Clinical Outcomes of a Bi-Aspheric Trifocal Diffractive Intraocular Lens.

Purpose: To assess refractive and visual outcomes post-cataract surgery with bilateral implantation of a bi-aspheric diffractive trifocal intraocular lens (IOL). Methods: A total of 24 patients who underwent bilateral implantation with the Asqelio Trifocal IOL TFLIO130C were evaluated at the 6 months postoperative mark. Key outcome measures included refractive error, photopic monocular and binocular uncorrected and corrected distance visual acuity (UDVA, CDVA), uncorrected and corrected intermediate visual acuity (UIVA, CDIVA) at 60 cm, and uncorrected and corrected near visual acuity (UNVA, CDNVA) at 40 cm. Additionally, monocular and binocular CDNVA were assessed under mesopic conditions. Monocular and binocular defocus curves, and binocular contrast sensitivity under photopic and mesopic conditions, with and without glare, were measured. Catquest-9SF and visual symptoms questionnaires were also administered. Results: Postoperative average values of binocular logMAR photopic CDVA, photopic CDIVA, photopic CDNVA and mesopic CDNVA were -0.01±0.06, 0.03±0.09, 0.02±0.05 and 0.19±0.13, respectively. About 100% of patients showed cumulative CDVA and CDNVA ≥20/25, and CDIVA ≥20/32. The average absolute depth-of-focus was about 4.50D. The average postoperative spherical equivalent was 0.05±0.30D and 100% and 93.75% eyes were within ±1.00D and ±0.50D, respectively. Contrast sensitivity was either within or above normal levels under both photopic and mesopic conditions, both with and without glare, except for 12 cpd under mesopic conditions with glare where the mean falls just below the normal range. Questionnaires revealed that 87.5% of patients were either satisfied or very satisfied with their vision after the surgery, and higher percentages for no difficulty in performing different activities, ranging from 70.83% to 95.83%, were reported. Conclusion: This study demonstrates that the bi-aspheric diffractive trifocal IOL yields very good visual performance across distances, fostering high satisfaction levels and minimal difficulties in daily activities.

Clinical outcomes of trifocal toric intraocular lenses.

The purpose of this report is to summarize the visual and refractive outcomes of patients with trifocal toric intraocular lens (IOL) implants. A peer-reviewed literature search in different databases was carried out to identify clinical publications reporting outcomes of patients with this type of implant. The analysis considered information on the sample of eyes, type and power of the trifocal toric IOLs, biometric preoperative data, postoperative refraction, rotational stability, visual acuity at different distances and other analyses undertaken, such as contrast sensitivity or quality of vision questionnaires. 20 clinical studies, encompassing a total of 1404 eyes implanted with three commercially available trifocal toric IOLs, were included in this review. The analysis assessed the outcomes reported for the AT LISA tri toric 939MP IOL, involving 3 articles and 313 eyes; the FineVision toric POD FT IOL, with 7 articles studying 370 eyes, and the AcrySof IQ PanOptix toric IOL, involving 11 articles and 721 eyes. Our assessment of the outcomes of the various studies indicates that the efficacy of the refractive correction (both sphere and cylinder) and visual acuity at different distances was similar between the IOL models. The same was found for the patients' quality of vision and satisfaction levels, in addition to photic phenomena reported. The outcomes summarized in this report lead us to conclude that the use of trifocal toric IOLs allows complete visual restoration over a wide range of distances.

Analysis of visual and refractive results after wedge resection for high astigmatism after penetrating keratoplasty in keratoconus.

