Depth of field and visual performance after implantation of a new hydrophobic trifocal intraocular lens.

PURPOSE: To assess the depth of field (DOF) by means of defocus curve analysis applying different visual acuity criteria in patients following cataract surgery and bilateral implantation of a new trifocal diffractive intraocular lens (IOL). METHODS: Fifty eyes of 25 consecutive patients who underwent implantation of the Asqelio™ trifocal IOL (AST Products Inc., USA) were enrolled in this observational prospective study. Monocular subjective DOF was obtained from defocus curves with absolute and relative criteria of tolerance for different visual acuities values. Patient's visual satisfaction, postoperative refraction and visual acuity at far, intermediate (67 cm) and near (40 cm) distances were also measured at 1 and 3-months post-surgery. Analysis of variance was used to assess differences in refractive error after the surgical procedure, and paired t-tests were used to assess differences in VA. Patient satisfaction results were reported as percentages. RESULTS: Spherical equivalent was 0.05 ± 0.23 D and residual cylinder 0.01 ± 0.23 D 3-months after the surgery. Absolute DOF obtained was 3.29 ± 0.91 D considering 0.1 LogMAR as cut-off value, and 4.82 ± 0.69 D when 0.3 logMAR as cutoff value. Relative DOF considering a drop of 0.1 logMAR from maximum visual acuity was 2.57 ± 0.82 D, and 1.27 ± 0.70 D when a drop of 0.04 logMAR was considered. Visual acuities obtained 3-months after the surgery were 0.03 ± 0.13, - 0.05 ± 0.06, 0.03 ± 0.08 and 0.04 ± 0.08 logMAR for uncorrected and best-corrected for distance, and best distance-corrected for intermediate and near distances, respectively. Average response to visual satisfaction queries was 8.24/10 at distance, 8.04/10 at intermediate, and 7.88/10 at near. CONCLUSIONS: Patients implanted with this trifocal IOL showed a significant improvement in visual acuity at different distances providing wide absolute and relative DOF values. The outcomes demonstrate that this lens is predictable yielding good patient satisfaction rates.

Comparison of 3-month visual outcomes of a new multifocal intraocular lens vs a trifocal intraocular lens.

PURPOSE: To compare the clinical performance of the TECNIS Synergy multifocal (model ZFR00V) intraocular lens (IOL) with that of the AcrySof PanOptix Trifocal (model TFNT00) IOL in patients undergoing bilateral cataract surgery. SETTING: Multicenter clinical setting. DESIGN: Prospective randomized comparative study. METHODS: Patients aged 22 years or older were randomly assigned (2:1) to bilateral implantation with ZFR00V or TFNT00 IOLs. End points included the mean binocular distance-corrected near visual acuity (DCNVA) at 40 cm, photopic and mesopic DCNVAs at 33 cm, photopic low-contrast corrected distance visual acuity (CDVA) and mesopic CDVA, nondirected patient responses to an ocular/visual symptoms questionnaire, and safety. RESULTS: Of the 150 patients implanted with IOLs, 95 of the 97 patients with ZFR00V IOLs and 52 of the 53 patients with TFNT00 IOLs completed the 3-month follow-up. Most patients in the ZFR00V and TFNT00 groups achieved 20/25 or better binocular CDVA (100% vs 96.2%) and DCNVA measured at 40 cm (88.4% vs 75.0%) and 33 cm (78.9% vs 51.9%). The mean between-group difference in binocular DCNVA at 40 cm favored ZFR00V IOLs (0.5 lines Snellen; 95% CI, 0.012 to 0.089; P ≤ .05). Similarly, the mean binocular photopic and mesopic DCNVAs at 33 cm (0.8 lines Snellen each; both P ≤ .05 vs TFNT00) and photopic high-contrast and low-contrast CDVA (0.5 lines Snellen each; both P ≤ .05 vs TFNT00) favored ZFR00V IOLs. Patient-reported ocular/visual symptoms and safety were generally similar between the 2 IOLs. CONCLUSIONS: The ZFR00V IOL showed an extensive range of vision, particularly through near distances, and better mesopic performance than the TFNT00 IOL in patients undergoing cataract surgery.

