Mix-and-match vs bilateral trifocal and bilateral EDOF intraocular lens implantation: the spline curve battle

PURPOSE

To compare the postoperative visual acuity curves following 3 pseudophakic presbyopic correction techniques.

SETTING

Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis, Greece.

DESIGN

Prospective, randomized, comparative trial.

METHODS

For this study, patients with stage 2 Lens Opacities Classification System III cataract were divided into 3 study groups: (1) premium monovision group, including patients who received the Panoptix intraocular lens (IOL) in the recessive eye and Vivity IOL in the dominant one; (2) bilateral trifocal group, including those who received bilaterally the Panoptix IOL; and (3) bilateral xEDOF group, including patients who received bilaterally the Vivity IOL. Postoperative bilateral uncorrected distance visual acuity was measured at 25.5, 28, 33, 40, 50, 66, 100, 200, and 300 cm distances. Spline curve fitting was attempted, and areas of the curves (AOCs) and curvature k were calculated. All patients responded to the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25).

RESULTS

90 patients were equally divided into the 3 groups. Premium monovision and bilateral trifocal implantations delivered similar visual acuity (all AOC P > .05); however, the trifocal patients suffered from drops in vision acuity in certain distance ranges as expressed by negative curvature values. Bilateral xEDOF patients demonstrated worse near vision acuity ( P < .05). Premium monovision patients reported better scores in NEI-VFQ 25 ( P = .03) and in the near activities ( P = .02) and distant activities ( P = .04) subscales.

CONCLUSIONS

All surgical options provided impressive outcomes. Premium monovision appeared to deliver the best results.

Validation of a web-based distance visual acuity test

PURPOSE

To validate the Democritus Digital Acuity and Reading Test (DDART) as a distance VA (dVA) test against a series of prevalent conventional distance vision charts.

SETTING

Ophthalmology Department, University Hospital of Alexandroupolis, Alexandroupolis, Greece; Ophthalmology Department, AHEPA University Hospital, Thessaloniki, Greece; and Ophthalmica Institute of Ophthalmology & Microsurgery, Thessaloniki, Greece.

DESIGN

Prospective multicenter validation study.

METHODS

The distance best spectacle-corrected visual acuity (dBSCVA) was compared in normal (NVG) and low (LVG) vision participants against 4 prevalent conventional distance vision charts (ETDRS, Snellen, Landolt C, and Tumbling E) by a predefined 2.5-symbol noninferiority margin and intraclass correlation coefficients (ICCs). DDART's test-retest (TRT) reliability was assessed with ICCs.

RESULTS

534 participants (471 and 63 with normal and low vision, respectively) were included in the study. The mean difference between dBSCVA measured with DDART and conventional charts ranged between -0.84 and +0.85 symbols, without exceeding the 2.5-symbol noninferiority margin. ICCs indicated an excellent level of agreement for all patient groups (from 0.848 to 0.985). TRT reliability indicated differences below 1 symbol both for the NVG and LVG, with ICCs ranging between 0.912 and 0.964 for the 4 DDARTs.

CONCLUSIONS

DDART was a valid web-based dVA test that provided reliable measurements in clinical and telemedical settings, both for normal and low vision patients.