The PanOptix Trifocal IOL vs the ReSTOR 2.5 Active Focus and ReSTOR 3.0-Add Multifocal Lenses: A Study of Patient Satisfaction, Visual Disturbances, and Uncorrected Visual Performance

Visual outcomes of an extended depth of focus intraocular lens in patients with high ocular axial length

OBJECTIVE

To evaluate the visual outcomes and quality of vision in patients receiving a nondiffractive extended depth of focus (EDOF) intraocular lens (IOL), when implanted in eyes with high ocular axial length (≥24.5 mm).

METHODS

This was a prospective, single-arm, single-surgeon study. Subjects were bilaterally implanted with the Vivity EDOF IOL (toric and nontoric). At 3 months postoperatively, assessments included binocular and monocular visual acuities at distance (6 m), intermediate (66 cm), and near (40 cm), manifest refraction, and administration of a visual disturbance questionnaire (QUVID) and a satisfaction questionnaire (IOLSAT).

RESULTS

At 3 months postoperatively, 100% (20/20), 100% (20/20), and 65% (13/20) of subjects had binocular visual acuity 20/32 or better at distance, intermediate, and near, respectively. Similar visual acuities were obtained with distance correction. At 3 months postoperatively, 93% of eyes (37/40) had manifest refraction spherical equivalent 0.5 D or less. Patient reported spectacle independence was 95% (19/20), 90% (18/20), and 40% (8/20) at distance, intermediate, and near, respectively. Patient-reported satisfaction with their corrected vision was 95% (19/20). In addition, 70% (14/20), 65% (13/20), and 70% (14/20) of subjects reported never or rarely experiencing starburst, halo, and glare, respectively.

CONCLUSIONS

The results of this study suggest that the Vivity nontoric and toric IOLs can provide excellent distance and intermediate vision and functional near vision in eyes with high ocular axial length. Good spectacle independence can also be achieved at distance and intermediate, with high reported patient satisfaction and low reported visual disturbances.

Visual outcomes, quality of vision, and patient satisfaction of a trifocal intraocular lens

OBJECTIVE

To evaluate visual outcomes, patient satisfaction, and quality of vision after bilateral Clareon PanOptix implantation.

METHODS

This was a prospective, observational, single-arm, single-surgeon, single-site study of the clinical outcomes following implantation of the Clareon PanOptix (toric and nontoric). A total of 28 subjects (56 eyes) completed the study. At 3 months postoperatively, assessments included binocular uncorrected and distance-corrected visual acuity at distance (UDVA, CDVA), intermediate (UIVA, DCIVA; 60 cm), and near (UNVA, DCNVA; 40 cm), refraction, and patient-reported outcomes on a satisfaction questionnaire (IOLSAT) and a visual disturbance questionnaire (QUVID).

RESULTS

Mean postoperative binocular CDVA, DCIVA, and DCNVA were -0.02 ± 0.09, 0.03 ± 0.11, 0.04 ± 0.07 logMAR, respectively. In addition, mean binocular UDVA, UIVA, and UNVA were 0.00 ± 0.09, 0.06 ± 0.11, 0.03 ± 0.06 logMAR, respectively. Mean postoperative manifest refraction spherical equivalent (MRSE) was 0.01 ± 0.23 D and 96% of eyes had MRSE of 0.5 D or less. The percentage of subjects reporting spectacle independence at distance, intermediate, and near was 100%, 100%, and 89%, respectively. Moreover, 89% of subjects rated their satisfaction as "Satisfied" or "Very Satisfied." Additionally, 0%, 8%, and 7% of subjects were "bothered quite a bit" or "bothered very much" by starbursts, halos, and glare, respectively.

CONCLUSIONS

Patients in this study who were implanted with the Clareon PanOptix intraocular lens had excellent refractive and visual outcomes and reported good spectacle independence at distance, intermediate, and near, high overall satisfaction, and low visual disturbances.

Intraoperative Aberrometer Plus Image-guided System for Astigmatism Correction Compared to Standard Image-guided System for Significant Lens Opacity

BACKGROUND/AIM

This study aimed to evaluate astigmatism after cataract surgery by comparing the use of an intraoperative aberrometer combined with an image-guided system (VLynk) versus an image-guided system alone (Verion) in patients with significant lens opacity.

PATIENTS AND METHODS

The main outcomes included the corrected distance visual acuity (CDVA), astigmatism, spherical equivalent (SE) status, and the predicting factors for reduced astigmatism in the two groups.

RESULTS

In this study, 73 patients were enrolled in the study group (VLynk); 76 individuals constituted the control group (Verion). Preoperative and postoperative CDVA between both groups were similar (all p>0.05). The postoperative cylinder power (p=0.002), postoperative SE (p=0.004), and the difference between real SE and estimated SE (p=0.001) were significantly lower in the VLynk group. Implantation of toric IOL was associated with less astigmatism in both groups (both p<0.05). Longer axial length (p=0.013) and higher central corneal power (p=0.023) were correlated with greater astigmatism in the Verion group.

CONCLUSION

VLynk is correlated with better postoperative astigmatism control and predictability compared to Verion in patients with significant lens opacity.

Risk factors in self-reported dissatisfied patients implanted with various presbyopia-correcting intraocular lenses after cataract surgery

BACKGROUND

This study aimed to investigate the self-reported dissatisfaction rates and associated risk factors among patients who underwent cataract surgery using different types of presbyopia-correcting intraocular lenses (IOLs).

METHODS

This retrospective case-control study analyzed the medical records in 340 eyes from 211 cataract surgery patients with presbyopia-correcting IOLs. The analyzed IOL types included bifocal (ReSTOR®), trifocal (PanOptix®), and extended depth-of-focus (EDOF; Symfony®) IOLs. The rates of self-reported dissatisfaction related to vision or photic disturbances were compared between these IOLs. Various factors, including sex, age, preoperative visual acuity and refractive status, and biometric indices, were analyzed to identify potential risk factors for dissatisfaction.