Recommendations for ophthalmologic practice during the easing of COVID-19 control measures.

In the context of the COVID-19 pandemic, this paper provides recommendations for medical eye care during the easing of control measures after lockdown. The guidelines presented are based on a literature review and consensus among all Spanish Ophthalmology Societies regarding protection measures recommended for the ophthalmologic care of patients with or without confirmed COVID-19 in outpatient, inpatient, emergency and surgery settings. We recommend that all measures be adapted to the circumstances and availability of personal protective equipment at each centre and also highlight the need to periodically update recommendations as we may need to readopt more restrictive measures depending on the local epidemiology of the virus. These guidelines are designed to avoid the transmission of SARS-CoV-2 among both patients and healthcare staff as we gradually return to normal medical practice, to prevent postoperative complications and try to reduce possible deficiencies in the diagnosis, treatment and follow-up of the ophthalmic diseases. With this update (5th ) the Spanish Society of Ophthalmology is placed as one of the major ophthalmology societies providing periodic and systematized recommendations for ophthalmic care during the COVID-19 pandemic.

Comparison of the accuracy of 11 intraocular lens power calculation formulas.

PURPOSE: To compare the accuracy of 11 intraocular lens (IOL) power calculation formulas (SRK-T, Hoffer Q, Holladay I, Haigis, Holladay II, Olsen, Barrett Universal II, Hill-RBF, Ladas Super formula, EVO and Kane). SETTING: Private university hospital (QuironSalud, Madrid, Spain). DESIGN: Retrospective case series. METHODS: Data were compiled from 481 eyes of 481 patients who had undergone uneventful cataract surgery with IOL insertion. Preoperative biometric measurements were made using an IOL Master® 700. Respective ULIB IOL constants (http://ocusoft.de/ulib/c1.htm) for each of 4 IOL models implanted were used to calculate the predictive refractive outcome for each formula. This was compared with the actual refractive outcome determined 3 months postoperatively. The primary outcome was mean absolute prediction error (MAE). The study sample was divided according to axial length (AL) into three groups of eyes: short (⩽22.00 mm), normal (22.00-25.00 mm) and long (⩾25.00 mm). RESULTS: The Barrett Universal II and Haigis formulas yielded the lowest MAEs over the entire AL range (p < .01, except EVO) as well as in the long (p < .01, all formulas) and normal (p < .01, except Haigis, Holladay II, Olsen and LSF) eyes. In the short eyes, the lower MAEs were provided by Haigis and EVO (p < .01 except Hoffer Q, SRK/T and Holladay I). CONCLUSIONS: Barrett Universal II was the most accurate for IOL power calculation in the normal and long eyes. For short eyes, the formulas Haigis and EVO seem best at predicting refractive outcomes.

Spectacle Independence for Pseudophakic Patients - Experience with a Trifocal Supplementary Add-on Intraocular Lens.

PURPOSE: To evaluate the refractive and functional outcomes of the trifocal 1stQ AddOn® (Medicontur) supplementary intraocular lenses (IOLs) designed for implantation into the ciliary sulcus. PATIENTS AND METHODS: The study included 18 eyes of 11 pseudophakic patients with uncomplicated previous implantation of monofocal capsular bag IOLs. These patients had a desire for spectacle independence. Distance, intermediate and near visual acuities were measured, and defocus curves were plotted over a period of 6 months following implantation of the add-on IOLs. Intraocular pressure (IOP), endothelial cell density measurements and biomicroscopic evaluation were also performed. RESULTS: In this study, 83.3% of eyes had spherical refractions within ±0.5 D from emetropia and 100% of eyes had spherical equivalent refractions that were within ±1.0 D of the target refraction. Visual acuities and defocus curves clearly confirmed trifocal optical performance (UDVA=0.03 ±0.05; UIVA=0.21 ±0.04; UNVA=0.12 ±0.04 logMAR; expressed as mean ±SD). Depth of focus showed identical results (DOF=0.486 D) compared to a trifocal capsular bag IOL, while the defocus curve was found to be superior in the intermediate and near ranges when compared to a trifocal capsular bag IOL. All patients achieved spectacle independence at all distances. All add-on IOLs were well positioned in the ciliary sulcus. No negative changes were noted in connection with endothelial cell counts, IOPs, the angle structure during surgery and during the follow-up period. CONCLUSION: The supplementary trifocal add-on IOL seems to be a safe, efficient and stable solution for achieving spectacle independence in pseudophakic patients with monofocal primary IOLs.