PURPOSE: To analyze visual and refractive results after wedge resection to correct high astigmatism after penetrating keratoplasty (PK) for keratoconus. SETTING: Cornea Unit of the Centro de Oftalmología Barraquer Barcelona, Spain. DESIGN: A retrospective quasi-experimental, before and after study. METHODS: Patients who developed high astigmatism or ectasia in the graft-host junction after PK were treated with wedge resection. The following variables were studied before the surgery, 1-year after and at the final visit: uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive and topographic astigmatism and spherical equivalent. Vectorial analysis of the astigmatism changes was performed. RESULTS: Fifty-one eyes were included with a mean follow-up of 4.19 ± 3.09 years. Mean refractive astigmatism was 11.47 ± 3.57 diopters (D) pre-operatively and 4.79 ± 3.32 D at the final follow-up (p < 0.001). The mean centroid changed from 2.65 ± 11.82 D at 23 degrees preoperatively to 0.35 ± 5.86 D at 127 degrees postoperatively. Concerning spherical equivalent, the mean preoperative value was -3.10 ± 4.15 D and the mean postoperative value was -1.55 ± 3.41 D (p = 0.002). Mean pre-operative and final follow-up UDVA were 1.25 ± 0.27 and 0.84 ± 0.50 (p < 0.001). Mean Pre-op and final follow-up CDVA were 0.27 ± 0.19 and 0.24 ± 0.24. CONCLUSIONS: Wedge resection is a useful surgical procedure to correct high astigmatism. It is a safe technique with moderate efficacy and may be considered as initial procedure of choice in high astigmatism due to long-term ectasia in the graft-host junction after PK for keratoconus.

Refractive and Visual Outcomes of a Monofocal Non-Constant Aberration Aspheric Intraocular Lens.

Purpose: To evaluate the refractive and visual outcomes following cataract surgery and implantation of a new monofocal non-constant aberration aspheric intraocular lens (IOL). Methods: Ninety eyes of 86 patients who underwent implantation the CT LUCIA 621P IOL (Carl Zeiss Meditec AG) were retrospectively analyzed in this study. Main outcome measures were refractive error and monocular corrected distance visual acuity (CDVA) and monocular uncorrected distance visual acuity (UDVA) values. Patients were evaluated at 1-month post-surgery and intra- and post-operative complications were recorded. Results: Eighty percent of the eyes showed a CDVA of 20/25 or better before surgery. The postoperative mean values of monocular distance Snellen decimal UDVA and CDVA were 0.64±0.22 and 0.89±0.13, respectively. All eyes showed the same or better difference between UDVA and CDVA. In relation to the postoperative spherical equivalent, the highest percentage of eyes, 31.11%, was for the range between -0.50 and -0.14D followed by 22.22% for the ±0.13D range. Ninety percent of the eyes were within ±1.00 D and 73.33% of eyes within ±0.50 D. The mean postoperative spherical equivalent was -0.18±0.55D. 37.78% and 76.67% of the eyes showed a value ≤0.50 D and ≤1.00D, respectively, being the mean postoperative refractive cylinder -0.81±0.50D. No adverse events were reported in whole sample intra and postoperatively. Conclusion: The present study shows that cataract surgery with an monofocal non-constant aberration aspheric IOL implantation resulted in good visual performance and refractive outcomes. This lens may be considered as a valid choice for patients in a standard-routine cataract surgery practice.

Acquisition Time for Swept-Source Optical Biometry Plus Corneal Power Measurement During Cataract Evaluation.

Purpose: To compare the acquisition time necessary to obtain the optical biometry plus corneal power measurement using the IOLMaster 700 with central topography with that found using the standard IOLMaster 700 in combination with two corneal topographers, when acquiring biometry measurements during cataract evaluation. Methods: This prospective, observational, controlled study included 96 eyes of 96 cataract patients. Acquisition times were registered for different conditions: time required for one complete measurement with IOLMaster 700 with central topography, time required for one complete measurement with standard IOLMaster 700 (without central topography), time required for one complete measurement with standard IOLMaster 700 plus time required for one complete measurement with Cassini, and time required for one complete measurement with standard IOLMaster 700 plus time required for one complete measurement with Pentacam HR. In addition, the agreement between keratometry (K), total keratometry (TK) and equivalent K reading (EKR) parameters using the three devices was performed. Results: The post hoc Tukey's test revealed that there were statistically significant differences for all pairwise comparisons (p < 0.001) except for the acquisition times of the IOLMaster with central topography and the standard IOLMaster 700 (p = 0.501). The acquisition time by the IOLMaster 700 with central topography takes approximately three less times than the use of a corneal topographer combined with a biometer. The agreement of K1, K2, TK1, TK2, EKR1 and EKR2 measurements between the three devices revealed statistically significant differences for all possible comparisons (p < 0.001) except for the comparison between the IOLMaster 700 and the Cassini for all parameters (p > 0.05). Conclusion: We consider that this is an efficient procedure that improves clinical flow. We also conclude that K readings obtained with the three devices cannot be used interchangeably since there are clinically relevant differences that may affect cataract surgery outcomes.

