Visual performance of an extended depth of focus intraocular lens for treatment selection.

PURPOSE: To evaluate the visual performance of an extended depth of focus (EDOF) intraocular lens (IOL) for patient selection. METHODS: This prospective non-comparative case series evaluated fifty-two eyes (26 patients) after bilateral implantation of the Tecnis Symfony IOL. Exclusion criteria were previous ocular surgeries, corneal astigmatism of >1.5 diopter, and ocular pathologies or corneal abnormalities. Uncorrected (UCVA) and distance-corrected (DCVA) visual acuity (VA) in 4 m, 80 cm, 60 cm and 40 cm (logMAR), defocus curve, contrast sensitivity (CS) and a questionnaire on subjective quality of vision (QoV) were assessed after 3 months. RESULTS: UCVA was -0.02 ± 0.071 logMAR at 4 m, 0.01 ± 0.077 logMAR at 80 cm, 0.08 ± 0.187 logMAR at 60 cm and 0.22 ± 0.153 logMAR at 40 cm. Defocus curve testing showed a flat VA range from 0.00 to -1.50 D (-0.05-0.02 logMAR). At near distance from -2.0 to -2.5 D a dip of DCVA was observed (0.14-0.28 logMAR). CS under photopic and mesopic conditions without and with glare was 1.56 logCS, 0.86 logCS, 0.78 logCS, respectively. Spectacle independence was achieved in 100% for distance and intermediate vision and 71% of patients at near distance. CONCLUSION: This EDOF IOL provides excellent intermediate and far (<0.1 logMAR) and acceptable near UCVA (<0.3 logMAR). Defocus curve testing confirmed an EDOF between far and intermediate distance and showed a dip at near distance. It provides good QoV, CS, high spectacle independence, perception of few optical phenomena, and particularly good night-driving capabilities.

Comparison of a panfocal and trifocal diffractive intraocular lens after femtosecond laser-assisted lens surgery.

PURPOSE: To compare the visual outcomes of 2 diffractive intraocular lenses (IOLs), a panfocal model and a trifocal model, after femtosecond laser-assisted lens surgery. SETTING: Department of Ophthalmology, Goethe University, Frankfurt, Germany. DESIGN: Prospective comparative case series. METHODS: This study comprised patients who had bilateral implantation of a Panoptix (panfocal) or AT LISA (trifocal) IOL. Exclusion criteria were previous ocular surgery, corneal astigmatism greater than 1.50 diopters, ocular pathology, and corneal abnormalities. Postoperative examinations included visual acuity at 4 m, 40 cm, 60 cm (panfocal), and 80 cm (trifocal); monocular distance-corrected defocus testing; and contrast sensitivity. A quality-of-vision questionnaire was also administered. RESULTS: The study comprised 80 patients. There was no significant difference in visual acuity (>0.1 logarithm of the minimum angle of resolution [logMAR]) at any distance between the 2 IOLs (P > .05). The defocus curve of the panfocal IOL (0.01 logMAR) showed significantly better visual acuity at 50 cm compared with the trifocal IOL (0.16 logMAR) (P < .001). There was no significant between-group difference in the defocus curve at other distances (P > .05). The contrast sensitivity under photopic, mesopic, and mesopic conditions with glare was similar between groups (P > .05). CONCLUSIONS: Both IOLs provided excellent distance, intermediate, and near vision. The lenses appear to be equally good options for patients with intermediate vision needs at their preferred foci, while the panfocal IOL might be better for patients with closer vision requirements at 60 cm compared to the trifocal IOL at 80 cm. Both yielded high spectacle independence with comparable contrast sensitivity and high patient satisfaction, despite some optical phenomena.

Comparison of 9 modern intraocular lens power calculation formulas for a quadrifocal intraocular lens.

PURPOSE: To evaluate the accuracy of 9 formulas (Barrett Universal II, Haigis, Hill-Radial Basis Function [RBF], Hoffer Q, Holladay 1, Holladay 2, Olsen, Sanders-Retzlaff-Kraff/theoretical [SRK/T], and T2) calculating the power of the quadrifocal Acrysof IQ Panoptix TFNT00 intraocular lens (IOL). SETTING: Department of Ophthalmology, Goethe University, Frankfurt, Germany. DESIGN: Retrospective case series. METHODS: The study included patients having cataract surgery with insertion of a quadrifocal IOL over 15 months. Preoperative biometry measurements were obtained from an IOLMaster 500. Optimized IOL constants were calculated to reduce the mean refractive prediction error. The primary outcomes were differences in mean absolute prediction error between the formulas. Median and maximum absolute prediction errors were evaluated as well as percentages of eyes within prediction errors of ±0.25 diopters (D), ±0.50 D, ±1.00 D, and ±2.00 D. RESULTS: The study comprised 75 eyes of 38 patients. The formulas were ranked by the mean absolute refractive prediction error as follows: Barrett Universal II (0.294 D), Hill-RBF (0.332 D), Olsen (0.339 D), T2 (0.351 D), Holladay 1 (0.381 D), Haigis (0.382 D), SRK/T (0.393 D), Holladay 2 (0.399 D), and Hoffer Q (0.410 D). The differences in absolute errors between the formulas were significant (P < .001). The lowest maximum absolute prediction error was obtained with the Barrett Universal II. CONCLUSION: The most accurate predictions of actual postoperative refraction were achieved using the Barrett Universal II, Hill-RBF, Olsen, or T2 formula. Thus, one of these formulas should be used for IOL power calculation of the quadrifocal IOL.

