Outcomes after accommodative bioanalogic intraocular lens implantation

Comparing an Advanced Monofocal With a Non-diffractive Extended Depth of Focus Intraocular Lens Using a Mini-Monovision Approach

PURPOSE

To compare interindividual differences in visual performance of an advanced monofocal with a nondiffractive extended depth of focus intraocular lens (IOL) using a mini-monovision approach.

DESIGN

Single-center, randomized, controlled, double-masked study.

METHODS

In total, 48 patients (96 eyes) with bilateral age-related cataract were enrolled. One group received an advanced monofocal IOL RAO200E (RayOne EMV; Rayner) and the other group a non-diffractive extended depth of focus IOL DFT015 (Acrysof IQ Vivity; Alcon) in both eyes. Target refraction for both groups was mini-monovision. After 3 months, monocular and binocular distance corrected and uncorrected distance (CDVA/UDVA), intermediate (DCIVA/UIVA), and near visual acuity (DCNVA/UNVA); contrast sensitivity; binocular defocus curves; halometry; and Quality of Vision questionnaire scores were compared.

RESULTS

Binocular mean CDVA, DCIVA at 66 cm, and DCNVA at 40 cm were -0.10±0.10, 0.15±0.11, and 0.32±0.16 logMAR for the RAO200E and -0.10±0.10, 0.12±0.10, and 0.27±0.16 logMAR for the DFT015, respectively, with no significant difference. A significant difference could be shown for the dominant eye in monocular DCIVA and DCNVA and for the dominant and nondominant eye in monocular UNVA, with 0.28±0.14, 0.48±0.22, 0.46±0.21, and 0.41±0.20 logMAR for the RAO200E and 0.14±0.10 (P = .023), 0.35±0.16 (P = .008), 0.30±0.14 (P = .001), and 0.21±0.10 (P = .003) logMAR for the DFT015, respectively. Significantly smaller halo size in the RAO200E group and significantly better distance-corrected defocus curve at -2.5 (P = .031), -2.0 (P = .03), and -1 diopters (P = .03) of defocus in the DFT015 group could be shown.

CONCLUSIONS

Distance corrected or uncorrected binocular visual acuity for far, intermediate, and near distance between the advanced monofocal IOL RAO200E and the non-diffractive extended depth of focus IOL DFT015, when compared in a mini-monovision setting, showed no significant differences.

[Pseudo-accommodative intraocular lenses]

This article reviews pseudo-accommodative intraocular lenses (IOLs), providing an analysis of the terminology used in this field of ophthalmology and describing the design of modern IOLs, the technological features used to achieve pseudo-accommodation that meets the needs of patients, particularly the new extended depth of focus (EDOF) IOL technology. The article presents the main types of extended depth of focus IOLs, their description, advantages and disadvantages, as well as comparison with multifocal and monofocal IOLs based on clinical studies conducted in different countries.

Long-Term Evaluation of Visual Outcomes and Patient Satisfaction after Binocular Implantation of a Bioanalogic Lens

Purpose

Long-term evaluation of the visual refractive outcomes and the quality of life after implantation of the WIOL-CF (Medicem, Czech Republic) in both eyes.

Design

retrospective, nonrandomized noncomparative case series.

Methods

50 eyes of 25 patients, including 11 women (44%) and 14 men (56%). The age range of the patients was 38 to 77 years (mean age 55.48 ± 10.97 years). All patients underwent bilateral implantation of the WIOL-CF. Exclusion criteria were previous ocular surgeries except for cataract surgery and refractive lens exchange, irregular corneal astigmatism of >1.0 diopter, and ocular pathologies or corneal abnormalities. Postoperative examinations were performed at 14 days and 3, 6, 12 months of surgery; the last follow-up was between 24 and 36 months after the procedure. All exams included manifest refraction, monocular uncorrected visual acuity (UCVA) and distance-corrected visual acuity (DCVA) in 5 m (Snellen), monocular uncorrected visual acuity in 70 cm and 40 cm (Jeager) and binocular UCVA, DCVA in 5 m, 70 cm, and 40 cm, binocular contrast sensitivity (CS) under photopic conditions, binocular defocus curves, high-order aberrations, quality-of-vision VF-14 questionnaire, and spectacle independence.

Results

Significant improvement in monocular visual acuity at all distances was demonstrated; the mean postoperative spherical equivalent was 0.32 ± 0.45D. The postoperative means of binocular distance UCVA and BCVA were also improved (p < .001) and so were the mean uncorrected intermediate VA (2.053 ± 1.268) and near uncorrected VA (2.737 ± 1.447). There was a significant improvement in contrast sensitivity at all spatial frequencies and higher-order aberration, compared to preoperative results.

Conclusions

The evaluation of a WIOL-CF showed good distance, intermediate, and near visual acuity. Contrast sensitivity increased after surgery in all spatial frequencies. Patient satisfaction was high despite some optical phenomena. The rate of postoperative spectacle independence also turned out high. Financial Disclosure. No author has a financial or proprietary interest in any material or method mentioned.