RESULTS

The overall dissatisfaction rate was 18.5% (63/340). Among the IOL types, Symfony®-implanted eyes had the highest rate of near-vision dissatisfaction, while PanOptix®-implanted eyes showed similar proportions of photic disturbances and near-vision discomfort. The major risk factor identified for overall dissatisfaction, regardless of IOL type, was preoperative myopia, which aligns with the risk factor for near discomfort. Meanwhile, the risk factors for photic phenomena were revealed to be thinner corneal thickness and greater corneal astigmatism. By IOL types, preoperative myopia caused near-vision discomfort in Symfony® eyes, whereas greater corneal astigmatism and thinner corneas were linked to photic disturbances in PanOptix® eyes.

CONCLUSIONS

It suggests that near-vision discomfort is related to myopic factors, whereas photic disturbances are associated with ocular aberrations. The types of dissatisfaction vary depending on the designs of presbyopia-correcting IOLs.

TRIAL REGISTRATION

This retrospective study adhered to the principles of the Declaration of Helsinki and was approved by the Institutional Review Board of the Seoul National University Hospital on March 13, 2023 (IRB No: 2303-025-1409).

Peripheral Refraction and Axial Growth Rate After Multifocal or Monofocal Intraocular Lens Implantation in Chinese Pediatric Cataract Patients

Purpose

The purpose of this study was to compare relative peripheral refraction (RPR) and axial growth in Chinese pediatric patients with cataract who underwent multifocal or monofocal intraocular lens (IOL) implantation.

Methods

Pediatric patients with cataract aged 3 to 6 years who underwent IOL implantation from 2020 to 2021 were enrolled in this study. The patients received multifocal or monofocal IOL implantations with optic capture in Berger's space. The axial length (AL) was measured with a Zeiss IOL Master 700, and autorefraction at the horizontal retina within 30 degrees eccentricities was recorded with a Grand Seiko WAM-5500 autorefractor. The RPR was calculated by subtracting the central refraction from the peripheral refraction. The axial growth rate was calculated as the change in the AL divided by the number of follow-up years.

Results

Twenty-six children (38 eyes) implanted with multifocal IOLs and 19 children (30 eyes) implanted with monofocal IOLs completed the study. No significant differences were observed in preoperative characteristics between the two groups (P > 0.05). The generalized estimating equation (GEE) model revealed that the axial growth rate was significantly associated with the IOL type (P = 0.049) after adjusting for surgical age and follow-up intervals, with multifocal IOL eyes showing lower annual growth rate than monofocal IOL eyes. Additionally, compared with monofocal IOL eyes, multifocal IOL eyes exhibited greater peripheral myopic defocus at 20 degrees and 30 degrees on the temporal retina (P < 0.001 and P = 0.005, respectively). The GEE model also revealed a positive correlation between the annual axial growth rate and the 20 degrees temporal retina RPR (P = 0.018).

Conclusions

Chinese pediatric patients with cataract who underwent multifocal IOL implantation exhibited less axial growth, potentially caused by greater peripheral myopic defocus.

Visual Outcomes and Patient Satisfaction of Two Continuous Range of Vision Intraocular Lenses

Purpose

To determine if visual outcomes with PanOptix are non-inferior to visual outcomes with Synergy.

Methods

This was an ambispective, single center, comparative, bilateral, observational study. Patients received bilateral implantation with either PanOptix or Synergy intraocular lenses (IOLs) and were enrolled at least 5 months after surgeries. Patients with postoperative spherical equivalent ± 0.50D and astigmatism ≤ 0.75D in both eyes were enrolled. Postoperatively, patients were tested for binocular uncorrected and distance corrected visual acuities at distance, intermediate (60cm), and near (40cm and 33cm), binocular defocus curve, and were administered questionnaires about quality of vision (QUVID) and spectacle independence (IOLSAT).

Results

A total of 230 subjects completed the study, 153 in the PanOptix group and 77 in the Synergy group. Non-inferiority of visual acuities were confirmed for all testing distances, with and without distance correction in place. No significant differences were observed for the binocular defocus curves (p > 0.05). Severity of starburst, halo, and glare were rated as "None" in 65% (98/150), 38% (58/152), and 48% (72/151) of subjects with the PanOptix Group, compared to 49% (37/76), 38% (29/77), and 55% (42/77) for the Synergy Group, respectively. The percentage of patients "Satisfied" or "Very Satisfied" with their vision was 89% (136/153) in the PanOptix group and 94% (72/77) in the Synergy group.

Conclusion

The results of this study suggest excellent visual acuities at distance, intermediate, and near, high spectacle independence, and high patient satisfaction with both the PanOptix and Synergy IOLs. The incidence of starbursts and blurred vision, as well as visual acuities at extreme near (33 cm), may be higher with the Synergy IOL.

Visual Outcomes and Quality of Vision After Bilateral Implantation of a Hydrophobic Acrylic Trifocal Intraocular Lens

Purpose

To evaluate visual outcomes and quality of vision following bilateral implantation of a hydrophobic acrylic intraocular lens (IOL) in eyes targeted for emmetropia.

Methods

This was a prospective, single arm study. Subjects were bilaterally implanted with the Clareon PanOptix IOL and evaluated at 1 and 3 months postoperatively. Endpoints included binocular uncorrected and distance-corrected visual acuities at distance (UDVA, CDVA), intermediate (UIVA, DCIVA; 60 cm), and near (UNVA, DCNVA; 40 cm, 33 cm), defocus curve, manifest refraction, and administration of a visual disturbance questionnaire (QUVID) and a satisfaction questionnaire (IOLSAT).

Results

A total of 24 subjects (48 eyes) completed the study. Mean postoperative binocular CDVA, DCIVA (60 cm), DCNVA (40 cm), and DCNVA (33 cm) were -0.04 ± 0.08 logMAR, -0.08 ± 0.10 logMAR, 0.01 ± 0.10 logMAR, and 0.04 ± 0.11 logMAR, respectively. Mean postoperative binocular UDVA, UIVA (60 cm), UNVA (40 cm), and UNVA (33 cm) were 0.02 ± 0.19 logMAR, -0.08 ± 0.09 logMAR, 0.04 ± 0.12 logMAR, and 0.08 ± 0.15 logMAR, respectively. Overall, postoperative spectacle independence at distance, intermediate, and near were 100%, 93%, and 73%, respectively. A total of 9%, 12%, and 0% of subjects were bothered "quite a bit" or "very much" by halos, starburst, and glare, respectively.

