Visual Performances of a New Extended Depth-of-Focus Intraocular Lens with a Refractive Design: A Prospective Study After Bilateral Implantation

Assessing the clinical outcomes of a novel EDOF intraocular lens: a functional classification approach

BACKGROUND

Functional assessment can help identify the true extended depth of focus intraocular lenses (EDOF IOLs) on the market. This study aimed to demonstrate the eligibility of the 877PEY ELON IOL (Medicontur Medical Engineering) as a suitable model for this category and to assess its efficacy in clinical settings.

METHODS

In total, 38 patients (76 eyes) were enrolled in the study with bilateral implantation of the investigational IOL. For functional classification, a distance-corrected monocular defocus curve was taken 3 months postoperatively. At the 3- and 12-month follow-ups, manifest refraction, monocular and binocular distance, intermediate and near visual acuities, contrast sensitivity, and patient-reported outcomes were recorded.

RESULTS

The defocus range (visual acuity [VA] ≤ 0.2 logMAR) on the distance-corrected monocular normalized defocus curve taken at 3 months was 1.7 D, which falls into the Partial Range of Field Extended (later referred to as PRoF-Ex) category, confirming expectations. The binocular depth of focus (VA ≤ 0.1 logMAR) spanned approximately 0.50 D to -1.50 D, and the functional visual acuity (VA ≤ 0.3 logMAR) spanned approximately 1.00 D to -2.50 D. Monocular CSV-1000 outcomes were above the population's normal ranges. 90.9% of the patients were within ± 0.50 D, and 97.7% were within ± 1.00 D SEQ at the 3-month follow-ups. The outcomes of the VFQ-25 questionnaire demonstrated high scores, and the level of spectacle independence, similar to visual acuity, reflected a strong efficacy in distance and intermediate correction with functional near vision. In terms of photopic phenomena, 90% and 87.5% of patients experienced no-to-moderate rates of glare and halos, respectively. The posterior capsular opacification (PCO) rate was 7.89% at the 12-month follow-up. No adverse events were considered serious.

CONCLUSIONS

The 877PEY model demonstrated capability as a PRoF-Ex IOL with remarkable performance. It is safe to use and delivers a high degree of patient satisfaction.

Clinical results after binocular implantation of a unique nondiffractive enhanced monofocal intraocular lens designed for enhanced monovision to increase the depth of focus

PURPOSE

To provide the reports of a pilot study to assess the visual acuity (VA) and contrast sensitivity with RayOne enhanced monovision (EMV), a unique nondiffractive enhanced monofocal intraocular lens (IOL) to increase the range of focus.

METHODS

A retrospective case series study was conducted by analyzing 25 patients (50 eyes) who had bilateral implantation of EMV IOL after cataract surgery. Data collected included biometry, spherical equivalent (SE), and VA for near, intermediate, and distance. Patients were reviewed at 1 day, 1 week, and 1 month after surgery. Contrast sensitivity (CS) was checked at 1 month.

RESULTS

The study included 14 males (56%). Age of participants was 61.4 ± 7.4 years. Uniocular uncorrected near and distance VA improved from 0.33 ± 0.13 to 0.05 ± 0.07 and from 0.63 ± 0.31 to 0.05 ± 0.10 log of minimum angle of resolution (logMAR) at 1 month (P < 0.001 for both). Binocular uncorrected near and distance VA improved from 0.09 ± 0.18 and 0.14 ± 0.27 to 0.05 ± 0.06 and 0.00 ± 0.09 logMAR, respectively (P < 0.001). SE changed from - 0.23 ± 2.55 to - 0.33 ± 0.46. CS at 3 months was 1.74 ± 0.21. At 1 month, 48 eyes (96%) achieved uncorrected intermediate VA 6/15 (0.4 logMAR) or better. When comparing eyes that had uncorrected intermediate vision of ≥ 0.2 (6/9 or better) to eyes that had < 0.2 logMAR at 1 month, there was no difference between groups with respect to baseline parameters.