Refractive predictability and visual outcomes of an extended range of vision intraocular lens in eyes with previous myopic laser in situ keratomileusis.

PURPOSE: To evaluate the refractive predictability obtained with an extended range of vision intraocular lens in eyes with previous myopic laser in situ keratomileusis, confirming which intraocular lens power formula provides the most accurate calculation. METHODS: The study enrolled 71 eyes with previous successful myopic laser in situ keratomileusis surgery of 43 patients undergoing cataract surgery with implantation of the extended range of vision intraocular lens TECNIS Symfony (Johnson and Johnson Vision). Intraocular lens power was calculated using all American Society of Cataract and Refractive Surgeons formulas, and their average value was selected for implantation. Refractive outcomes were evaluated at 3 months postoperatively. RESULTS: Postoperative spherical equivalent within ±0.50 and ±1.00 D was found in 61.6% and 86.3% of eyes, respectively. In eyes with pre-laser in situ keratomileusis data available, no significant correlation was found between pre-laser in situ keratomileusis spherical equivalent and post-cataract surgery spherical equivalent (r = 0.237, p = 0.114). A postoperative spherical equivalent within ±0.50 D was found in 65.2% and 55.6% of eyes in the subgroups with and without pre-laser in situ keratomileusis data available, respectively (p = 0.480). Statistically significantly higher differences between the intraocular lens power implanted and the calculation provided by the Potvin-Hill (p = 0.028) and Barrett True K No History formulas (p = 0.022) were found in those eyes with postoperative spherical equivalent > 0.50 D. CONCLUSION: The extended range of vision intraocular lens evaluated can provide a predictable refractive correction in eyes with previous laser in situ keratomileusis surgery. The Potvin-Hill and Barrett True K No History are the most adequate formulas to perform intraocular lens power calculations in these cases.

Evolution of visual performance in 250 eyes implanted with the Tecnis ZM900 multifocal IOL.

PURPOSE: To evaluate visual performance in relation to time after implantation of the multifocal Tecnis intraocular lens (IOL) in patients with cataract. METHODS: This prospective case series involved 250 eyes of 137 patients with cataract aged 68.5+/-9.9 years. Monocular uncorrected and corrected near visual acuity (NVA and DCNVA) and distance visual acuity (UCVA and BCVA), occurrence of visual symptoms, and patient satisfaction were evaluated at 1-3 days, 30-90 days, and 150-210 days after surgery. Posterior capsule opacification and contrast sensitivity under photopic conditions were also assessed. RESULTS: At the last follow-up visit, mean NVA and DCNVA was 0.215+/-0.082 and 0.189+/-0.045 logMAR, respectively. The majority of eyes (96.8%) could read J2 without correction, including 83.2% reading J1. With best distance correction, 95.6% of eyes were able to read J1. Mean UCVA and BCVA was 0.144+/-0.101 and 0.09+/-0.03 logMAR, including 77.6% and 98.4% of eyes that achieved 20/30 or better, respectively. The majority of patients (>90%) ranked their near, distance, and global vision as good or excellent and 88.4% were free from spectacles. A significant improvement of uncorrected and corrected distance and near VA as well as a decrease in the intensity of subjective photic phenomena was observed over time. At the last follow-up visit, the rate of posterior capsule opacification (grade 1) was 4.4% and mean monocular contrast sensitivity was 1.44+/-0.26. CONCLUSIONS: The multifocal Tecnis IOL provides excellent near vision and good distance vision in patients with cataract. However, most patients required a neuroadaptation period of approximately 6 months to experience full visual benefits of the lens.

Evaluation of image quality after implantation of 2 diffractive multifocal intraocular lens models.

