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

PURPOSE

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

DESIGN

Experimental laboratory investigation.

METHODS

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

RESULTS

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

CONCLUSIONS

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

Visual function in eyes with diffractive extended depth-of-focus and monofocal intraocular lenses: 2-year comparison

PURPOSE

To compare long-term visual function after implantation of diffractive extended depth-of-focus (EDF) intraocular lenses (IOLs) using echelett optics and monofocal IOLs with the same platform.

METHODS

In this prospective comparative case series, diffractive EDF or monofocal IOLs were implanted binocularly and followed up for 2 years. At the last visit, distance-corrected binocular visual acuities were measured at distances of 0.3, 0.5, 0.7, 1, 2, 3, and 5 m. Photopic and mesopic contrast sensitivity was also examined. Dynamic visual function was evaluated in terms of functional visual acuity (FVA), standard deviation of visual acuity (SDVA), visual maintenance ratio (VMR), mean response time, and number of blinks. The outcomes were compared between the two IOLs, and the influence of posterior capsule opacification (PCO) on contrast sensitivity and FVA was examined.

RESULTS

Binocular visual acuity of eyes with EDF IOLs was better at distances of 0.5 and 0.7 m than that of eyes with monofocal IOL (P < 0.026). There were no differences in binocular visual acuity at other distances, contrast sensitivities, or dynamic visual functions. The influence of PCO on the visual functions was not found in eyes with EDF IOLs.

CONCLUSION

Up to 2 years postoperatively, eyes with diffractive EDF IOLs sustained superior intermediate visual acuity together with visual function comparable to that of eyes with monofocal IOLs.

Visual outcomes and subjective experience with three intraocular lenses based presbyopia correcting strategies in cataract patients

To compare the visual outcomes and subjective experience of three intraocular lenses (IOL) implant strategies. Retrospective comparative study. This study comprised patients who underwent phacoemulsification and bilateral implantation of extended depth of focus (EDOF) IOL (ZXR00; EDOF group), blended implantation of EDOF and bifocal IOL (ZXR00/ZLB00; blended group), and bilateral implantation of trifocal IOL (AT LISA tri 839MP; trifocal group). The outcomes included visual acuity (VA), visual defocus curve, contrast sensitivity, visual quality, quality of life, spectacle independence, and patient satisfaction. Follow-up was performed 3 months after the surgery. This study included 114 eyes of 57 patients (20 in EDOF group; 16 in blended group; 21 in trifocal group). Patients in the three groups had high quality of life, patient satisfaction, and good contrast sensitivity. The EDOF group had the worst near VA, but the visual quality was the best. The blended group had good VA and slight photic disturbance. The trifocal group obtained the best whole range of VA, but the photic disturbance was significantly severe than the EDOF group. Both the blended and trifocal groups achieved high spectacle independence, but some patients in the EDOF group need spectacle when dealing with close-range tasks.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

One-year post-operative comparison of visual function and patient satisfaction with trifocal and extended depth of focus intraocular lenses

PURPOSE

To evaluate visual performance with trifocal and extended depth of focus IOL at 1 year post-operatively.

SETTING

BMI Southend Hospital.

DESIGN

Cohort study.

METHODS

An age-matched cohort of forty subjects bilaterally implanted with the AT LISA 839MP trifocal IOL (20 patients, 40 eyes) and the Tecnis Symfony extended depth of focus IOL (20 patients, 40 eyes) were assessed at 3-6 months and 12-18 months post-operatively. Primary outcome measures were distance (6 m), intermediate (70 cm), near visual acuity (40 cm), and analysis of defocus profiles. Secondary outcomes included contrast sensitivity, Radner reading performance, quality of vision and assessment of halos.

RESULTS

Distance visual acuity (VA) and defocus areas were similar (p = 0.07). No significant difference in intermediate VA was noted but the intermediate area of focus was greater in the EDoF (0.31 ± 0.12 LogMAR*m^-1) compared to the trifocal (0.22 ± 0.08LogMAR*m^-1) (p = 0.02). However, all near metrics were significantly better in the trifocal group. 80% of trifocal subjects were spectacle independent compared to 50% EDoF subjects. Quality of vision questionnaire found no significant differences between groups, however halo scores were greater at 3-6 months in the trifocal group (p < 0.01) but no differences were noted at 12-18 months.