Conclusion

The results of this study suggest that bilateral implantation with the Clareon PanOptix can achieve excellent visual outcomes, high spectacle independence, and low reports of bothersome dysphotopsia.

Efficacy, safety, and satisfaction in patients with a functional 5-focus pseudophakic lens 2 years after surgery

Purpose

To evaluate the safety, visual performance, and patient satisfaction of a new presbyopic pseudophakic intraocular lens (IOL).

Methods

An ambispective non-randomized study was performed in Buenos Aires, Argentina. Patients included in the study underwent a programmed femtosecond laser-assisted cataract surgery (FLACS), performed between October 2020 and September 2021, with a 24-month follow-up period. The Intensity SL (Hanita Lenses) IOL was bilaterally implanted. Uncorrected distance, intermediate, and near visual acuity (UDVA/UIVA/UNVA, respectively), and defocus curve as well as safety parameters were measured, and patient satisfaction was evaluated with the VF-14 QOL questionnaire.

Results

A total of 120 eyes of 60 patients (34 women and 26 men) aged 68.32 ± 8.9 years (54-85) were included. At the last follow-up, the mean monocular UDVA in eyes (n = 120) with an Intensity SL IOL implanted was 0.01 ± 0.07 logMAR, and the corrected distance visual acuity (CDVA) was -0.05 ± 0.06 logMAR. For 120 cm, mean UIVA was 0.06 ± 0.11 logMAR; for 80 cm, mean UIVA was 0.07 ± 0.07 logMAR; for 66 cm, mean UIVA was 0.05 ± 0.07 logMAR and for 40 cm, mean UNVA was 0.09 ± 0.08 logMAR (-0.1 to 0.2). The mean binocular UDVA in our patient group was -0.05 ± 0.05 logMAR. Glare and halo were rare phenomena. Patient satisfaction was high. The mean score value of the VF-14 QOL questionnaire 24 months postoperatively was 98.6.

Conclusion

Patients underwent safe bilateral implantation with Intensity SL IOL, achieving spectacle independence in most cases, and reported a high degree of satisfaction, refraction, and vision stability 24 months after surgery.

The Clareon Vs AcrySof PanOptix Trifocal IOL: A Comparative Study of Patient Satisfaction and Visual Performance

Purpose

To evaluate patient-reported outcomes of cataract surgery using the Clareon Panoptix and Panoptix Toric trifocal lenses and to compare these to the data collected previously for the AcrySof Panoptix and Panoptix Toric.

Patients and Methods

Prospective, open-label, multicenter analysis of satisfaction, spectacle independence, presence of unwanted side effects, and best-corrected visual acuity among patients undergoing cataract surgery who had been implanted at least 1 month previously with the Clareon PanOptix or PanOptix Toric trifocal IOL bilaterally. Results were compared to outcomes measured two years ago from a similar study with the AcrySof version of the same lens.

Results

No significant differences in patient satisfaction rates were reported between the two cohorts. Spectacle independence was similar with 88% of Clareon Panoptix and 83% of AcrySof Panoptix patients having no need for any corrective lenses. Quality of vision was not statistically different with 7% of Clareon vs 15% of AcrySof patients reporting "very much" or more of glare/halo severity. Significantly more AcrySof (66%) than Clareon (42%) patients achieved a spherical equivalent outcome within 0.25 D of target. Best corrected distance visual acuity differences were not statistically significant, and no safety concerns were reported.

Conclusion

The Clareon PanOptix trifocal lens provides similar satisfaction and spectacle independence and has a similar side effect profile and BCVA outcome to the identical lens made of the predecessor AcrySof lens.

Visual outcomes comparing emmetropia vs mini-monovision after bilateral implantation of a nondiffractive extended vision intraocular lens: randomized trial

PURPOSE

To compare visual outcomes and patient satisfaction after bilateral implantation of a nondiffractive extended vision intraocular lens (IOL) when targeting emmetropia vs mini-monovision.

SETTING

Iladevi Cataract & IOL Research Centre, Ahmedabad, India.

DESIGN

Prospective, randomized controlled trial.

METHODS

Patients undergoing bilateral cataract surgery with an extended vision IOL (Vivity) randomized to group I-IOL implantation with emmetropic target in both eyes or group II-IOL implantation with mini-monovision of -0.5 diopters (D) were included in this study. Outcome measures evaluated 6 months postoperatively were unaided and corrected near visual acuity (UNVA, CNVA) at 40 cm and unaided and corrected distance (UDVA, CDVA) and intermediate (UIVA, CIVA) visual acuity at 66 cm. Mesopic contrast sensitivity, binocular defocus curve, Patient-Reported Spectacle Independence Questionnaire, and satisfaction on the McAlinden questionnaire were also assessed.

RESULTS

70 patients enrolled in this study. 34 and 33 patients in groups I and II, respectively, completed follow-up. Binocular UNVA was significantly better in group II (0.26 ± 0.05 vs 0.22 ± 0.08 logMAR, P = .03). Reading add required in group II was significantly lower. UIVA (0.09 ± 0.06 vs 0.07 ± 0.08 logMAR, P = .15) and UDVA (0.02 ± 0.04 vs 0.02 ± 0.05 logMAR, P = .78) were not significantly different between groups. Mesopic contrast sensitivity was not significantly different between the groups. Binocular defocus curve showed significantly better mean visual acuities between -2.0 D and -3.0 D in group II. Patients in both groups had high levels of spectacle independence, with no patient reporting dysphotopsia.

CONCLUSIONS

Binocular UNVA was significantly better, with comparable UDVA and mesopic contrast sensitivity when targeting mini-monovision with the nondiffractive extended vision IOL as compared with targeting binocular emmetropia.

Outcomes After Implantation of a Trifocal Toric Intraocular Lens Using Intraoperative Aberrometry, Digital Image Tracking, and Femtosecond Laser

Purpose

To evaluate the refractive and visual acuity outcomes when using trifocal toric intraocular lenses (IOLs), femtosecond laser assisted cataract surgery (FLACS), swept-source optical coherence tomography (SS-OCT) biometry, digital image tracking (DT) and intraoperative aberrometry (IA).

