Comparing clinical outcomes of trifocal intraocular lens in patients with and without prior history of laser in situ keratomileusis for myopia.

BACKGROUND: To compare clinical outcomes of trifocal intraocular lens in patients with and without prior history of laser in situ keratomileusis (LASIK). METHODS: A retrospective study included patients who underwent bilateral cataract surgery and PanOptix trifocal intraocular lens (IOLs) implantation. Patients were grouped: Group A for patients with history of LASIK and Group B for patients without history of LASIK. Postoperative outcome measures comprised distance, intermediate, and near visual acuity, manifest refraction, defocus curve, contrast sensitivity, visual quality, patient satisfaction, and the rate of spectacle independence. RESULTS: A total of 288 eyes (144 patients) were included: 132 eyes in Group A and 156 eyes in Group B. At 6 months post-surgery, patients of both groups achieved a continuous satisfying visual acuity from 33 cm to distance. 73% of eyes in Group A and 75% of eyes in Group B were within ± 0.50 D of emmetropia (P > 0.05). The percentages of eyes within ± 1.00 D of emmetropia were 98% for Group A and 96% for Group B (P > 0.05). The total scores of satisfaction were 52.58 ± 3.46 for Group A and 53.23 ± 3.46 for Group B (P > 0.05). Most of patients (98% for Group A, 99% for Group B) were able to be spectacle independence for daily living. 53% of patients in Group A and 51% in Group B experiencd mild to moderate negative visual symptoms, which made it a little or moderate difficult to drive at night. CONCLUSIONS: Cataract patients with and without history of LASIK could safely undergo implantation of the PanOptix IOLs, which results in precise refractive outcomes and satisfactory visual acuity. Although contrast sensitivity decreased and some negative visual symptoms were observed, patients' satisfaction was generally high due to the high rate of spectacles independence. There were no statistically significant differences between the study groups.

Analysis of visual quality improvement after implantation of PanOptix trifocal intraocular lens in cataract patients with different axial lengths.

OBJECTIVE: To assess the visual quality, both subjective and objective, of cataract patients with varying axial lengths (AL) after PanOptix trifocal intraocular lens (IOL) implantation and investigated the lens tilt and its correlation with visual outcomes. METHODS: From July 2020 to June 2022, 70 patients (140 eyes) diagnosed with age-related cataracts and undergoing PanOptix implantation at Chongqing Eye and Vision Care Hospital, Aier Eye Hospital Group, were included. Patients were assigned to either the observation group (35 cases, 70 eyes with PanOptix trifocal IOL) or the control group (35 cases, 70 eyes with bifocal IOL). Patients were further subdivided based on AL into AL < 24 mm (observation group: 23 eyes; control group: 26 eyes) and AL ≥ 24 mm (observation group: 47 eyes; control group: 44 eyes). Postoperative follow-up lasted three months. Visual acuity (distant, intermediate, near), objective visual quality (Strehl ratio: SR, total eye modulation transfer function (MTF)), and visual aberrations were measured preoperatively and at 3 months post-operation. RESULTS: Postoperatively, all groups saw significant improvements in uncorrected distance visual acuity (UCDVA), uncorrected intermediate visual acuity (UCIVA), and uncorrected near visual acuity (UCNVA) compared to preoperative values (T0) (all P < 0.05). Notably, UCIVA was significantly better in the observation group than in the control group (P < 0.05). At three months (T1), reductions in total high-order aberration (tHOA), internal high-order aberration (iHOA), coma, and trefoil aberrations were observed in both groups compared to baseline, with more significant decreases in the observation group (all P < 0.05). Both SR and MTF cutoff showed marked improvement from T0 to T1, with the observation group experiencing greater enhancements (both P < 0.05). The defocus curve of the observation group showed a gentle slope between +0.5 D and -3.0 D, maintaining superior visual acuity compared to the control group (P < 0.05). Subjective visual quality scores at T1 were significantly higher than at T0 for both groups (P < 0.05), with patients in the observation group scoring higher than those in the control group across all AL categories (P < 0.05). Spearman correlation analysis indicated that the tilt after PanOptix trifocal IOL implantation was associated with tHOA (r = 0.273, P = 0.022), iHOA (r = 0.433, P < 0.001), Trefoil (r = 0.360, P = 0.002) and coma (r = 0.688, P < 0.001). CONCLUSION: PanOptix trifocal IOL implantation in cataract patients across different AL significantly enhances visual quality compared to bifocal IOLs, suggesting a strong case for its clinical adoption.

