprehensive preoperative ophthalmic examination included the manifest refraction; monocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA); visual field (VF); and contrast sensitivity (CS); defocus curves and questionnaires were assessed three months postoperatively. Totals of 34 and 38 patients had enhanced and standard monofocal IOLs, respectively. The enhanced monofocal IOL provided better UIVA than the standard monofocal IOL (p = 0.003) but similar UDVA, CDVA, and UNVA. The enhanced monofocal IOL had more consistent defocus curves than the standard monofocal IOL, especially at -1 (p = 0.042) and -1.5 (p = 0.026) diopters. The enhanced monofocal IOL provided better satisfaction (p = 0.019) and lower spectacle dependence (p = 0.004) than the standard monofocal IOL for intermediate vision, with similar VF and CS outcomes. In conclusion, enhanced monofocal IOLs are recommended for patients with OAG because they provide better intermediate vision, higher satisfaction, and lower dependence on spectacles than standard monofocal IOLs, without worsening other visual outcomes.

Spherical Aberration of Cataractous Eyes and Its Relationship With Age, Ocular Biometry, and Various IOL Platforms

PURPOSE

To determine the median spherical aberration (SA) of the cataractous population, how it relates to biometry, and the theoretical effect of different intraocular lens (IOL) platforms.

METHODS

A retrospective chart review of patients undergoing cataract surgery evaluation with a high quality Pentacam (Oculus Optikgeräte GmbH) were included. Age, gender, Q-value, mean total SA, higher order aberration root mean square wavefront error, and equivalent keratometry were collected from the Holladay report and axial length and anterior chamber depth (ACD) from the IOLMaster 700 (Carl Zeiss Meditec AG).

RESULTS

Data from 1,725 eyes of 999 patients were collected. SA had a median of 0.37 µm (95% confidence interval: 0.36 to 0.38. Age (r = .136, P < .001), Q-factor (r = .743, P < .001), and higher order aberration root mean square wavefront error (r = .307, P < .001) were positively correlated with SA. Average equivalent keratometry (r = -.310, P < .001) was negatively correlated with SA. Axial length (r = -0.037, P = .120) and ACD (r = .004, P = .856) had no association with SA. Up to 1,499 (86.9%) theoretically had SA moved closer to zero with IOLs that had negative SA. Up to 102 (5.9%) had SA theoretically worsened.

CONCLUSIONS

SA is not normally distributed, suggesting that there may be no "average" SA that IOLs should aim to correct. Patients might benefit from tailoring IOL choice to individual SA. Without access to SA data, eyes with steeper average keratometry or younger patients may have less SA, which could influence IOL choice. [J Refract Surg. 2023;39(2):89-94.].

Implantation of diffractive extended depth-of-focus intraocular lenses in normal tension glaucoma eyes: A case series

Purpose

Implantation of presbyopia-correcting intraocular lenses (IOLs) has not been advised for glaucomatous eyes because of the risk of decreased contrast sensitivity with progress of glaucoma. Extended depth-of-focus (EDF) IOLs have been reported to provide comparable postoperative visual function and influence on the visual field to monofocal IOLs.

Methods

This case series was a retrospective medical record review of 16 eyes of 10 patients who had normal tension glaucoma (NTG) with no central visual field defects and underwent cataract surgery with implantation of diffractive EDF IOLs. At 3 months postoperatively, distance-corrected visual acuities (DCVAs) at distances of 5, 1, and 0.5 m and photopic contrast sensitivity were examined. Automated perimetry using the 30-2 Swedish interactive threshold algorithm was also performed, and the mean variance (MD) values, mean deviation values at the central four points (central MD), and foveal threshold were recorded.

Results

The mean age of the patients (5 men, 5 women) was 66.5 years. Over 80% of eyes obtained DCVAs of 20/20, 20/20, and 20/25 at 5 m, 1 m, and 0.5 m, respectively. Whereas 5 of 16 eyes were categorized as severe by the Hodapp-Parrish-Anderson classification, postoperative contrast sensitivity was within the normal range, except for 4 eyes at 18 cycles per degree.

Conclusions and importance

In this case series, the postoperative visual functions of NTG patients with EDF IOLs were almost comparable to those of normal eyes with the same IOLs, which demonstrated that the use of EDF IOLs for controlled NTG eyes would be permissible. While careful patient selection and follow-up for NTG progress are important, further investigations are necessary for confirming the safety and exploring the selection criteria.

Influence of implantation of diffractive trifocal intraocular lenses on standard automated perimetry

Background

This prospective comparative study aimed to investigate the influence of diffractive trifocal intraocular lenses (IOLs) implantation on standard automated perimetry.

Methods

Patients with no diseases affecting the visual field had undergone cataract surgery following the implantation of trifocal or monofocal IOLs from July 2019 to August 2020 were recruited. The normality of the anterior and posterior segments and absence of glaucomatous optic nerve cupping were confirmed preoperatively by slit-lamp examination. Standard automated perimetry was performed using Humphrey Visual Field 10–2 testing, 2–3 months after cataract surgery in only one eye per patient. The mean deviation (MD) and foveal sensitivity were compared between IOLs in eyes with acceptable reliability indices and best-corrected visual acuity of 20/25 or better.

Results

Among the 83 eyes of the 83 patients included, 39 and 29 eyes eligible for perimetry analysis had trifocal and monofocal IOLs, respectively. The mean MD and foveal sensitivity in eyes with trifocal IOLs were significantly lower than those in eyes with monofocal IOLs (P < 0.021), with mean differences of 0.77 and 1.01 dB, respectively.

Conclusion

The comparison in nonglaucomatous eyes demonstrated that the influence of trifocal IOLs on standard automated perimetry was greater than that of monofocal IOLs.

Comparative analysis of visual outcome with three intraocular lenses: monofocal, enhanced monofocal, and extended range of vision

PURPOSE

To compare the visual performance, spectacle independence and subjective visual quality of three intraocular lenses (IOLs): monofocal, enhanced monofocal, and extended range of vision.

SETTING

Ophthalmology Department, San Raffaele Scientific Institute, Milan, Italy.

DESIGN

Prospective case series.

METHODS

We included patients without ocular comorbidities and corneal astigmatism <0.75 diopters (D) undergoing cataract surgery with bilateral implantation of: monofocal Tecnis ZCB00, enhanced monofocal Eyhance ICB00, and extended range of vision Symfony ZXR00. Six months postoperatively we analyzed the following parameters: subjective and objective refraction; monocular and binocular corrected distance (4 m) and uncorrected distance visual acuity (UDVA); corrected distance, intermediate (66 cm) and near (40 cm) visual acuity, as well as uncorrected intermediate (UIVA) and uncorrected near (UNVA) visual acuity; photopic contrast sensitivity, binocular defocus curve; halo and glare perception; spectacle independence.

RESULTS

We evaluated 150 eyes of 75 patients (25 patients per IOL group). Monocular and binocular UDVA was excellent in all three groups. Eyhance achieved binocular UIVA similar to that of Symfony, the latter showing the highest binocular UNVA. The defocus curves at -1 D were equivalent for both Eyhance and Symfony, whereas contrast sensitivity was similar in all three groups. The Eyhance spectacle independence score was comparable to Symfony's for intermediate-distance activities, the latter however achieving the worst results for halos and glare.

CONCLUSIONS

Enhanced monofocal Eyhance was not inferior to Symfony as regards intermediate-distance visual outcome and spectacle independence, also providing lower subjective perception of halos and glare.