Methods

This prospective, single-arm, observational study of refractive and visual outcomes included 40 eyes of 34 subjects. Preoperative biometry was performed with the Argos, FLACS and digital marking with LenSx, and IA and DT with ORA. Eyes were implanted with the Clareon PanOptix toric IOL. Study outcome measures included absolute prediction error, residual refractive astigmatism, and monocular uncorrected and distance corrected visual acuity at distance (UDVA, CDVA), intermediate (UIVA, DCIVA; 60cm), and near (UNVA, DCNVA; 40cm).

Results

Mean absolute prediction error (spherical equivalent) was 0.43 ± 0.36 D, and the percentage of eyes with absolute prediction error ≤ 0.5 D was 72.5% (29/40 eyes). Mean residual astigmatism was 0.36 ± 0.65 D, and the percentage of eyes with residual astigmatism ≤ 0.5 D was 80% (32/40 eyes). Monocular UDVA, UIVA, and UNVA was 20/25 or better in 75%, 64%, and 87% of eyes respectively. Monocular CDVA, DCIVA, and DCNVA was 20/25 or better in 95%, 64%, and 87% of eyes respectively.

Conclusion

The results of this study suggest that trifocal toric implantation with SS-OCT, FLACS, DT, and IA can provide excellent refractive and visual outcomes.

Visual Function After Implantation of Trifocal and Trifocal Toric Intraocular Lenses Using Intraoperative Aberrometry

Purpose

To evaluate patient outcomes and visual function following trifocal and trifocal toric intraocular lens (IOL) implantation using intraoperative aberrometry at a single site in the US.

Methods

This prospective, single arm study included 21 subjects that completed 3 month follow-up. Inclusion criteria were visually significant cataract and potential post-operative visual acuity of 20/25 or better. Endpoints included postoperative prediction error, refractive outcomes, uncorrected visual acuities at distance (UDVA), intermediate (UIVA), and near (UNVA), contrast sensitivity, and subject responses on the modified Visual Function Quality of Life Questionnaire (VF-14 QOL).

Results

Binocular UDVA, UIVA, and UNVA were 20/25 or better in 100% (21/21), 100% (21/21), 90% (19/21) of subjects. The absolute prediction error was 0.50 D or less in 79% (33/42) of eyes, and 81% (34/42) and 86% (36/42) of eyes achieved ≤0.5 D of residual astigmatism and manifest refraction spherical equivalent, respectively. On the modified VF-14 QOL, driving at night, reading small print, and reading a newspaper or book were the tasks that had the lowest percentages of subjects reporting no difficulty or a little difficulty.

Conclusion

Implantation with trifocal and trifocal toric IOLs using intraoperative aberrometry can provide high refractive precision, leading to excellent visual performance and low visual task difficulty at all ranges (distance, intermediate, and near).

Refractive outcomes following bilateral implantation of a diffractive toric intraocular lens in a multisurgeon hospital setting

OBJECTIVE

To assess residual postoperative refractive astigmatism following bilateral implantation of a trifocal toric intraocular lens (IOL) in a real-world multisurgeon setting.

DESIGN

Prospective multisurgeon study (6 surgeons at 2 sites).

METHODS

Bilateral implantation of a trifocal toric IOL (AcrySof PanOptix IOL; Alcon Vision LLC, Fort Worth, TX, USA) was performed in 140 eyes of 70 patients. Patients were assessed on day 1 and 3 months postoperatively. The primary outcome measure was residual astigmatism. Secondary endpoints included absolute prediction error, IOL rotation, binocular uncorrected and distance-corrected visual acuities at near (40 cm), intermediate (60 cm), and distance (6 m) and spectacle independence evaluated with the validated Intraocular Lens Satisfaction questionnaire.

RESULTS

Mean preoperative cylinder was 1.25 ± 0.72 D and was 0.39 ± 0.28 D at 3 months postoperatively. At 3 months postoperatively, mean residual astigmatism was 0.39 ± 0.28 D (range, 0-1.25 D), and 118 eyes (84.3%) had postoperative astigmatism of 0.5 D or less. Mean absolute prediction error was 0.25 ± 0.21 D (range, 0-1.13 D), and 124 eyes (88.6%) had absolute prediction error of 0.5 D or less. At 3 months postoperatively, mean absolute rotation was 2.0 ± 2.7 degrees compared with baseline (range, 0-15 degrees), and 133 IOLs (95.0%) were within 5 degrees of the implanted axis. Additionally, 55 patients (79%) reported never or rarely using spectacles at near, 66 (94%) at intermediate, and 67 (96%) at distance.

CONCLUSIONS

The results of this study demonstrate that implantation with the PanOptix toric IOL can provide excellent refractive and visual outcomes with minimal residual astigmatism.

The Role of Early Nd:YAG Laser Capsulotomy in Improving Visual Performance in Mild to Moderately Symptomatic Trifocal Patients

Purpose

To determine the effect of early Nd:YAG (neodymium:yttrium-aluminum-garnet) laser capsulotomy on objective and subjective visual quality in symptomatic trifocal intraocular lens (IOL) patients.

Methods

A single-center, prospective study examined symptomatic patients after bilateral cataract extraction with trifocal IOL implantation. A ten-question survey was conducted one month after surgery. Study endpoints included the assessment of monocular and binocular uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), contrast sensitivity (CS), and subjective visual quality before and after Nd:YAG capsulotomy prior to 4 months after cataract surgery.

Results

A total of 38 eyes from 21 patients were included with a TFAT00 (n = 23) or TFAT30-60 (n = 15). Overall satisfaction with the IOL was 8.55 ± 1.77 (range 5-10). A Nd:YAG capsulotomy was performed at 55 ± 26 days. Monocular UDVA and UNVA > 20/25 before Nd:YAG were 53.0% and 42.0%, which improved post-Nd:YAG to 63.0% and 66.0%, respectively (P = 0.41, P = 0.051). Binocular UDVA and UNVA >20/25 before Nd:YAG were 82.0% and 63.0%, which increased to 97% and 97%, respectively (P < 0.05, P < 0.001). CS increased in all post-Nd:YAG capsulotomies (P < 0.01). The presence of glare was documented at 74% pre-Nd:YAG, which decreased to 41% post-Nd:YAG (P < 0.01). Glare which limited activities was documented at 24%, which decreased to 5% post-Nd:YAG (P = 0.21).