Agreement of predicted intraocular lens power using swept-source optical coherence tomography and partial coherence interferometry.

PURPOSE: To analyze the agreement of the predicted intraocular lens (IOL) power obtained with ANTERION, IOLMaster 700 and Pentacam AXL biometers. METHODS: We calculated the monofocal and trifocal IOL power using the SRK/T, Haigis, Barrett Universal II and Hoffer Q formulas for 106 eyes. IOL power agreement between devices was evaluated using the Bland-Altman method. RESULTS: We found significant differences between biometers comparisons (p < 0.001). ANTERION and IOLMaster 700 did not produce significant IOL power differences (p > 0.05), with the same outcomes for medium- and long-eyes. No significant differences were found using the SRK/T, Haigis, or Hoffer Q formulas for short-eyes (p > 0.1). However, Barrett Universal II formula produced significant differences (p < 0.05) and these differences lay between the ANTERION and Pentacam AXL. ANTERION versus IOLMaster 700 comparison showed limits of agreement (LoA) varying from 1.1071D in SRK/T monofocal medium-eyes to 1.6828D in Hoffer Q trifocal all-eyes. The largest LoA (about 3.0D) was found for short-eyes when comparing the Pentacam AXL with the other two devices. CONCLUSIONS: These devices provided statistically significant but clinically insignificant mean differences in predicted IOL power. However, wide LoA values suggest that for specific eyes these outcomes could be clinically significant.

Enhanced Monofocal Extended Depth of Focus IOL With a Diffractive Surface Design.

PURPOSE: To evaluate the refractive and visual outcomes following cataract surgery and implantation of a new enhanced monofocal extended depth of focus (EDOF) intraocular lens (IOL). METHODS: Fifty eyes of 25 consecutive patients who underwent implantation of the xact Mono-EDoF IOL (Santen Pharmaceutical Co, Ltd) were enrolled in this study. Main outcome measures were refractive error and monocular corrected (CDVA) and uncorrected (UDVA) distance visual acuity values. Monocular visual acuity at different vergences (defocus curve) was obtained. Patients were evaluated at 12 months postoperatively. RESULTS: At 1 year of follow-up, all eyes showed a postoperative spherical equivalent within ±1.00 diopters (D) and 95% of eyes within ±0.50 D. The mean postoperative spherical equivalent was -0.15 ± 0.28 D. A total of 88% and 100% of eyes showed UDVA and CDVA of 20/25 or better, respectively. The mean values of UDVA and CDVA (Snellen decimal) were 0.94 ± 0.09 (range: 0.70 to 1.00) and 0.99 ± 0.03 (range: 0.79 to 1.00), respectively. Defocus curve showed good visual acuity at distance and intermediate distances with a depth of focus value of 1.25 D. No visual disturbances were reported in the whole sample during the entire follow-up. CONCLUSIONS: The current study shows that this EDOF IOL provides good visual performance at far and intermediate distances. The lens may be considered for patients interested in reducing spectacle independence at intermediate distances. [J Refract Surg. 2021;37(9):595-600.].

Agreement between intraoperative anterior segment spectral-domain OCT and 2 swept-source OCT biometers.

Purpose: To evaluate the agreement of different biometric parameters obtained using intraoperative spectral-domain optical coherence tomography (SD-OCT) and two swept-source optical coherence tomography (SS-OCT) based biometers.Methods: 102 eyes were assessed using the intraoperative SD-OCT integrated into the Catalys femtosecond-laser, and the IOLMaster 700 and Anterion SS-OCT-based-biometers. Central corneal thickness (CCT), anterior chamber depth (ACD), white-to-white (WTW), and lens thickness (LT) were measured.Results: There were statistically significant differences for CCT, ACD, WTW and LT between devices (p < 0.001). The mean difference for ACD ranged from -0.067 to -0.250 mm, with the largest mean difference being between the IOLMaster 700 and Catalys. CCT mean differences ranged from 7 to 32 µm, with the largest mean difference being between the Anterion and Catalys. For WTW, the comparison between the IOLMaster 700 vs Catalys showed the largest mean difference (0.38 mm). However, the mean differences for LT from all three devices were quite similar, ranging from -0.02 to -0.08 mm.Conclusions: SS-OCT biometers showed good agreement for ACD, CCT, WTW and LT. The SD-OCT showed ACD, CCT and WTW values that do not seem to be interchangeable with the SS-OCT biometers; however, this device did show excellent agreement in the case of LT.