PURPOSE: To compare the visual quality after implantation of multifocal intraocular lenses (IOLs). SETTING: Departments of Ophthalmology, Hospital Quirón and Hospital Clínico San Carlos, Madrid, Spain. METHODS: In a prospective nonrandomized consecutive trial, patients had bilateral implantation of Acri.LISA 366D (Group A) or Tecnis ZM900 (Group B) multifocal IOLs. One eye of each patient was included in the study. Three months postoperatively, uncorrected and corrected distance and near visual acuities, pupil diameter, and refraction were assessed. The modulation transfer function (MTF), point-spread function (PSF), and light scattering were calculated using the double-pass Optical Quality Analysis System for distance vision with a 4.0 mm pupil diameter. RESULTS: Each IOL group comprised 20 patients. No statistically significant differences were found between the 2 groups in postoperative mean spherical equivalent or mean monocular corrected distance or near visual acuity. The PSF variables were slightly lower in Group B, although the difference between groups was not statistically significant. The MTF parameters (double-pass value at 100%, 20%, and 9% contrast) were slightly higher in Group A (P = .07, P = .04, and P = .09, respectively). The mean objective scatter index was 1.83 +/- 0.91 (SD) in Group A and 2.00 +/- 0.74 in Group B (P = .43). CONCLUSIONS: Both diffractive multifocal IOLs improved functional visual capacity at distance and near. Although the visual quality variables were slightly better in Group A than in Group B, the differences were not statistically significant.

Secondary glaucoma and severe endothelial damage after silicone phakic posterior chamber intraocular lens implantation.

We report a patient who developed secondary glaucoma 1 year after phakic posterior chamber intraocular lens implantation.

Ultrasound biomicroscopy of silicone posterior chamber phakic intraocular lens for myopia.

PURPOSE: To study the intraocular position and anatomic relationships of PRL-III (phakic refractive lens) (PRL) posterior chamber phakic intraocular lens (PCP IOL) for high myopia using ultrasound biomicroscopy (UBM). SETTING: Centro Oftalmológico Real Vision, and Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain. METHODS: Sixteen phakic myopic eyes that had had PRL implantation were examined by UBM 1 month after surgery. The PRL position, PRL-crystalline lens peripheral distance, and central distance between the corneal endothelium and the PRL were measured. RESULTS: Both haptics were on the zonule in 6 eyes, in the ciliary sulcus in 5 eyes, and impacted in the ciliary body in 1 eye. In the 4 remaining eyes, the haptics were in mixed positions. The mean PCP IOL crystalline lens peripheral distance in the minor axis was 588.1 microm +/- 232.5 (SD), and the mean PCP IOL-endothelium central distance was 2082.8 +/- 277.6 microm. CONCLUSIONS: Phakic refractive lens implantation should be done carefully because of the sulcus location of the haptics in many cases. This, with the iris-PRL contact, suggests caution for the long-term outcome.

High-frequency ultrasound biomicroscopy of silicone posterior chamber phakic intraocular lens for hyperopia.

PURPOSE: To study the intraocular position and anatomic relationships of the PRL-III phakic refractive lens (PRL), a posterior chamber phakic intraocular lens (PCP IOL), in cases of hyperopia using ultrasound biomicroscopy (UBM). SETTING: Centro Oftalmológico Real Vision, Madrid, Spain, and Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense, Madrid, Spain. METHODS: Eleven phakic hyperopic eyes of 6 patients who had PRL implantation were examined by UBM 1 month after surgery. The PRL position, PRL-crystalline lens peripheral distance, and central distance between the corneal endothelium and the PRL were measured. RESULTS: Eight eyes had both haptics on the zonule, 2 had 1 haptic in the sulcus and 1 on the zonule, and 1 had 1 haptic in the sulcus and the other in the ciliary body. The mean PCP IOL-crystalline lens peripheral distance in the minor axis was 239.7 microm +/- 179.4 (SD) and the mean PCP IOL-endothelium central distance, 2146.98 +/- 219.6 microm. Contact between the PCP IOL and crystalline lens was observed in 1 eye. CONCLUSIONS: In this study of hyperopic eyes, the PRL was located on the zonule in most cases. However, the location of the haptics in the sulcus and contact between the PCP IOL and the crystalline lens that occurred in some cases suggest further study of possible long-term complications is needed.