Conclusion

Early treatment of posterior capsule opacities in mild to moderately dissatisfied trifocal IOL patients may be beneficial in improving CS, visual quality, and reducing the presence and severity of dysphotopsias.

Outcomes after bilateral implantation of AcrySof IQ PanOptix trifocal intraocular lens: a prospective interventional study

Background

Implantation of multifocal intraocular lenses (IOLs) is becoming increasingly popular for the treatment of visual demands at various distances in patients undergoing phacoemulsification cataract surgery. We aimed to assess the visual performance and rates of photic phenomena, posterior capsule opacification (PCO), and spectacle independence in patients with bilateral implantation of the AcrySof® IQ PanOptix® multifocal IOL model TFNT00 at one and six months postoperatively.

Methods

This prospective interventional cohort study included adult patients who underwent uneventful phacoemulsification cataract surgery with bilateral implantation of AcrySof® IQ PanOptix® IOL. Uncorrected and corrected visual acuities at far, intermediate, and near distances were measured preoperatively and at the one- and six-month postoperative follow-up examinations. The rates of photic phenomena, postoperative need for near and distance spectacles, and PCO were also recorded.

Results

We included 164 eyes of 82 patients with a male-to-female ratio of 38 (46.3%) to 44 (53.7%) and a mean (standard deviation [SD]) age of 52.37 (7.62) years. There were statistically significant improvements in the visual acuities of both eyes across all distances at the one- and six-month follow-up examinations compared to the preoperative values (all P < 0.001), except for corrected near visual acuity in the right eye (P > 0.05) at six-month. We also detected significant postoperative improvements in visual acuities of both eyes across all distances at the six-month follow-up compared to values at the one-month follow-up (all P < 0.05), except for corrected near visual acuity in the right eye (P > 0.05). The photic phenomenon was reported by 12 (14.6%) of the 82 patients at the six-month postoperative follow-up. Five (6.1%) and eight (9.8%) of the 82 patients reported using spectacles for distance and near, respectively. Additionally, PCO developed in 19 (11.6%) of the 164 included eyes, although it was not clinically significant at six months.

Conclusions

The AcrySof® IQ PanOptix® IOL model TFNT00 is recommended for use, given its excellent performance in all ranges of vision, a high rate of spectacle independence, and a good safety profile. Future comparative studies with longer follow-up periods are warranted to verify superiority of its performance over that of other available multifocal IOLs.

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

INTRODUCTION

Refractive lens exchange (RLE) patients represent a unique population with a different baseline and set of expectations compared to their cataract counterparts. Visual outcomes and patient satisfaction following RLE with bilateral implantation of a trifocal intraocular lens (IOL) were assessed in a cohort of patients with presbyopia and without cataract.

METHODS

Charts of patients with presbyopia who underwent femtosecond laser-assisted RLE with bilateral implantation of the PanOptix trifocal IOL (toric and non-toric) at a single-surgeon, private practice center from September 2019 to August 2020 were retrospectively reviewed. Eyes with prior keratorefractive surgery, amblyopia, or underlying pathology were excluded. Primary endpoints included corrected and uncorrected visual acuity at distance (CDVA and UDVA), intermediate (DCIVA and UIVA), and near (DCNVA and UNVA) at 6 months. Secondary endpoints included residual refractive error, patient-reported satisfaction, spectacle independence, and visual disturbance profile as assessed by a validated questionnaire at 6 months.

RESULTS

Seventy-eight eyes of 39 patients (mean age 56 ± 6 years; 79% female) were included. Most eyes were hyperopic (mean SE 2.35 ± 1.81). Postoperatively, 100% and 92% of eyes were within ± 1.00 D and ± 0.50 D of emmetropia, respectively. One hundred percent, 97%, and 97% of patients achieved UDVA, UNVA, and UIVA of logMAR 0.1 or better. Starbursts were the most frequent (67%) and bothersome (41%) visual disturbance cited, but nearly half (41%) of patients rated them as absent or "not bothersome at all." Overall, 77% of patients reported achieving complete spectacle independence with 87% and 90% of patients stating they were satisfied with their vision and would recommend the same procedure to others, respectively.

CONCLUSIONS

RLE with bilateral implantation of the PanOptix IOL is a safe and effective procedure with good patient satisfaction. Because of their relatively clear native lenses and visually demanding needs compared to their cataract counterparts, surgeons should take extra precautions to counsel RLE patients on the limitations of trifocal technology.

Randomized and double-blind comparison of clinical visual outcomes of 2 EDOF intraocular lenses

PURPOSE

To assess and compare the visual disturbance profiles of 2 extended depth-of-focus (EDOF) intraocular lenses (IOLs).

SETTING

Private practice (West Kootenays, British Columbia, Canada).

DESIGN

Prospective, randomized, single-surgeon study.

METHODS

This was a double-blind prospective study of 138 eyes (69 patients) that underwent bilateral implantation of 1 of 2 EDOF IOLs. Participants were randomized to either the Symfony group or the Vivity group. Outcome measures included Questionnaire for Visual Disturbances; binocular corrected distance visual acuities at distance (6 m), intermediate (66 cm), and near (40 cm); and refractive outcomes.

RESULTS

At 3 months postoperatively, 21 patients (60%) reported not experiencing glare in the Symfony group compared with 30 (88%) in the Vivity group, a difference of 28% (P = .008). Reports of experiencing starbursts were also significantly different between the Symfony and Vivity groups (23 participants [66%] Symfony and 30 participants [88%] Vivity; P = .027). In addition, 12 participants (34%) reported "moderate" or "severe" starbursts in the Symfony group compared with 3 (9%) in the Vivity group, a difference of 25% (P = .019). Visual acuities and refractive outcomes were similar between groups.

CONCLUSIONS

Both EDOF lenses provide good visual outcomes at distance and intermediate with acceptable near vision. The Symfony group had increased reports of some visual disturbances, notably the frequency, severity, and bothersomeness of starbursts and glare.