Extended depth-of-focus technology in intraocular lenses

The extended depth-of-focus (EDOF) intraocular lens (IOL) is an emerging technology that is designed to improve range of vision, especially at intermediate distances. In this review, we describe the clinical performance of 4 emerging EDOF IOL technologies; that is, small aperture, bioanalogic, diffractive optics, and nondiffractive optical manipulations. The American Academy of Ophthalmology generated a consensus statement for EDOF IOLs that provided benchmarks and recommendations for classifying an implant as an EDOF IOL as well as standardized testing criteria for evaluating performance. Although many types of EDOF technologies are being developed, there are important differences in their performance that require further testing and evaluation.

Lens-based surgical correction of presbyopia. Where are we in 2020?

INTRODUCTION

Presbyopia is the progressive and irreversible loss of accommodation due to aging. It is one of the main causes of loss of quality of life in people from 45 years of age, due to the, often novel, dependence on spectacles. The eagerness to correct it by ophthalmologists impulsed by the desire of millions of people who suffer from it, has become one of the main drivers for the development of intraocular lens (IOL) technology over the last twenty years.

MATERIAL AND METHODS

This review briefly presents the different alternatives that have allowed us to improve the crystalline lens surgical approach of presbyopia; from monofocal lenses and monovision technique, accommodative, refractive, and diffractive multifocal lenses, and finally the most recent extended depth of focus/field lenses known as EDOFs.

RESULTS

Each IOL has its advantages, limitations and disadvantages. Furthermore, there is no single lens that suits the needs of all patients.

CONCLUSIONS

It is necessary to know the variety of lenses available, and to have an in-depth understanding of their optical properties, as well as the impact that these will have later on their clinical performance and on the visual quality of the patients. This should help us to select the best alternative for each of them.

[Current Review: Multifocal Intraocular Lenses and Extended Depth of Focus Intraocular Lenses]

Presbyopia and cataract patients' wish to be increasingly independent of spectacles after surgery and this is one of the main drivers for the development of multifocal intraocular lenses (MIOL) and extended depth of focus (EDOF) intraocular lenses (IOL). As education, biometry, diagnostics, surgical techniques, and MIOL/EDOF IOL designs have improved over the past decade, an increasing number of cataract surgeons have become cataract refractive surgeons to help address this need. There is not one single MIOL/EDOF IOL, however, that suits all patients' needs. The wide variety of MIOL and EDOF IOL, their optics, and their impact on our patients' quality of vision have to be fully understood if we have to choose the appropriate IOL for each individual; MIOL/EDOF IOL surgery has to be customized. This review article looks at the different optical aspects and clinical consequences of MIOL/EDOF IOL, in order to help surgeons find an appropriate solution for each of their individual patients.

Diffractive multifocal intraocular lens implantation in patients with monofocal intraocular lens in the contralateral eye

AIM

To evaluate clinical outcomes of unilateral implantation of a diffractive multifocal intraocular lens (IOL) in patients with contralateral monofocal IOL.

METHODS

Twenty-two patients who already had implantation of a monofocal IOL in unilateral eye underwent implantation of a diffractive multifocal IOL in contralateral eye were enrolled. After 1, 6, and 12mo, uncorrected and distant corrected distant visual acuity (UCDVA and DCDVA), uncorrected and distant corrected intermediate-visual acuity (UCIVA and DCIVA), uncorrected and distant corrected near visual acuity (UCNVA and DCNVA), and contrast sensitivity were obtained. Halo/glare symptoms, spectacle dependence, and patient satisfaction were also evaluated.

RESULTS

The mean age was 67.86±7.25y and the average interval between two IOL implantations was 645.82±878.44d. At 1mo, binocular UCDVA was lower than 0.20 logMAR in 76% of patients (mean 0.12±0.13 logMAR), which increased to 90% by 6 and 12mo. The binocular UCDVA was significantly better than the monocular results (P<0.05) at 1, 6, and 12mo. Additionally, UCNVA was lower than 0.40 logMAR in 82% of patients, increasing to 90% by 6 and 12mo. Mean UCNVA in the multifocal IOL implanted eye was statistically significantly better than that in the monofocal IOL implanted eye (P<0.05) at 1, 6, and 12mo. About 5% of patients at 1 and 6mo, reported "severe glare or halo". Patient satisfaction rates were 95% and 91% at 6 and 12mo, respectively.

CONCLUSION

Unilateral implantation of multifocal IOL in patients with a contralateral, monofocal IOL implantation results in high patient satisfaction rate, with low severe glare or halo rate during follow-up. It can represent a good option for patients who have previously had a monofocal IOL implantation regardless of two year interval duration between two IOL implantations.

Optical aberrations, accommodation, and visual acuity with a bioanalogic continuous focus intraocular lens after cataract surgery

Purpose

To evaluate the visual outcomes, pseudoaccommodation, and wavefront aberrometry after implantation of Wichterle IOL-Continuous Focus (WIOL-CF^®, Gelmed International, Kamenne Zehrovice, Czech Republic) by i-Trace aberrometry.

