Nondiffractive wavefront-shaping extended depth-of-focus intraocular lens: visual performance and patient-reported outcomes.

PURPOSE: To evaluate visual performance and patient-reported outcomes after bilateral implantation of a new nondiffractive wavefront-shaping extended depth-of-focus (EDoF) intraocular lens (IOL). SETTING: Department of Ophthalmology, Goethe University, Frankfurt, Germany. DESIGN: Prospective, single-arm, single-center study. METHODS: Patient population: 16 patients (32 eyes) who received bilateral implantation of a nondiffractive wavefront-shaping EDoF IOL (AcrySof IQ Vivity) were included. Target refraction in both eyes was emmetropia. Observation procedure: Monocular and binocular uncorrected (UCVA) and distance-corrected (DCVA) visual acuity (VA), refractive outcome, defocus curve, and contrast sensitivity (CS) were evaluated 3 months after surgery with a questionnaire on optical phenomena and spectacle independence. Main outcome measure: 3-month postoperative monocular and binocular UCVA and CDVA (logMAR), defocus curve, CS, and quality of vision (QoV) questionnaire results. RESULTS: 16 patients with 32 eyes were included. Mean spherical equivalent was -0.16 ± 0.37 diopters (D) 3 months postoperatively. Binocular uncorrected distance VA at distance, intermediate, and near was 0.01 ± 0.05 logMAR at 4 m, 0.05 ± 0.05 logMAR at 80 cm, 0.07 ± 0.06 logMAR at 66 cm, and 0.25 ± 0.11 logMAR at 40 cm, respectively. Despite some minor optical phenomena, 88% of patients would choose the same lens. 63% of patients reported no optical phenomena at all. CS was 1.25 ± 0.41 logCS (photopic), 0.96 ± 0.24 logCS (mesopic), and 0.93 ± 0.24 (mesopic + glare). CONCLUSIONS: This nondiffractive wavefront-shaping EDoF IOL provides good VA at far and intermediate distance and functional near VA. It showed good QoV and CS and high spectacle independence for distance and intermediate vision with significantly less optical phenomena than with other EDoF or multifocal IOLs.

Visual and patient-reported factors leading to satisfaction after implantation of diffractive extended depth-of-focus and trifocal intraocular lenses.

PURPOSE: To evaluate factors that influence postoperative satisfaction in patients with diffractive extended depth-of-focus (EDoF) and multifocal intraocular lenses (mIOLs). SETTING: Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany. DESIGN: Observational case study. METHODS: Patients were evaluated after implantation of a diffractive EDoF (Symfony, AT LARA) or trifocal/quadrifocal (AT LISAtri, Panoptix) 3 months postoperatively. A subjective refraction was performed, uncorrected and corrected visual acuities were tested for distance (UDVA, CDVA), intermediate (at 60 cm and 80 cm, UIVA, DCIVA), and near (at 40 cm, UNVA, DCNVA). A test for contrast sensitivity was performed, and the patients filled 2 different questionnaires on daily activities and optical phenomena. Parameters with a potential correlation to the postoperative overall satisfaction were investigated. RESULTS: 94 patients with a mean age of 66 ± 19 years were included. Patients with a better UDVA and UIVA at 60 cm were more likely to choose the same IOL again. The intensity of subjective optical phenomena and the visual quality at different tasks of daily living influenced overall satisfaction. UIVA at 80 cm, UNVA, and corrected visual acuity demonstrated no significant influence on patient satisfaction. The uncorrected visual acuity at specific distances had a direct impact on the subjective visual quality regarding the task performed at those distances. CONCLUSIONS: For patients with diffractive EDoF and tri-/quadrifocal IOLs, the UDVA and UIVA at 60 cm seem to be more important than the UNVA and UIVA at 80 cm. Subjective visual quality and optical phenomena influence patient satisfaction, as well.

Impact of Pseudoexfoliative Syndrome on Effective Lens Position, Anterior Chamber Depth Changes, and Visual Outcome After Cataract Surgery.