Rate of Complete Spectacle Independence with a Trifocal Intraocular Lens: A Systematic Literature Review and Meta-Analysis

INTRODUCTION

A systematic literature review and meta-analysis was conducted to identify and obtain a precise single summary estimate on complete spectacle independence after bilateral implantation of a trifocal intraocular lens (IOL) (AcrySof PanOptix, TFNTXX/TFATXX) for patients undergoing cataract surgery.

METHODS

A search was conducted in PubMed from January 2017 to September 2021. Relevant congress presentations were also searched to include data from completed studies not yet published. Search terms included the intervention (TFNTXX, TFATXX, PanOptix) and outcomes of interest (patient-reported spectacle independence rates). A Bayesian random-effects meta-analysis was conducted, providing a pooled estimate (median and its 95% credible interval) of complete spectacle independence rates among cataract surgery patients. Subgroup analyses evaluated spectacle independence after cataract surgery across different working distances (near, intermediate, far).

RESULTS

Nineteen unique clinical studies were identified. Based on a meta-analysis of 13 studies (N = 513 patients), the complete spectacle independence rate after cataract surgery with TFNTXX/TFATXX IOL was 91.6% (95% credible interval 86.8-95.9%). Additionally, the spectacle independence rates at each focal point (N = 13 studies, 603 patients) were 89.6% (near), 96.3% (intermediate), and 95.9% (far).

CONCLUSIONS

This meta-analysis demonstrated that at least nine out of ten patients receiving TFNTXX/TFATXX trifocal IOL during cataract surgery can expect to achieve complete spectacle independence. This study provides informative data for clinicians and patients to feel confident in the use of trifocal intraocular lenses as presbyopia-correcting IOLs that offer high rates of complete spectacle independence.

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

BACKGROUND

Presbyopia occurs when the lens of the eyes loses its elasticity leading to loss of accommodation. The lens may also progress to develop cataract, affecting visual acuity and contrast sensitivity. One option of care for individuals with presbyopia and cataract is the use of multifocal or extended depth of focus intraocular lens (IOL) after cataract surgery. Although trifocal and bifocal IOLs are designed to restore three and two focal points respectively, trifocal lens may be preferable because it restores near, intermediate, and far vision, and may also provide a greater range of useful vision and allow for greater spectacle independence in individuals with presbyopia.

OBJECTIVES

To assess the effectiveness and safety of implantation with trifocal versus bifocal IOLs during cataract surgery among people with presbyopia.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2022, Issue 3); Ovid MEDLINE; Embase.com; PubMed; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 31 March 2022.  SELECTION CRITERIA: We included randomized controlled trials that compared trifocal and bifocal IOLs among participants 30 years of age or older with presbyopia undergoing cataract surgery.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodology and graded the certainty of the body of evidence according to the GRADE classification.

MAIN RESULTS

We identified seven studies conducted in Europe and Turkey with a total of 331 participants. All included studies assessed visual acuity using a logarithm of the minimum angle of resolution (LogMAR chart). Of them, six (86%) studies assessed uncorrected distance visual acuity (the primary outcome of this review). Some studies also examined our secondary outcomes including uncorrected near, intermediate, and best-corrected distance visual acuity, as well as contrast sensitivity. Study characteristics All participants had bilateral cataracts with no pre-existing ocular pathologies or ocular surgery. Participants' mean age ranged from 55 to 74 years. Three studies reported on gender of participants, and they were mostly women. We assessed all of the included studies as being at unclear risk of bias for most domains. Two studies received financial support from manufacturers of lenses evaluated in this review, and at least one author of another study reported receiving payments for delivering lectures with lens manufacturers. Findings All studies compared trifocal versus bifocal IOL implantation on visual acuity outcomes measured on a LogMAR scale. At one year, trifocal IOL showed no evidence of effect on uncorrected distance visual acuity (mean difference (MD) 0.00, 95% confidence interval (CI) -0.04 to 0.04; I2 = 0%; 2 studies, 107 participants; low-certainty evidence) and uncorrected near visual acuity (MD 0.01, 95% CI -0.04 to 0.06; I2 = 0%; 2 studies, 107 participants; low-certainty evidence). Trifocal IOL implantation may improve uncorrected intermediate visual acuity at one year (MD -0.16, 95% CI -0.22 to -0.10; I2 = 0%; 2 studies, 107 participants; low-certainty evidence), but showed no evidence of effect on best-corrected distance visual acuity at one year (MD 0.00, 95% CI -0.03 to 0.04; I2 = 0%; 2 studies, 107 participants; low-certainty evidence). No study reported on contrast sensitivity or quality of life at one-year follow-up. Data from one study at three months suggest that contrast sensitivity did not differ between groups under photopic conditions, but may be worse in the trifocal group in one of the four frequencies under mesopic conditions (MD -0.19, 95% CI -0.33 to -0.05; 1 study; I2 = 0%, 25 participants; low-certainty evidence). One study examined vision-related quality of life using the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) at six months, and suggested no evidence of a difference between trifocal and bifocal IOLs (MD 1.41, 95% CI -1.78 to 4.60; 1 study, 40 participants; low-certainty evidence). Adverse events Adverse events reporting varied among studies. Of five studies reporting information on adverse events, two studies observed no intraoperative and postoperative complications or no posterior capsular opacification at six months. One study reported that glare and halos were similar to the preoperative measurements. One study reported that 4 (20%) and 10 (50%) participants had glare complaints at 6 months in trifocal and bifocal group, respectively (risk ratio 0.40, 95% CI 0.15 to 1.07; 40 participants). One study reported that four eyes (11.4%) in the bifocal group and three eyes (7.5%) in the trifocal group developed significant posterior capsular opacification requiring YAG capsulotomy at one year. The certainty of the evidence for adverse events was low.

AUTHORS' CONCLUSIONS

We found low-certainty of evidence that compared with bifocal IOL, implantation of trifocal IOL may improve uncorrected intermediate visual acuity at one year. However, there was no evidence of a difference between trifocal and bifocal IOL for uncorrected distance visual acuity, uncorrected near visual acuity, and best-corrected visual acuity at one year. Future research should include the comparison of both trifocal IOL and specific bifocal IOLs that correct intermediate visual acuity to evaluate important outcomes such as contrast sensitivity, quality of life, and vision-related adverse effects.