CONCLUSIONS

Near vision is significantly better for the trifocal, thus greater levels of spectacle independence. The range of intermediate vision was greater for the EDoF but no difference in intermediate VA. In the early period, differences in contrast sensitivity and halo size/intensity were noted, however, by one-year these measures were not significantly different.

In Vitro Optical Performance of Multifocal and Extended Depth-of-Focus Intraocular Lenses in Spherical Aberration Conditions

ABSTRACT

PurposeTo evaluate and compare the optical performances of 4 different types of intraocular lenses (IOLs) in various spherical aberration (SA) conditions.SettingPOSTECH, Pohang, Republic of Korea.DesignIn vitro laboratory study.MethodsA custom optical bench system with adaptive optics (AO) was used. A monofocal IOL, a bifocal IOL, a trifocal IOL, and an extended depth-of-focus (EDOF) IOL from the Zeiss were evaluated by measuring through-focus modulation transfer function (MTF) as a function of vergence. MTF changes with SA from -0.1μm to +0.1μm with 0.05μm step size were analyzed and compared.ResultsIn aberration free condition, the 4 IOLs showed different MTF curves consistent with their designs In SA conditions, all the IOLs showed MTF value decreases and the decrease rates at the far focus varied from 28% to 38% per 0.1μm SAs. The trifocal IOL had low MTF values at the intermediate focus in the noise level with ±0.1μm SAs.ConclusionsAll the tested IOLs showed MTF decreases with SA in different levels. The trifocal and EDOF IOLs were the most and least sensitive to SA among the evaluated IOLs. The study results might be useful in the selection of IOLs for cataract patients with SAs.

A comparison of clinical outcomes and optical performance between monofocal and new monofocal with enhanced intermediate function intraocular lenses: a case-control study

Background

To compare clinical outcomes and optical performance of a new monofocal with enhanced intermediate function intraocular lenses (IOLs) with that of conventional monofocal IOLs.

Methods

Sixty eyes of 30 patients who underwent phacoemulsification with bilateral implantation of the ICB00 (15 patients) or ZCB00 (15 patients) IOLs were enrolled. Binocular corrected distance visual acuity (CDVA), distance corrected near visual acuity (DCNVA), and distance corrected intermediate visual acuity (DCIVA) were measured at 4 weeks after surgery. Patient satisfaction for overall, near, intermediate, and distance vision were assessed. The binocular defocus curves were measured. The root mean square of modulation transfer function (MTF_RMS) was measured in the optical bench study.

Results

The mean binocular DCIVA was significantly better in the ICB00 group (0.01 logMAR) compared to the ZCB00 group (0.13 logMAR), but CDVA and DCNVA were not. The patient satisfaction for near and intermediate vision was significantly higher in the ICB00 group compared to the ZCB00. However, there was no difference in patient satisfaction for overall and distance vision between two groups. The defocus curves showed that mean visual acuity of the ICB00 group was significantly better than that of the ZCB00 group at between − 1.00 D to − 3.00 D of defocus. The ICB00 IOL had higher MTF_RMS values at between − 0.50 D to − 2.00 D of defocus compared to the ZCB00 IOL.

Conclusions

The ICB00 IOL provides better binocular intermediate vision and higher satisfaction for near and intermediate vision than the ZCB00 IOL while maintaining excellent distance vision.

Optical Performance of a Monofocal Intraocular Lens Designed to Extend Depth of Focus

PURPOSE

To test the performance of a new monofocal intraocular lens, intended to extend depth of focus (Tecnis Eyhance, ICB00; Johnson & Johnson Vision, Inc) (ICB-IOL), in comparison to a standard monofocal IOL (Tecnis 1-piece, ZCB00; Johnson & Johnson Vision, Inc) (ZCB-IOL) of the same platform and material.