Methods

In this retrospective interventional case series study, after cataract surgery with implantation of accommodative WIOL-CF^®, the patients were evaluated with i-Trace aberrometer for measurement of modulation transfer function (MTF), point spread function (PSF), total aberrations, higher order aberrations (HOAs) at far and near and pseudoaccommodation. The pre and postoperative visual acuity at near and distance were also measured.

Results

Forty eyes of 20 patients (aged 40-77 years) were enrolled in this study with mean follow-up time of up 13.10 ± 5.52 months. The mean logMAR corrected distance visual acuity (CDVA) improved from 0.20 ± 0.14 preoperatively to 0.10 ± 0.09 at the last follow-up after surgery (P = 0.002). The results were 60% J1, 70% J2, 85% J3, 90% J4, 95% J5 and 100% for J6. The mean pseudoaccommodation, range of accommodation volume, and average of peak accommodation were -2.52 ± 1.56 diopters (D), 1.50 to 5.25 D and -3.25 ± 1.25 D, respectively. The mean MTF at 5 cycles per degree at far was 0.200 ± 0.10 and for near was 0.207 ± 0.10. PSF at far and near was 0.0002 and 0.001, respectively. The mean root mean square (RMS) value of HOAs; total, coma spherical aberration, trefoil, and secondary astigmatism were 1.08 ± 0.48 μm, 0.89 ± 0.45 μm, -0.33 ± 0.23 μm, 0.25 ± 0.17 μm, and 0.15 ± 0.13 μm for far and 0.88 ± 0.49 μm, 0.73 ± 0.46 μm, -0.25 ± 0.22 μm, 0.19 ± 0.16 μm and 0.11 ± 0.10 μm for near, respectively. There was a decrease in HOAs at near relative to far (P < 0.05).

Conclusion

WIOL-CF^® seems to be an acceptable accommodative intraocular lens (IOL) in terms of uncorrected near and distant visual outcomes, MTF and HOA.

Multifocal Intraocular Lenses and Extended Depth of Focus Intraocular Lenses

Presbyopia and cataract patients' desire for increased spectacle independence after surgery is one of the main drivers for the development of multifocal intraocular lenses (MIOLs) and extended depth of focus (EDOF) intraocular lenses (IOLs). As education, biometry, diagnostics, surgical techniques, and MIOL/EDOF IOL designs have improved over the past decade, an increasing number of cataract surgeons have become cataract-refractive surgeons to help address this need. There is not 1 single MIOL/EDOF IOL, however, that suits all patients' needs. The wide variety of MIOLs and EDOF IOLs, their optics, and their respective impact on our patients' quality of vision have to be fully understood to choose the appropriate IOL for each individual; MIOL/EDOF IOL surgery has to be customized. This review article looks at the different optical aspects and clinical consequences of MIOLs/EDOF IOLs to help surgeons find an appropriate solution for each of their individual patients.

Accommodating Intraocular Lenses

With an explosive increase in the worldwide prevalence of presbyopia, development of an accommodating intraocular lens (IOL) with expansive accommodative amplitude remains the holy grail in lens-based refractive surgery. A dynamic change in the dioptric power of the eye can be accomplished by various strategies alone or in combination, including changes in the position, shape, or refractive index of a single- or dual- optic IOL. This article reviews the cumulative advances in these various lens designs, along with clinical outcomes and complications of those that have been implanted. The challenges that remain in each cat-egory are also highlighted.

Clinical Experience with the WIOL-CF Accommodative Bioanalogic Intraocular Lens: Czech National Observational Registry

Purpose

To assess efficacy and patient satisfaction after cataract surgery and implantation of a new accommodative bioanalogic intraocular lens (IOL).

Methods

We evaluated the collected data of 48 patients with bilateral cataract surgery and Wichterle IOL (WIOL) implantation included in the Czech national observational registry. Monocular and binocular uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity, uncorrected near visual acuity (UNVA), best spectacle-corrected visual acuity for distance (CDVA), best spectacle-corrected visual acuity for near (CNVA), distance-corrected near visual acuity (DCNVA), and distance-corrected intermediate visual acuity were evaluated 6 months after surgery. Subjective patient satisfaction was assessed at 3 months postoperatively.

Results

The mean monocular UDVA was 0.074 ± 0.108 logMAR, the mean monocular CDVA was 0.047 ± 0.125 logMAR, the mean monocular UNVA was 0.328 ± 0.146 logMAR, the mean monocular DCNVA was 0.339 ± 0.131 logMAR, and the mean monocular CNVA was 0.139 ± 0.107 logMAR. A total of 24 patients (50%) had no problems with any light phenomena. A total of 18 patients were very satisfied (37.5%), 11 were satisfied (22.9%), 15 (31.2%) were rather satisfied, 4 (8.3%) were rather dissatisfied, and 0 were dissatisfied.

Conclusions

The WIOL–continuous focus polyfocal lens offers very good vision at far and intermediate distance comparable with other types of multifocal IOLs, and relatively good near vision, while the incidence of adverse side phenomena is relatively low.