Visual Outcomes After Implantation of a Segmental Refractive Multifocal Intraocular Lens Following Cataract Surgery.

PURPOSE: To evaluate visual outcomes, with particular attention to intermediate visual acuity (VA), of a segmental refractive multifocal intraocular lens (IOL) with optimized depth of focus (DoF). DESIGN: Prospective, nonrandomized, noncomparative case series. METHODS: Setting: Department of Ophthalmology, Goethe University, Frankfurt/Germany. Patient or Study Population: Fifty eyes (25 patients) were included. Inclusion criteria were bilateral cataract, age > 45 years, corneal astigmatism ≤ 0.75 diopter (D) postoperatively, pupil size 3-6 mm (mesopic), and center shift < 1 mm (Pentacam). Exclusion criteria were ocular surgeries, amblyopia, or potential postoperative distance-corrected VA (DCVA) > 0.3 logMAR. Intervention or Observation: Uncorrected (UCVA) and DCVA in 4 m, 80 cm, 40 cm; contrast sensitivity (CS); reading skills; defocus curve; and questionnaire on optical quality (OQ) and spectacle independence were assessed after 3 months. MAIN OUTCOME MEASURES: UCVA and DCVA in 4 m, 80 cm, 40 cm; defocus curve. RESULTS: UCVA was 0.05 ± 0.122 logMAR at 4 m, 0.18 ± 0.164 logMAR at 80 cm, and 0.16 ± 0.140 logMAR at 40 cm. Defocus curve testing showed, respectively, a flat monocular and binocular VA range from 0.00 to -2.00 D (-0.03 to 0.11 logMAR, -0.05 to 0.05 logMAR). Median CS under photopic and mesopic conditions without and with glare was 1.81 logCS, 1.65 logCS, 1.52 logCS, and 1.14 logCS, respectively. Reading speed at 40 cm showed a reading acuity of 0.100 logRAD with 94 words/minute. CONCLUSION: This segmental multifocal IOL provides good VA at all distances (<0.20 logMAR), particularly providing good intermediate visual acuity and DoF. It showed good reading skills, OQ, and CS and high spectacle independence.

Visual Performance of a Quadrifocal (Trifocal) Intraocular Lens Following Removal of the Crystalline Lens.

PURPOSE: To evaluate visual performance after implantation of a quadrifocal intraocular lens (IOL). METHODS: Setting: Department of Ophthalmology, Goethe University, Frankfurt, Germany. STUDY POPULATION: Twenty-seven patients (54 eyes) received bilateral implantation of the PanOptix IOL (AcrySof IQ PanOptixTM; Alcon Research, Fort Worth, Texas, USA) pre-enrollment. Exclusion criteria were previous ocular surgeries, corneal astigmatism of >1.5 diopter (D), ocular pathologies, or corneal abnormalities. Intervention or Observational Procedure(s): Postoperative examination at 3 months including manifest refraction; uncorrected visual acuity (UCVA) and distance-corrected visual acuity (DCVA) in 4 m, 80 cm, 60 cm, and 40 cm slit-lamp examination; defocus testing; contrast sensitivity (CS) under photopic and mesopic conditions; and a questionnaire on subjective quality of vision, optical phenomena, and spectacle independence was performed. MAIN OUTCOME MEASURE(S): At 3 months postoperatively, UCVA and DCVA in 4 m, 80 cm, 60 cm, and 40 cm (logMAR), defocus curves, CS, and quality-of-vision questionnaire results. RESULTS: Mean spherical equivalent was -0.04 ± 0.321 D 3 months postoperatively. Binocular UCVA at distance, intermediate (80 cm, 60 cm), and near was 0.00 ± 0.094 logMAR, 0.09 ± 0.107 logMAR, 0.00 ± 0.111 logMAR, and 0.01 ± 0.087 logMAR, respectively. Binocular defocus curve showed peaks with best visual acuity (VA) at 0.00 D (-0.07 logMAR) and -2.00 D (-0.02 logMAR). CONCLUSION: Visual performance of the PanOptix IOL showed good VA at all distances; particularly good intermediate VA (logMAR > 0.1), with best VA at 60 cm; and high patient satisfaction and spectacle independence 3 months postoperatively.