Agreement Between Angle-to-Angle Distance and Aqueous Depth Obtained With Two Different Optical Coherence Tomographers and a Scheimpflug Camera.

PURPOSE: To compare angle-to-angle (ATA) distance and aqueous depth (AQD) readings produced by two different optical coherence tomography (OCT) devices and a Scheimpflug camera. METHODS: ATA distance and AQD were measured in 60 eyes using the Visante time-domain OCT (TD-OCT) (Carl Zeiss Meditec AG), the Anterion swept-source OCT (SS-OCT) (Heidelberg Engineering GmbH), and the Pentacam HR Scheimpflug camera (Oculus Optikgeräte GmbH). Moreover, ATA distance was measured along the horizontal and vertical meridians. Bland-Altman analysis was used to assess the agreement between devices. RESULTS: All three devices did not yield similar horizontal ATA distance: 11.96 ± 0.47 mm (TD-OCT), 11.96 ± 0.42 mm (SS-OCT), and 11.05 ± 0.52 mm (Pentacam). More specifically, the Pentacam yielded significantly smaller values (approximately 0.9 mm, P < .001). Mean vertical ATA distance was 12.61 ± 0.65 and 12 ± 0.65 mm for the TD-OCT and SS-OCT, respectively (P = .983). Vertical ATA distance was significantly larger than horizontal ATA distance for both OCT devices (approximately 0.6 mm, P < .001). The lowest mean difference was found between both OCT devices (0.0068 and -0.0415 mm, for horizontal and vertical meridians, respectively) and the highest between the Pentacam and the two OCT devices (approximately 0.9 mm). As for AQD, inter-device mean values were also statistically significant: 2.89 ± 0.48, 2.82 ± 0.49, and 2.79 ± 0.50 mm, for the TD-OCT, SS-OCT, and Pentacam, respectively (P < .001). Mean differences were similar for the TD-OCT versus SS-OCT and SS-OCT versus Pentacam (approximately 0.02 mm), and larger between the TD-OCT and Pentacam (approximately 0.05 mm). CONCLUSIONS: The results show that the TD-OCT and SS-OCT are interchangeable instruments for ATA distance measurement but the Pentacam is not with either of the two OCT devices. A clinical criterion should assess whether these three devices could be used interchangeably for AQD measurement. [J Refract Surg. 2021;37(2):133-140.].

Optical and visual quality assessment of an extended depth-of-focus intraocular lens based on spherical aberration of different sign.

PURPOSE: To assess the optical quality and the visual performance of patients implanted with an extended depth-of-focus (EDOF) intraocular lens (IOL). METHODS: Thirty-eight eyes underwent implantation of the Mini WELL Ready EDOF IOL and were evaluated at 3-months postsurgery. Higher-order aberrations (HOAs) and modular transfer function (MTF) were measured at 3- and 5-mm pupils. Binocular uncorrected-distance visual acuity (UDVA) and corrected-distance visual acuity (CDVA), uncorrected-distance intermediate visual acuity (UIVA) and corrected-distance intermediate visual acuity (CDIVA) at 80 cm, and uncorrected-distance near visual acuity (UNVA) and corrected-distance near visual acuity (CDNVA) at 40 cm were obtained. Postoperative refraction, binocular defocus curve, halometry and subjective ad hoc patients' questionnaire were also evaluated. RESULTS: HOAs were 0.171 ± 0.046 µm and 0.406 ± 0.137 µm at 3 and 5 mm, respectively. MTFs decreased as the spatial frequency increased being comparable for both pupils. 92.10% of eyes were within ± 1.00D, and the mean postoperative spherical equivalent was - 0.25 ± 0.65D. Mean UDVA, UIVA and UNVA were 0.06 ± 0.12, 0.05 ± 0.10 and 0.26 ± 0.28 logMAR, respectively. Mean CDVA, CDIVA and CDNVA were - 0.01 ± 0.08, 0.06 ± 0.11 and 0.24 ± 0.12 logMAR, respectively. Defocus curve showed a continuous range of vision, especially at intermediate distances. Mean discrimination index was 0.79 ± 0.04. Questionnaire revealed that about 79% of patients reported a high or moderately high satisfaction with the procedure, and about 95% of patients would undergo the same procedure again. CONCLUSIONS: The Mini WELL Ready EDOF IOL provided good optical and visual quality with high level of patient satisfaction and seems to be a valuable option to provide unaided vision at different distances minimizing visual disturbances.