Comparative Study Between Non-Diffractive Extended Depth of Focus and Monofocal Intraocular Lenses

Purpose

To evaluate the visual acuity and quality of vision in bilaterally implanted ZCBOO/ZCTx monofocal (Johnson & Johnson Vision) intraocular lens (IOL) and bilaterally implanted DATx15 extended depth of focus (EDOF) IOL (Alcon Vision, LLC).

Methods

A single site, non-interventional study comparing ZCBOO/ZCTx monofocal IOL patients implanted with DATx15 IOL toric or non-toric versions in both eyes. A total of 30 patients (60 eyes) completed the study in the monofocal group, 32 (64 eyes) in the EDOF group, and all were targeted for emmetropia. Binocular uncorrected distance, intermediate (66cm), and near (40cm) visual acuities and distance corrected distance, intermediate (66cm) and near (40cm) visual acuities were assessed. Binocular distance corrected defocus curve testing was from -3.5 D to +3 D. Patient reported visual disturbances (QUVID) and IOL satisfaction (IOLSAT) questionnaires were administered.

Results

The DATx15 group mean uncorrected visual acuity was 0.15 ± 0.10 logMAR at 66cm and 0.36 ± 0.14 logMAR at 40cm, compared to 0.24 ± 0.15 logMAR and 0.59 ± 0.17 logMAR respectively for the ZCBOO/ZCTx group. The DATx15 group (23 respondents, 74%) also reported significantly more spectacle independence at near with the IOLSAT (p < 0.01), compared to the ZCBOO/ZCTx group (13 respondents, 43%). Glare, halos, starbursts, and blur reported on the QUVID questionnaire were similar in the two groups.

Conclusion

The DATx15 group had improved near and intermediate vision and increased spectacle independence compared to the ZCBOO/ZCTx group.

Visual and Refractive Efficacy of Panoptix Toric Intraocular Lens in a Clinical Setting

Purpose

Trifocal Intraocular Lenses (IOLs) were developed to provide patients with effective near, intermediate and distance vision, thus minimizing spectacle dependency. Residual astigmatism has previously been shown to impact unaided visual acuity across all distances; therefore, to optimise the expected outcomes, consideration of preoperative corneal astigmatism is essential. The purpose of this study was to provide a real-world, multi-site review of visual and refractive outcomes in eyes undergoing implantation with the Panoptix Trifocal toric IOL platform.

Patients and Methods

This study represents a two-fold approach. Patients who had previously undergone routine cataract removal and IOL insertion with the Panoptix Toric IOL were retrospectively analysed for routine efficacy and safety endpoints ("Retrospective Cohort"). Data was retrieved from the preoperative, surgical and postoperative visits (range 2-6 weeks). A further subset of patients undergoing lens removal and bilateral Panoptix Toric IOL insertion were identified at surgery ("Qualitative Cohort"). These patients underwent additional testing inclusive of quality of vision questionnaire and bilateral defocus curve.

Results

A total of 466 eyes of 254 patients were included in the retrospective cohort. Between 91% and 98% of eyes, respectively, were within 0.50D and 1.00D of target. Mean absolute difference from Spherical Equivalent (SE) target was 0.22 ± 0.24Ds. Following surgery, 94% of eyes demonstrated a refractive astigmatism of 0.50D or less. Further, 61% eyes achieved uncorrected distance visual acuity (UDVA) of 20/20 or better, increasing to 94% achieving 20/32 or better. Seventy percent of eyes unilaterally achieved N5 unaided and 66.0% achieved N8 or better at intermediate. In the qualitative cohort, no patient described any symptom as significant or requested explant.

Conclusion

In a real-world setting, the PanOptix toric trifocal IOL continues to demonstrate refractive accuracy and good visual performance at all focal distances. This IOL also exhibited good quality of vision, with minimally bothersome visual disturbances or photic phenomena.

Clinical outcomes of new multifocal intraocular lenses with hydroxyethyl methacrylate and comparative results of contrast sensitivity, objective scatter, and subjective photic phenomena

Background

We investigate the performance of new hydrophobic diffractive multifocal intraocular lenses (IOL) with hydroxyethyl methacrylate (HEMA) and compare their optical quality, contrast sensitivity, and subjective photic phenomena.

Methods

Medical records of patients who underwent routine simple cataract surgery and insertion of an existing multifocal IOL (TFNT, TF group) or a new multifocal IOL (CNWT, CN group) were retrospectively reviewed. Clinical data was collected 2 months postoperatively and included optical quality analysis system (OQAS) indices, contrast sensitivity, and subjective degrees of photic phenomena.

Results

One hundred thirty-five eyes of 135 patients were included (CN group, 71; TF group, 64). There was no significant difference between the two groups in the visual acuity and defocus curve. The indices of OQAS did not show a significant difference between groups. Contrast sensitivity was significantly better in the CN group at all degrees, including the area under the log contrast sensitivity function (p = 0.01). The subjective photic phenomena survey showed better results for the CN group, with the proportion of patients reporting no photic phenomena as 9.9% and 3.1% in the CN and TF groups, respectively. The proportion of patients who reported severe photic phenomena was 11.3% in the CN group and 25.0% in the TF group. Although the follow-up period was only 2 months, glistening, surface scattering, and posterior capsule opacity were not observed in any patient.

Conclusions

The new multifocal IOL with HEMA is safe, and provides stable visual acuity as well as superior contrast sensitivity and lower subjective photic phenomena, over the prior IOL.

Refractive Outcomes Following Trifocal Intraocular Lens Implantation in Post-Myopic LASIK and PRK Eyes

Purpose

To assess refractive outcomes of a trifocal intraocular lens (IOL) in post-myopic laser refractive surgery eyes.

Methods

This was a retrospective chart review of 35 eyes (21 patients), with history of laser refractive surgery, who were implanted with a trifocal IOL. Surgeon’s standard procedure included femtosecond laser (FLACS), digital registration, and intraoperative aberrometry (IA). The primary outcome measure was absolute prediction error. Secondary measures were refractive outcomes, postoperative residual astigmatism (PRA), monocular uncorrected visual acuity at distance (UDVA; 4m), intermediate (UIVA; 60cm), and near (UNVA; 40cm), and monocular best-corrected visual acuity at distance (BCVA; 4m).