METHODS

Assessment of the optical performance of the two IOLs was made in vitro using an optical test bench with a model eye. The spherical aberration, modulation transfer function (MTF), and area under the MTF (MTFa) were obtained for pupil sizes ranging from 2 to 5 mm. Through-focus MTFa curves between -3.00 and +1.00 diopters (D) were obtained with three pupil sizes (2, 3, and 4.5 mm). Halo formation was also assessed for both lenses.

RESULTS

The ICB-IOL had slightly worse optical quality at its best focus (ie, lower MTF scores at distance vision) and more negative spherical aberration than the ZCB-IOL for pupils ranging from 2 to 3 mm. The maximum of the through-focus MTFa curve of the ICB-IOL with a 2-mm pupil shifted to a myopic defocus of -0.50 D. For larger pupils (≥ 3.5 mm), there were no differences in spherical aberration, MTF scores, and halo energy between the two lenses.

CONCLUSIONS

The new ICB-IOL is a modified monofocal lens with 0.50 D of additional power in its central 2-mm zone and more negative spherical aberration values, which induce a myopic shift of the maximum of optical quality and could improve intermediate vision. For pupils larger than 3.5 mm, there were no differences between IOLs. The new ICB-IOL design would produce photic phenomena comparable to a standard IOL. [J Refract Surg. 2020;36(9):625-632.].

Changes in Optical Quality Induced by Tilt and Decentration of a Trifocal IOL and a Novel Extended Depth of Focus IOL in Eyes With Corneal Myopic Ablations

PURPOSE

To assess the effect of decentration and tilt combined with prior myopic ablations on the optical performance of a trifocal intraocular lens (IOL) and a novel IOL with an extended depth of focus (EDOF) design.

METHODS

The XACT Mono-EDOF ME4 (Santen Pharmaceutical Co Ltd) and the trifocal FineVision (PhysIOL) IOLs were analyzed with and without simulated previous myopic ablations. The optical quality of the IOLs was evaluated with the PMTF optical bench (LAMBDA-X). The through-focus modulation transfer function (MTF) curves were recorded. Measurements were done for three situations: centered, 0.4 mm decentered, and 4 degrees tilted.

RESULTS

The trifocal IOL showed three peaks of vision and the EDOF IOL showed a far distance peak with intermediate addition. When decentration or tilt were induced, the trifocal IOL showed negligible changes but the EDOF IOL showed a -0.50 diopters (D) shift of the overall curve. With simulated myopic ablation, the trifocal IOL showed a -0.50 D shift of the curve. When tilt or decentration were also induced, the better optical results were found at -1.00 D. With myopic ablations, the EDOF IOL showed a -0.50 D shift of the optical quality and when decentration or tilt were then induced, negative shifts over -1.00 D were found.

CONCLUSIONS

The trifocal IOL was less affected by mis-alignments. When myopic ablations were induced, both lenses decreased their optical quality and the effects of misalignments were higher. In patients who have undergone corneal myopic ablation procedures, proper alignment of the implanted IOL and obtaining effective emmetropia becomes even more critical. [J Refract Surg. 2021;37(8):532-537.].

Visual outcomes and patient satisfaction after implantation of a presbyopia-correcting intraocular lens that combines EDOF and Multifocal profiles

PURPOSE

To evaluate clinical outcomes delivered by a new hybrid presbyopia-correcting intraocular lens: Tecnis Synergy ZFR00V IOL model (Johnson & Johnson Vision) SETTING:: Hospital da Luz Lisboa, Lisbon, Portugal DESIGN:: Prospective observational study METHODS:: A total of 27 patients undergoing bilateral IOL implantation were included. Visual acuity (VA) was measured for far distance, intermediate (66 cm) and near (40 cm) vision under both photopic and mesopic conditions. In addition, at the 3-month follow-up visit, the defocus curve was obtained for binocular vision and questionnaires were administered to measure spectacle-independence and level of satisfaction (QoV and Catquest-SF9) with the surgical outcomes.