CONCLUSION

The pilot study shows that the nondiffractive EMV IOL is safe, effective, and stable, providing excellent distance and intermediate vision and good near vision.

Patient reported outcomes after implementation of an enhanced depth of focus intraocular lens with low postoperative myopia

Background

Enhanced depth-of- focus intraocular lenses (EDOF IOL) have filled the gap between monofocal and multifocal intraocular implants with optical qualities of monofocal lenses and usually minor dysphotopsias typical for multifocal lenses. The purpose of this study was to evaluate visual outcomes after bilateral implantation of a new EDOF IOL in patients with requirements for perfect near and intermediate vision.

Methods

The study included 15 patients (29 eyes as one was amblyopic) with bilateral implantation of LUXSMART EDOF IOL (Bausch & Lomb) with a targeted myopia (between -0.25 and -0.50D) in both eyes. Monocular corrected and uncorrected visual acuity for far, intermediate and near as well as refractive outcomes were evaluated at 1, 3, 6 and 12 months after the surgery. Additionally, binocular visual acuity, contrast sensitivity and defocus curve were measured at the final follow-up visit. At 12 months' visit patients completed a questionnaire evaluating patient satisfaction, spectacle independence and presence of dysphotopsias.

Results

Binocular uncorrected visual acuities at 12 month's visit were 0.13 ​± ​0.16, 0.06 ​± ​0.08, 0.07 ​± ​0.09 and 0.15 ​± ​0.09 logMAR for far distance, 80 ​cm, 66 ​cm and 40 ​cm respectively. Corrected binocular visual acuities at 12 months were 0.00 ​± ​0.00, 0.05 ​± ​0.07, 0.05 ​± ​0.06, 0.13 ​± ​0.16 respectively for distance, 80 ​cm, 66 ​cm and 40 ​cm. Automated refraction spherical equivalent at 12 months' visit stood at -0.70 ​± ​0.48D, which was 0.46D less than calculated biometric target, however spherical equivalent of subjective refraction at 12 months equaled -0.49 ​± ​0.46D, which was closer to preoperative biometric target. Defocus curve had gentle shape without peaks typical for monofocal IOLs. Binocular contrast sensitivity results were superior to average results for that age group and equaled 1.78 ​± ​0.16 logMAR without correction and 1.81 ​± ​0.13 logMAR with correction. Spectacle independence for near and intermediate distances was achieved in all patients and for far distance in 73.3% of patients. Burdensome dysphotopsias were not reported in any case.

Conclusions

EDOF IOLs targeted bilaterally at low myopia can provide excellent near and intermediate visual acuity and independence of any optical correction in majority of cases. This approach can be used in selected patients who are focused on stationary activities.

Astigmatism Tolerance and Visual Outcomes After Bilateral Implantation of a Hybrid Continuous Transitional Focus IOL

PURPOSE

To evaluate the astigmatism tolerance and the visual outcomes after implantation of a premium intraocular lens (IOL) with a continuous transitional focus (Precizon Presbyopic; Ophtec BV) in pseudophakic presbyopia correction.

METHODS

This prospective study enrolled 20 patients (40 eyes) after bilateral phacoemulsification and IOL implantation. Corrected and uncorrected visual acuities at 4 m and 80, 67, and 40 cm (CDVA, UDVA, DCI80VA, UI80VA, DCI67VA, UI67VA, DCNVA, and UNVA), astigmatic and spheric defocus curve, mean reading speed (MRS), critical print size (CPS), contrast sensitivity, optical aberrations (modulation transfer function [MTF] cut-off, Strehl ratio, and higher order aberration root mean square [HOA RMS]), objective halometry, and National Eye Institute Refractive Error Quality of Life Instrument 42 [NEI RQL-42] questionnaire were evaluated 3 months after surgery.