Results

At 3 months postoperatively, 71% and 68% of eyes had absolute prediction error 0.5 D or less with IA and preoperative planning respectively, which was not statistically significant (p > 0.05). The PRA was 0.5 D or less in 91% of eyes with IA and 56% of eyes with preoperative planning. The PRA differences between IA and preoperative planning were statistically significant (p < 0.002). The percentage of eyes 20/20 or better for monocular UCVA, BCVA, UIVA, and UNVA was 29%, 77%, 78%, and 66%, respectively. Absolute prediction error 0.5 D or less was significantly higher in post-LASIK eyes versus post-PRK eyes (p < 0.003), at 85% and 56% of eyes, respectively.

Conclusion

Implantation with a trifocal IOL can provide acceptable refractive and visual outcomes with minimal residual astigmatism in post-myopic LASIK and PRK eyes.

Clinical Outcomes and Quality of Vision Associated with Bilateral Implantation of a Wavefront Shaping Presbyopia Correcting Intraocular Lens

Purpose

To provide normative visual acuity and quality of vision data related to bilateral implantation of a wavefront shaping presbyopia correcting intraocular lens (IOL).

Patients and Methods

This was a non-interventional research study of the refraction, visual acuity (VA) and quality of vision achieved after bilateral implantation of a wavefront shaping presbyopia correcting intraocular lens between 3 months and 12 months post-surgery. The manifest refraction, and uncorrected and distance corrected VA at near, intermediate and distance (40 cm, 50 cm, 66cm, 4 m) were tested. Binocular mesopic VA at 4m and uncorrected photopic low contrast (25%) VA at 4 m were also tested, the latter with and without a glare source. A patient reported outcome questionnaire was administered. Defocus curve testing with and without simulated myopia in the non-dominant eye was also tested (reported elsewhere).

Results

Forty subjects completed the study. There was no statistically significant difference between the uncorrected and distance corrected VA at any distance. Mean logMAR binocular VAs were (−0.07 ± 0.07) at 4 m, (0.00 ± 0.07) at 66 cm and (0.07 ± 0.11) at 40 cm. Uncorrected photopic low contrast VA was statistically significantly better without glare (0.09 ± 0.10) compared to with glare (0.44 ± 0.21, p < 0.01). Reported glare, halos and starbursts were “not at all” Or “a little” bothersome for more than 95% of subjects. Hazy vision and blurred vision were reported most often.

Conclusion

The Vivity IOL provided patients with good distance and intermediate vision, and functional near vision with low reported bother from glare, halos, or starbursts.

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The Effect of Spectacle-Induced Low Myopia in the Non-Dominant Eye on the Binocular Defocus Curve with a Non-Diffractive Extended Vision Intraocular Lens

Purpose

To quantify the changes in the binocular defocus curve associated with the Vivity™ non-diffractive extended vision intraocular lens when the dominant eye was targeted for emmetropia and the non-dominant eye was artificially targeted for slight myopia using spectacles.

Patients and Methods

This was a non-interventional research study of the corrected binocular defocus curve associated with binocular emmetropia (Setting A) and with emmetropia in the dominant eye and two different levels of myopia simulated in the non-dominant eye (−0.50 D, Setting B and −1.00 D, Setting C). Subjects were patients implanted with the AcrySof^® IQ Vivity^® intraocular lens in both eyes 3 to 12 months previously. Using the defocus data, the percentage of subjects with a continuous 2.5 D range of vision (distance to 40 cm) was calculated for various levels of minimum visual acuity (VA).

Results

Forty subjects were enrolled. The mean spherical equivalent refraction was −0.06 D ± 0.36 D, with 0.37 D ± 0.29 D of refractive cylinder. There was no statistically significant difference in the mean VA at −0.25 D or at −0.50 D vergences between the test Settings, but there was a statistically significant difference at all other vergences. Differences were particularly noticeable at −2.00 D, −2.50 D and −3.00 D, where higher myopia in the non-dominant eye yielded better binocular VA. A 2.5 D range of functional vision (20/25) was achieved by 38% of subjects at Setting A, 68% of subjects at Setting B and 85% of subjects at Setting C. At setting C, all but one subject (39/40, 97.5%) had a 2.5 D range of vision with a VA of 20/32 or better.

Conclusion

Significant gains in binocular near vision, with only a nominal effect on distance vision, can be achieved with the Vivity IOL by leaving the non-dominant eye of patients with 0.50 D or 1.00 D of myopia.

Reported Patient Satisfaction and Spectacle Independence Following Bilateral Implantation of the PanOptix® Trifocal Intraocular Lens

Purpose

To assess the spectacle independence and satisfaction of subjects after bilateral implantation of the PanOptix^® trifocal intraocular lens (IOL) at the time of cataract surgery.

Design

Single site, prospective, single-arm study.

Methods

Eligible subjects interested in a trifocal IOL to potentially reduce dependence on spectacles for near, intermediate and distance vision were enrolled and followed for 3 months after the second eye surgery. Visual acuity and refractive data were collected 1 month and 3 months postoperative, including the uncorrected and best distance-corrected binocular visual acuities at distance (4m), intermediate (60 cm) and near (40cm). A patient satisfaction and spectacle independence questionnaire were administered at the 3-month visit.

Results

A total of 30 subjects successfully completed the study. Eighty-five percent of eyes (51/60) had a refraction within 0.50 D of plano with ≤ 0.50 D of refractive cylinder. One subject (3%) reported needing glasses for distance work, 3 (10%) for intermediate work and 4 (13%) for near work. Ninety percent or more of all subjects reported never wearing glasses or wearing them only a little at all working distances. Ninety percent or more were able to function without glasses at all 3 working distances all or most of the time. More than ninety percent of subjects reported being “com.pletely” or “mostly” satisfied with their vision without glasses or contact lenses at all three distances and overall.

Conclusion

A high percentage of patients are likely to achieve spectacle independence for distance, intermediate and near vision with this trifocal IOL.