RESULTS

At 3-month follow-up, under photopic conditions, VA values were: CDVA = -0.02 ± 0.07, DCIVA = 0.03 ± 0.11, and DCNVA = 0.00 ± 0.08, while under mesopic conditions, VA values were: CDVA = -0.01 ± 0.05, and DCNVA = 0.07 ± 0.09. The binocular defocus curve revealed that mean visual acuity was better than 0.30 LogMAR within the +1.00 D to -4.00 D interval, and better than 0.10 LogMAR between +0.50 D and -3.00 D. All patients achieved distance-vision spectacle freedom, while 3.7% of them said they used them in certain intermediate- or near-vision situations. As much as 88% of the patients reported being fairly satisfied or very satisfied.

CONCLUSIONS

The Tecnis Synergy ZFR00V intraocular lens model used for cataract surgery is capable of restoring visual function while providing very good intermediate and near vision, under both photopic and mesopic conditions, resulting in a high level of patient satisfaction.

Comparison of the intermediate distance of a trifocal IOL with an extended depth-of-focus IOL: results of a prospective randomized trial

PURPOSE

To compare visual outcomes, reading ability, and visual quality between the Symfony extended depth-of-focus intraocular lens (IOL) and the trifocal AT LISA tri 839MP IOL.

SETTING

University Eye Clinic Maastricht, The Netherlands.

DESIGN

Prospective randomized controlled trial.

METHODS

Patients were randomly assigned to bilateral Symfony IOL or AT LISA tri 839MP IOL implantation. The primary outcome measure was uncorrected intermediate visual acuity (UIVA measured at 66 cm). Secondary outcomes included uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), reading ability, and comparison of defocus curves, contrast sensitivity, optical adverse effects, and quality of vision.

RESULTS

The study enrolled 60 eyes of 30 patients. The mean UIVA was -0.02 ± 0.03 (SD) vs 0.01 ± 0.03 logarithm of the minimal angle of resolution (logMAR) in the Symfony and AT LISA tri 839MP groups, respectively (P = .047). The UDVA was 0.01 ± 0.12 and -0.05 ± 0.07 logMAR (P = .11) and the UNVA was 0.09 ± 0.05 and 0.04 ± 0.07 logMAR (P = .052) in the Symfony and AT LISA tri 839MP groups, respectively. Reading ability was similar in both groups at 40 cm and 66 cm (P = .87 and P = .14, respectively). Less than 10% of patients in both groups experienced disabling glare. Patients experienced disabling halos in the AT LISA tri 839 MP group compared to the Symfony group in 39% and 21% of cases, respectively (P = .12). The mean score for visual functioning was 88.0 ± 14.1 n the trifocal group and 88.2 ± 10.9 for the EDOF group (P = .96).

CONCLUSIONS

The UIVA was better in the Symfony group than in the AT LISA tri 839MP group. No significant differences were seen in the binocular UNVA and UDVA, contrast sensitivity, reading ability, incidence of photopic phenomena, and patient satisfaction.

Assessment of the image quality of extended depth-of-focus intraocular lens models in polychromatic light

PURPOSE

The use of monochromatic light in the assessment of intraocular lenses (IOLs) has been criticized for not representing the real-world situation. This study aimed to measure and compare the image quality of 3 extended depth-of-focus (EDOF) IOL models in monochromatic and polychromatic light.

SETTING

David J Apple Laboratory, Heidelberg, Germany.

DESIGN

In vitro study.

METHODS

An optical metrology instrument was used to study image quality metrics of diffractive IOLs with chromatic aberration correction (Symfony and AT Lara) and a refractive lens (Mini Well). The modulation transfer function (MTF) was measured in green and polychromatic light at a 2.0 mm, 3.0 mm, and 4.0 mm aperture. The EDOF IOL's tolerance to defocus was tested against a monofocal lens.

RESULTS

The mean MTF of the EDOF IOL at far distance was decreased in polychromatic compared with monochromatic light. The largest effect was found in the refractive lens; however, at intermediate distance, only small differences occurred. In their tolerance to defocus, the EDOF IOLs were superior to the monofocal IOL. The diffractive IOL had higher MTFs than that of the refractive IOL at 2 primary foci, the refractive IOL's optical quality varied less with defocus at 3.0 mm. The refractive lens was the most susceptible to changes in aperture size.

CONCLUSION

The diffractive EDOF IOL was more resistant to chromatic effects than the refractive IOL. The EDOF IOLs provided an extended through-focus performance compared with the monofocal IOL, but differences in optical design, particularly pupil dependency, should be considered when refining IOL selection for patients.