PURPOSE: To compare the effective lens position (ELP), anterior chamber depth (ACD) changes, and visual outcomes in patients with and without pseudoexfoliation syndrome (PEX) after cataract surgery. DESIGN: Prospective, randomized, fellow-eye controlled clinical case series. METHODS: This prospective comparative case series enrolled 56 eyes of 56 consecutive patients with (n = 28) or without PEX (n = 28) and clinically significant cataract who underwent standard phacoemulsification and were implanted with single-piece acrylic posterior chamber intraocular lenses (IOLs). The primary outcome parameters were the ACD referring to the distance between the corneal anterior surface and the lens anterior surface, which is an indicator of the postoperative axial position of the IOL (the so-called ELP) and distance corrected visual acuity (DCVA). RESULTS: Before surgery, the ACD was 2.54 ± 0.42 mm in the PEX group and 2.53 ± 0.38 mm in the control group (p = 0.941). Postoperatively, the ACD was 4.29 ± 0.71 mm in the PEX group and 4.33 ± 0.72 mm in the normal group, respectively (p = 0.533). There was no significant difference in ACD changes between groups (PEX group: 1.75 ± 0.74 mm, control group: 1.81 ± 0.61 mm, p = 0.806) and DCVA pre- (p = 0.469) and postoperatively (PEX group: 0.11 ± 0.13 logMAR, control group: 0.09 ± 0.17 logMAR, p = 0.245) between groups. CONCLUSION: Preoperative and postoperative ACD, as an indicator of ELP, between PEX eyes and healthy eyes after cataract surgery showed no significant difference. Phacoemulsification induced similar changes in eyes with PEX compared to healthy eyes.

Ray-tracing Calculation Using Scheimpflug Tomography of Diffractive Extended Depth of Focus IOLs Following Myopic LASIK.

PURPOSE: To evaluate a ray-tracing formula for intraocular lens (IOL) calculation of diffractive extended depth of focus IOLs after myopic laser in situ keratomileusis (LASIK) compared to formulas from an established online calculator. METHODS: This retrospective, consecutive case series included patients after cataract surgery with implantation of an extended depth of focus (EDOF) IOL (AT LARA, Carl Zeiss Meditec; Symfony, Johnson & Johnson) and a history of myopic LASIK. Preoperative assessments included biometry (IOLMaster; Carl Zeiss Meditec) and corneal tomography, including true net power (TNP) (Pentacam; Oculus Optikgeräte GmbH). To evaluate the measurements, the simulated keratometry values (SimK) were compared to the TNP. Regarding IOL calculation, the mean prediction error, mean and median absolute prediction error (MAE and MedAE), and number of eyes within ±0.50, ±1.00, and ±2.00 diopters (D) from the Haigis-L, Shammas, and Barrett True K No History formulas to the Potvin-Hill and Haigis with TNP (Pentacam) formulas were compared. RESULTS: Thirty-six eyes matched the inclusion criteria with a mean spherical equivalent of -6.26 ± 3.25 diopters (D) preoperatively and -0.79 ± 0.75 D postoperatively. The mean difference from SimK and TNP was significantly different from zero (P < .001; -1.24 ± 0.81 D). The best performing formulas by MedAE were the Potvin-Hill and Barrett True K No History (0.39 ± 0.78 and 0.64 ± 1.00 D). The formula with the most eyes within ±0.50 D was the Potvin-Hill (64%), followed by the Barrett True K No History (44%). For MAE and percentage of eyes within ±0.50 D, the Potvin-Hill formula was significantly better than the Haigis-L, Shammas, and Haigis-TNP formulas (P < .05). CONCLUSIONS: Calculation of IOLs in patients who had LASIK remains less predicable than calculations for virgin eyes. Using ray-tracing to calculate diffractive EDOF IOLs after myopic LASIK, the Potvin-Hill formula outperformed established formulas in terms of the percentage within target refraction and the MAE. [J Refract Surg. 2021;37(4):231-239.].

Presbyopia Correction in Astigmatic Eyes Using a Toric Trifocal Intraocular Lens With Quadrifocal Technology.