Angle-to-angle and spur-to-spur distance analysis with high-resolution optical coherence tomography.

BACKGROUND: To measure angle-to-angle (ATA) and spur-to-spur (STS) distances along six meridians using high-resolution swept-source optical coherence tomography (SS-OCT) and to compare those values with horizontal white-to-white (WTW) distance. METHODS: 68 eyes from 68 patients were quantitatively assessed with the Anterion SS-OCT (Heidelberg Engineering, Heidelberg, Germany). ATA and STS distances were measured with the SS-OCT's B-Scan in six cross-sectional images corresponding to the vertical (6-12 o'clock), 1-7 o'clock, 2-8 o'clock, horizontal (3-9 o'clock), 4-10 o'clock and 5-11 o'clock meridians. WTW was measured horizontally with the device's infrared camera. A Pearson correlation analysis was carried out to compare ATA and STS distances with WTW. RESULTS: The largest values were found for the vertical meridian and the shortest for the 2-8 o'clock meridian, both for ATA and STS distances. No statistically significant differences were found between WTW, ATA and STS along the horizontal meridian (p > 0.1). However, ATA and STS showed statistically significant differences elsewhere, except for the horizontal and the 2-8 o'clock meridians (p > 0.05). Moreover, we found that ATA and STS varied significantly depending on the meridian being assessed, except for ATA at 4-10 versus 3-9 o'clock and for STS at 4-10 versus 3-9 o'clock and at 3-9 versus 2-8 o'clock (p > 0.1). R2 values ranged from 0.49 to 0.75 for ATA and STS at the different meridians, showing the best correlation at 3-9 o'clock meridian (0.64 and 0.75, respectively) and the worst at 6-12 o'clock meridian (R2 = 0.49 for both ATA and STS). CONCLUSIONS: ATA and STS distances vary radially, thus showing that the anterior chamber is vertically oval. Therefore, it is advisable to measure these two distances along the meridian to be used.

A comparative study of the visual outcomes between a new trifocal and an extended depth of focus intraocular lens.

PURPOSE: To evaluate and compare the visual outcomes and ocular optical performance of the PanOptix trifocal intraocular lens (IOL) and Symfony extended range of vision IOL. METHODS: Sixty-eight eyes of 34 patients were divided into 2 groups: 20 patients with the PanOptix IOL and 14 patients with the Symfony IOL. Binocular uncorrected distance visual acuity, best-corrected distance visual acuity (BCDVA), distance-corrected intermediate visual acuity (DCIVA) at 80 and 60 cm, and distance-corrected near visual acuity (DCNVA) at 40 cm were evaluated. Additionally, preferred reading distance with best-corrected distance and visual acuity at that distance, binocular defocus curves, mesopic and photopic contrast sensitivity, photic phenomena, and monocular total higher order aberrations (HOAs) were also measured. RESULTS: The visual outcomes for PanOptix and Symfony IOL groups, respectively, were as follows: BCDVA: -0.03 ± 0.03 and -0.02 ± 0.03 logMAR; DCIVA at 80 cm: 0.06 ± 0.06 and 0.06 ± 0.04 logMAR; DCIVA at 60 cm: 0.06 ± 0.10 and 0.05 ± 0.04 logMAR; DCNVA: 0.04 ± 0.06 and 0.20 ± 0.07 logMAR (p<0.001). Similar preferred reading distances were found for both groups (37.0 ± 4.6 and 38.9 ± 5.7 cm, respectively). The visual acuities at those distances were 0.09 ± 0.08 and 0.19 ± 0.08 logMAR (p<0.001), respectively. The defocus curves showed significantly better outcomes for the PanOptix IOL from -2.0 to -4.0 D (p<0.001). No significant differences were found for contrast sensitivity, halometry, or HOAs between the groups. CONCLUSIONS: The PanOptix and Symfony IOLs showed comparable visual performance at distance and intermediate. However, the PanOptix IOL provided better near and preferred reading distance VAs and showed a more continuous range of vision than the Symfony IOL.