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

PURPOSE

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

STUDY DESIGN

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

RESULTS

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

CONCLUSION

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

Influence of implantations of extended depth-of-focus on standard automated perimetry

This prospective study aimed to investigate the influence of an extended depth-of-focus intraocular lens (EDOF IOL) on standard automated perimetry. Ninety eyes of 90 patients who had undergone cataract surgery from February 2018 to December 2018 were included. No patients had any diseases that might affect the visual field. ZMB00 (+ 4.00 D add), ZXR00V (+ 1.75 D add), and ZCB00V (Johnson & Johnson Surgical Vision, Santa Ana, CA, USA) were used as multifocal, EDOF, and monofocal IOLs, respectively. Humphrey Visual Field 10–2 testing was performed 2–3 months after cataract surgery, acceptable reliability indices were measured, and mean deviation (MD), pattern standard deviation (PSD), foveal sensitivity and mean sensitivity (MS) were compared. Seventy-one eyes (ZXR00V: 24 eyes, ZMB00: 25 eyes, ZCB00V: 22 eyes) were used for the analyses. The MD and MS of the EDOF and monofocal groups were significantly higher than those of the multifocal group (P < 0.0051). However, the MD and MS of the EDOF and monofocal groups were not different (P > 0.23). The PSD and foveal sensitivity were not different among the groups. In non-glaucomatous patients, the MD and MS of the EDOF IOL were comparable to those of the monofocal IOL and better than those of the multifocal IOL.

Comparative Analysis of Visual Performance and Astigmatism Tolerance with Monofocal, Bifocal, and Extended Depth-of-Focus Intraocular Lenses Targeting Slight Myopia

Purpose

To compare the visual performance and astigmatism tolerance of 3 intraocular lens (IOL) groups: monofocal, bifocal, and extended depth-of-focus (EDOF) IOLs targeting slight myopia.

Methods

Overall, there were 60 cataract surgery eyes from 60 patients with implantation of a monofocal, bifocal, or EDOF IOL (20 eyes in each IOL group). The EDOF IOLs targeted slight myopia (−0.25 D to −0.75 D). Intragroup comparison of visual acuity, defocus curve, objective optical quality, contrast sensitivity, visual function questionnaire scores, patients' overall satisfaction, and the astigmatism tolerance was performed 3 months after surgery.

Results

The EDOF group provided equivalently excellent distance visual outcomes (0.06 ± 0.12) as the monofocal (0.06 ± 0.09) and bifocal (0.03 ± 0.09) groups (P=0.554), better intermediate vision than the other 2 groups (P < 0.05), and similarly satisfactory near visual outcomes (0.23 ± 0.16 at 20 cm, and 0.17 ± 0.14 at 33 cm) as the bifocal group (0.28 ± 0.14 at 20 cm and 0.08 ± 0.10 at 33 cm) (P > 0.05). The contrast sensitivity of EDOF IOL was slightly decreased compared to that of monofocal IOL, but it was better than that of bifocal IOL. The EDOF group showed significantly higher satisfaction than the bifocal group did when preoperative corneal astigmatism was 0.75 D or greater (P=0.009). A significant negative correlation between the corneal astigmatism and patient satisfaction was observed in only the bifocal group.

Conclusions

The EDOF IOLs targeting slight myopia offered satisfactory visual outcomes at an extended range from far to near distances. The EDOF and monofocal IOLs showed a better tolerance to astigmatism than did the bifocal IOL.

Visual performance after bilateral toric extended depth-of-focus IOL exchange targeted for micromonovision

PURPOSE

To evaluate overall patient satisfaction, spectacle independence, binocular visual acuity, rotational stability, prevalence of optical phenomena, and decentration and tilt after bilateral toric extended depth-of-focus intraocular lens (EDOF IOL) implantation targeted for micromonovision.

SETTING

Department of Ophthalmology, Hanusch Hospital, Vienna, Austria.

DESIGN

Prospective case series.