RESULTS

Astigmatic defocus curves revealed a tolerance up to -1.00 and +0.75 diopters (D) for with-the-rule astigmatism, and up to -1.00 and +1.00 D for against-the-rule astigmatism. Binocular spheric defocus curve showed that the mean visual acuity was greater than 0.15 logMAR from 1.00 to -1.00 D. MRS, CPS, MTF cut-off, Strehl ratio, and HOA RMS were 116.97 ± 21.94 words/min, 0.45 ± 0.06 logRDA, 20.03 ± 4.86 cycles/degree, 0.11 ± 0.07, and 0.28 ± 0.09, respectively. Contrast sensitivity was within the normal range for all tested light conditions. The NEI RQL-42 evidenced high subjective satisfaction for all subscales, especially for far vision, activity limitations, dependence on correction, suboptimal correction, appearance, and satisfaction with correction.

CONCLUSIONS

The Precizon Presbyopic IOL allows good astigmatism tolerance and both objective and subjective high quality of vision. [J Refract Surg. 2023;39(1):33-39.].

A prospective study of a new presbyopia pseudophakic intraocular lens: Safety, efficacy and satisfaction

Purpose

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

Methods

A prospective non-randomized case-series study was performed in Buenos Aires, Argentina. Patients included in the study underwent a programmed Femtosecond laser assisted cataract surgery (FLACS), performed between October and December 2020, with a 6-month follow-up period. The Intensity (Hanita Lenses) IOL was bilaterally implanted. Spherical equivalent (SE) refraction, uncorrected distance and near visual acuity (UDVA/UNVA), defocus curve, endothelial cell density (ECD), central corneal thickness (CCT), and a satisfaction questionnaire were evaluated.

Results

A total of 56 patients (112 eyes), aged 65 ± 6.12 years were included. The mean ± SD of preoperative SE was 1.85 ± 2.24 D (range; -4.50 to 4.75), which had decreased 6 months after surgery to -0.08 ±0.32 D (range; -0.75 to 0.63). No eyes experienced a loss of lines of vision, and 94% obtained SE values between ± 0.50 D. Defocus curve for different additions was 0.03 LogMAR (logarithm of the minimum angle of resolution) for -3.0 D, -0.005 LogMAR for -1.5 D, and -0.07 LogMAR for 0 D. The ECD, CCT remained stable (P: 0.09 and 0.58, respectively) and all patients achieved their preoperative expectations, with a 6-month follow-up period.

Conclusion

Patients who underwent a safe bilateral implantation with Intensity IOL achieved a high degree of spectacle independence and satisfaction, 6 months after surgery.

Refractive and Visual Outcomes After Implantation of a Secondary Sulcus Intraocular Lens with an Extended Depth of Focus

Purpose

To evaluate the range of vision, visual function, and quality of vision after implantation of a secondary extended depth of focus intraocular lens (EDOF IOL) implanted in the sulcus.

Setting

One clinical practice in Haugesund, Norway.

Design

Prospective single arm non-interventional study.

Methods

Eligible subjects presenting for surgery, or who had previous successful primary cataract or refractive lens exchange surgery in both eyes were subsequently implanted with the AddOn® secondary EDOF IOL in the sulcus. Manifest refraction and visual acuity at distance, intermediate and near were measured 3 months after surgery, along with the monocular defocus curve. Subjects also completed a visual function and a quality of vision questionnaire.

Results

The study included 32 eyes of 16 subjects. At 3 months postoperative, the mean refraction spherical equivalent (MRSE) was −0.16 ± 0.30 D, with a residual cylinder of 0.29 ± 0.27 D. The mean monocular uncorrected VA was 0.1 logMAR (20/25) or better at all test distances. The monocular defocus curves showed a depth of focus of 2.0 D. For every category except reading fine print, all but one subject (94%) had no difficulty or little difficulty with near tasks. Glare and halos were the most common visual disturbances, with no reports of starbursts. There was no evidence of any intralenticular opacification in any of the eyes, and no evidence of iris chafing/depigmentation.

Conclusion

This secondary EDOF IOL provided excellent distance and intermediate vision, and very good near vision to subjects. Subject reported near visual function was also very good and visual disturbances were limited. This lens appears to be a good option for patients who would like to improve their range of vision. Results appear as good or better than those reported for primary EDOF lenses.