Comparison of a new Scheimpflug imaging combined with partial coherence interferometry biometer and a low-coherence reflectometry biometer.

PURPOSE: To evaluate the repeatability of a new biometer using Scheimpflug technology combined with partial coherence interferometry (PCI) (Pentacam AXL) and its agreement with a device based on optical low-coherence reflectometry (OLCR), the Allegro Biograph. SETTING: Oftalvist Centro Integral Ocular Jerez, Jerez de la Frontera, Spain. DESIGN: Evaluation of a diagnostic test. METHODS: The mean keratometry (K), central corneal thickness (CCT), anterior chamber depth (ACD), and axial length (AL) were measured with the 2 devices 3 times by the same examiner in 2 groups (patients with cataract and patients without cataract). The repeatability was determined using the within-subject standard deviation, test-retest repeatability, coefficient of variation, and intraclass correlation coefficient. The correlation was evaluated with the Pearson coefficient and interchangeability with the Bland-Altman plot. RESULTS: Eighty eyes (40 eyes in each group) of 80 patients were analyzed. Significant differences were found between the Scheimpflug-PCI device and the OLCR device for mean K in the normal group (P < .001) and for CCT in the normal group (P < .05) and the cataract group (P < .001). There were no differences between devices in ACD and AL in either group. The repeatability between devices was similar. Although a significant correlation between devices was found for all measurements (all P < .001), wide limits of agreement were found in both groups for all biometric parameters. CONCLUSIONS: The Scheimpflug-PCI and OLCR devices showed excellent intravisit repeatability and high correlation for mean K, CCT, ACD, and AL in healthy and cataractous eyes. No differences were found in AL; however, the 2 devices might not be interchangeable.

Comparison of visual outcomes after bilateral implantation of extended range of vision and trifocal intraocular lenses.

PURPOSE: To compare visual outcomes after cataract surgery with bilateral implantation of 2 intraocular lenses (IOLs): extended range of vision and trifocal. METHODS: Each group of this prospective study comprised 40 eyes (20 patients). Phacoemulsification followed by bilateral implantation of a FineVision IOL (group 1) or a Symfony IOL (group 2) was performed. The following outcomes were assessed up to 1 year postoperatively: binocular uncorrected distance visual acuity (UDVA), binocular uncorrected intermediate visual acuity (UIVA) at 60 cm, binocular uncorrected near visual acuity (UNVA) at 40 cm, spherical equivalent (SE) refraction, defocus curves, mesopic and photopic contrast sensitivity, halometry, posterior capsule opacification (PCO), and responses to a patient questionnaire. RESULTS: The mean binocular values in group 1 and group 2, respectively, were SE -0.15 ± 0.25 D and -0.19 ± 0.18 D; UDVA 0.01 ± 0.03 logMAR and 0.01 ± 0.02 logMAR; UIVA 0.11 ± 0.08 logMAR and 0.09 ± 0.08 logMAR; UNVA 0.06 ± 0.07 logMAR and 0.17 ± 0.06 logMAR. Difference in UNVA between IOLs (p<0.05) was statistically significant. There were no significant differences in contrast sensitivity, halometry, or PCO between groups. Defocus curves were similar between groups from 0 D to -2 D, but showed significant differences from -2.50 D to -4.00 D (p<0.05). CONCLUSIONS: Both IOLs provided excellent distance and intermediate visual outcomes. The FineVision IOL showed better near visual acuity. Predictability of the refractive results and optical performance were excellent; all patients achieved spectacle independence. The 2 IOLs gave similar and good contrast sensitivity in photopic and mesopic conditions and low perception of halos by patients.