METHODS

The study included 52 eyes of 26 patients with regular corneal astigmatism from 0.75 to 2.60 diopters (D) that were implanted bilaterally with a toric EDOF IOL targeted for micromonovision. Postoperative visual acuity, astigmatism reduction, rotation, tilt, decentration, spectacle independence, patient satisfaction, and photic phenomena were assessed.

RESULTS

For the 52 eyes studied, binocular means expressed in logarithm of the minimum angle resolution for postoperative corrected distance, uncorrected distance, uncorrected intermediate, and uncorrected near visual acuities were -0.10 (±0.12), -0.01 (±0.13), 0.01 (±0.14), and 0.13 (±0.14), respectively. Mean refractive astigmatism reduction was 1.31 ± 0.67 D resulting in a mean refractive cylinder of 0.47 ± 0.46 D at the 3-month visit. Mean postoperative rotation was 3.5 ± 3.5 degrees, at the 3-month time point. Most prevalent dysphotopsia were halos, starburst, and glare affecting 6 (23%), 6 (23%), and 5 (19%) of 26 patients, respectively; 20 (77%) of 26 patients reported spectacle independence, with 19 (95%), 19 (95%), and 14 (70%) of 20 patients questioned being satisfied with distance, intermediate, and near vision, respectively.

CONCLUSIONS

Toric EDOF IOL implantation targeted for micromonovision resulted in reliable reduction of preoperative astigmatism with a high degree of postoperative rotational predictability and centration, enabling functional distance, intermediate, and near vision, which manifested itself in high patient satisfaction.

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

Purpose

To investigate the influence of EDOF IOLs, TECNIS Symfony^® (Johnson & Johnson Surgical Vision, Inc.), on visual field sensitivity and to compare the IOLs with other kinds of IOLs.

Methods

The subjects included the normal fellow eyes of patients who underwent the Humphrey Field Analyzer (HFA) 30–2 with Swedish Interactive Threshold Algorithm Fast within 6 months after cataract due to glaucoma or suspected glaucoma. Each parameter of HFA was compared among eyes implanted with TENIS Symfony^® (EDOF group), diffractive bifocal IOLs (bifocal group), and monofocal IOLs (monofocal group).

Results

The total of 76 eyes, including 24 eyes in the EDOF group, 26 eyes in the bifocal group, and 26 eyes in the monofocal group, were included in this study. Mean deviation (MD) of HFA was -0.24±0.58 dB in the EDOF group, -1.38±0.58 dB in the bifocal group, and 0.02±0.44 dB in the monofocal group. Foveal threshold (FT) of HFA was 35.8±1.6 dB in the EDOF group, 33.6±1.7 dB in the bifocal group, and 36.6±1.4 dB in the monofocal group. In both MD and FT, there was significant difference between the bifocal group and the others (p<0.001). There was no difference between the EDOF group and the monofocal group. Moreover, there was no significant difference between the three groups about pattern standard deviation (PSD) of HFA.

Conclusion

TECNIS Symfony^® may have little influence on visual field sensitivity, whereas diffractive bifocal IOLs decrease visual field sensitivity.

Visual acuity and defocus curves with six multifocal intraocular lenses

PURPOSE

The purpose of this prospective, randomized, double-masked, study was to compare the visual performance of patients after bilateral implantation of six different IOLs.

METHODS

The following IOLs were used in the study: SV25T0 (n = 19), ATLISA 809M (n = 18), ATLISA Tri 839MP (n = 19), ZKB00 (n = 20), ZLB00 (n = 20) and Symfony ZXR00 (n = 20). Visual performance was assessed by the monocular distance-corrected visual acuity at 4 m (CDVA), distance-corrected intermediate visual acuity (DCIVA) at 60 cm and distance-corrected near visual acuity (DCNVA) at 40 cm. Binocular defocus curves were obtained for a range of defocus from + 1.50 D to - 4.50 D, in 0.50 D steps. Quality of life was assessed with the VF-14 questionnaire.