PURPOSE: To evaluate the visual performance after bilateral implantation of a toric diffractive aspheric multifocal intraocular lens (IOL) with a +2.17 diopters (D) (60 cm) intermediate and a +3.25 D (40 cm) addition (add) power. METHODS: This prospective single-arm study was conducted at the Department of Ophthalmology, Goethe University, Frankfurt, Germany. Twenty-five patients (50 eyes) received bilateral implantation of the toric PanOptix IOL (AcrySof IQ PanOptix; Alcon Research LLC) before enrollment. Exclusion criteria were previous ocular surgeries excluding lens surgery and ocular pathologies or corneal abnormalities. Examination at 3 months postoperatively included manifest refraction; monocular and binocular uncorrected distance (UDVA) and distance-corrected (DCVA) visual acuity at 4 m and 80, 60, and 40 cm; and slit-lamp examination. At 3 months postoperatively, monocular and binocular defocus, binocular contrast sensitivity under photopic and mesopic conditions, and optical phenomena, and spectacle independence were evaluated. RESULTS: Mean refractive spherical equivalent was 0.12 ± 0.380 D and mean refractive cylinder was -0.21 ± 0.237 D at 3 months postoperatively. A significant decrease in refractive cylinder was observed postoperatively (P < .05), with 98% showing a postoperative astigmatism below 0.75 D. Monocular UDVA was better than 0.14 logMAR in all distances. Binocular defocus curve showed peaks at 0.00 D (-0.09 logMAR) and -1.50 and -2.00 D (-0.02 and 0.00 logMAR). The worst values between far (4 m) and near (40 cm) distance were 0.04 logMAR at -1.00 D. Despite some optical phenomena, 92% of patients would choose the same IOL again and recommend it to others. CONCLUSIONS: The visual performance of the toric PanOptix IOL showed good visual acuity at all distances; more than 90% achieved a decrease of refractive cylinder below 0.75 D, high patient satisfaction despite some optical phenomena, and high spectacle independence 3 months postoperatively. [J Refract Surg. 2020;36(10):638-644.].

Prediction accuracy of IOL calculation formulas using the ASCRS online calculator for a diffractive extended depth-of-focus IOL after myopic laser in situ keratomileusis.

BACKGROUND: To evaluate IOL calculation formulas provided by an online calculation tool from the ASCRS for an extended depth-of-focus (EDOF) IOL after previous myopic laser in situ keratomileusis (LASIK). SETTING: Department of Ophthalmology, Goethe University, Frankfurt, Germany. DESIGN: Retrospective consecutive case series. METHODS: Patients who underwent cataract surgery or refractive lens exchange with implantation of a diffractive EDOF IOL and who had a history of myopic LASIK were included. Biometry, refractive data regarding the LASIK procedure, target refraction, and postoperative refraction were collected. Mean prediction error, mean absolute error (MAE), and the number of eyes within ±0.5 diopters (D), ±1.0 D, ±1.5 D, and ±2.0 D were calculated with the following formulas from the ASCRS calculator: Shammas, Haigis-L, Barrett True-K, Barrett No History, Masket, modified Masket, and the average of all formulas (average). RESULTS: Twenty-five eyes matched the inclusion criteria. Mean spherical equivalent (SE) was -0.81 ± 0.69 D; the mean pre-LASIK SE was -6.4 ± 3.63 D. The formulas ranked by MAE were Shammas (0.7 ± 0.75 D), Haigis-L (0.72 ± 0.57 D), average (0.79 ± 0.8 D), Barrett True-K (1.14 ± 0.89 D), modified Masket (1.4 ± 1.15 D), Barrett No History (1.45 ± 0.7D ), and Masket (1.64 ± 1.27 D). The formulas with the most eyes within ±0.5 D were average (52%), Shammas (48%), and Haigis-L (44%) formulas. CONCLUSIONS: Calculation of IOLs in eyes with a history of refractive surgery remains a challenge. In this study, the Shammas and Haigis-L formulas performed best regarding MAE and percentage of eyes within ±0.5 D; however, the average of all formulas delivered reasonable results.