RESULTS

CDVA was better with the Symfony ZXR00 than with the SV25T0 (p = 0.032), ATLISA Tri 839MP (p = 0.032) and ATLISA 809M (p = 0.018). The Symfony ZXR00 offered the best DCIVA, followed by the ZKB00. The best and worst DCNVA results corresponded to the ZLB00, and the SV25T0 and Symfony ZXR00, respectively. Defocus curves at distance were good in all groups, although the Symfony had a wider range of clear vision (- 1.50 D to + 0.50 D), with no decay. For intermediate vision, only the Symfony obtained sharp visual acuity. The ATLISA 809M, ATLISA Tri 839MP and ZLB00 were superior at near distance.

CONCLUSIONS

The extended depth of focus of the Symfony ZXR00 offers a superior range of clear vision at far and intermediate distances than other multifocal designs, with worse results at near distance. Visual outcomes reflect the particular optical, geometrical and power distribution characteristics of each IOL.

Optical evaluation of new-design multifocal IOLs with extended depth of focus

In this study, we investigate in vitro the optical performance of new-design extended depth of focus (EDOF) complementary intraocular lenses (IOLs) (ACTIVE, Cristalens Industrie, France), compared with traditional bifocal ones. Evaluation of their optical quality was achieved by measuring the point spread function at multiple distances (through focus) using an optical bench. In addition, the modulation transfer function through focus was calculated, correlating our results with actual visual outcomes. Our results may suggest that these new EDOF IOLs, when implanted together, could possibly better control multifocality, offering an increased DOF at all distances.

Optimal near and distance stereoacuity after binocular implantation of extended range of vision intraocular lenses

PURPOSE

To evaluate stereopsis and visual quality after bilateral implantation of extended range of vision intraocular lenses (ERV IOLs).

SETTING

R.P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India.

DESIGN

Prospective interventional study.

METHODS

Patients underwent phacoemulsification with bilateral implantation of ERV IOLs. The primary outcome measures were stereopsis (distance and near Randot) and visual quality (ray-tracing aberrometry). The secondary outcome measures were visual acuity and patient satisfaction. Follow-up was performed on day 1 and at 1, 3, 6, and 12 months postoperatively.

RESULTS

The study comprised 50 patients (100 eyes). The mean age of the patients was 58.9 years ± 8.9 (SD). At 1 year, the mean distance stereopsis was 103.6 ± 49.1 seconds of arc (arcsec) and near stereopsis was 21.1 ± 2.3 arcsec. Perfect near stereopsis of 20 arcsec was present in 80% of cases, and 82% had good distance stereopsis of 100 arcsec or better. Stereopsis correlated well with the patient satisfaction score (P < .001) and average internal modulation transfer function (MTF) (P < .015). The mean Strehl ratio was 0.029 ± 0.021, MTF was 0.24 ± 0.08, total higher-order aberrations were 0.62 ± 0.41 μm, and coma was 0.25 ± 0.18 μm. The mean binocular uncorrected decimal visual acuities were 0.98 ± 0.07 (distance), 0.82 ± 0.09 (intermediate) and 0.64 ± 0.08 (near). The mean patient satisfaction score was 9.08 ± 1.1, and no case required IOL explantation because of visually disturbing phenomena or patient dissatisfaction.

CONCLUSION

Excellent stereoacuity was observed after bilateral implantation of ERV IOLs, which correlated well with patient satisfaction and quality of vision.

Visual acuity of pseudophakic patients predicted from in-vitro measurements of intraocular lenses with different design

The optical quality of a set of IOLs (modeling set: one monofocal and two bifocals) was assessed through focus by the area under the modulation transfer function (MTFa) metric and related to the visual acuity (VA) defocus curves of pseudophakic patients implanted with said IOLs. A non-linear relationship between the MTFa and clinical VA was obtained with an asymptotic limit found to be the best VA achievable by the patients. Two mathematical fitting functions between clinical VA and MTFa were derived with high correlation coefficients (R²≥0.85). They were applied to the MTFa obtained from a different set of IOLs with advanced designs (trial set: one extended range of vision -ERV-, one trifocal ERV and one trifocal apodized) to predict VA versus defocus of patients implanted with these IOLs. Differences between the calculated VA and the clinical VA for both fitting models were within the standard deviation of the clinical measurements in the range of -3.00 D to 0.00 D defocus, thus proving the suitability of the MTFa metric to predict clinical VA performance of new IOL designs.