Modified femtosecond laser-assisted arcuate keratotomy for managing low corneal astigmatism using trifocal intraocular lens implantation in Chinese cataract patients.

To evaluate the visual outcome and astigmatic correction following trifocal intraocular lens (IOL) implantation using the modified femtosecond laser-assisted arcuate keratotomy (FSAK) in Chinese cataract patients with low astigmatism. This retrospective study included consecutive cataract patients with regular corneal astigmatism ranging from 0.75 to 1.5 D who underwent FSAK combined with the trifocal IOL implantation between November 2020 and September 2022. Monocular uncorrected distance visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity, and refractive data were collected at the 3-month follow-up. The pre- and post-operative high-order aberrations (HOAs) were recorded. The variation in astigmatism was analyzed using Alpins vector analysis. A total of 27 eyes from 23 patients were analyzed. The monocular uncorrected distance visual acuity (UDVA) (5 m) at the 3-month follow-up was 0.04 ± 0.09 logarithm of the minimum angle of resolution (logMAR), which was significantly improved compared with the preoperative value of 0.95 ± 0.51 logMAR (P <.001). The corneal astigmatism was significantly reduced from 1.24 ± 0.42 D to 0.49 ± 0.34 D (P <.001). The target-induced astigmatism (TIA) was 1.25 ± 0.43 D, the surgically induced astigmatism (SIA) was 1.16 ± 0.52 D, and the difference vector (DV) was 0.5 ± 0.34 D. The magnitude of error (ME) (difference between SIA and TIA) was -0.1 ± 0.41 D, and the correction index (CI) (ratio of SIA to TIA) was 0.93 ± 0.36. The angle of error was 3.92° ± 16.90°. Total HOA was reduced from 0.89 ± 1.11 to 0.41 ± 0.55 (P = 0.184), and the corneal HOA was lowered from 0.17 ± 0.18 to 0.10 ± 0.10 (P = 0.129). Implantation of trifocal IOL following the modified FSAK in Chinese cataract patients exhibited excellent visual efficacy and effectively reduced corneal astigmatism.

Visual performance, safety, and patient satisfaction after binocular clear lens extraction and trifocal intraocular lens implantation in Chinese presbyopic patients.

BACKGROUND: Addressing presbyopia in the aging population, particularly in non-cataractous patients, remains a challenge. This study evaluates the outcomes of refractive lens exchange (RLE) with AT LISA tri 839MP trifocal intraocular lens (IOL) implantation in a Chinese presbyopic population without cataracts. METHODS: The study included 164 eyes from 82 patients undergoing bilateral RLE at Peking Union Medical College Hospital. Comprehensive evaluations encompassed visual acuities, refraction, ocular aberrometry, and subjective outcomes via the VF-14 questionnaire. The focus was on postoperative visual performance, refractive outcomes, safety, objective optical quality, and patient satisfaction. RESULTS: 100%, 90.2%, and 89.0% of patients achieved binocular UDVA, UNVA, and UIVA of logMAR 0.1 or better at 6 months postoperatively. 97.6% of eyes were within ± 1.00 D of emmetropia postoperatively. Optical quality assessments showed increases in modulation transfer function and Strehl ratios (p < 0.05). High-order aberrations decreased significantly (p < 0.05). Despite the high incidence of posterior capsule opacification (83.2%), managed with early Nd: YAG capsulotomy, no other severe complications were reported. Patient-reported outcomes indicated high satisfaction, with an average VF-14 score of 94.3 ± 10.2 and 93.5% achieving complete spectacle independence. Halo (66.2%) was the most commonly reported optical phenomena, followed by glare (18.2%), and starburst (7.8%) after surgery. CONCLUSIONS: Bilateral RLE with trifocal IOLs in presbyopic patients without cataracts significantly improves visual acuity and reduces ocular aberrations in presbyopic patients. The procedure offers high patient satisfaction and spectacle independence, though it requires careful patient selection and management of expectations regarding potential photic phenomena.

Comparison of Two Presbyopia-Correcting Trifocal Intraocular Lenses: A Prospective Study.

Objectives: To evaluate the clinical results of a new trifocal intraocular lens (IOL) with sinusoidal design by comparing with a traditional trifocal IOL. Materials and Methods: A total of 79 patients undergoing uneventful microincisional cataract surgery with bilateral implantation of one of two types of trifocal IOLs, the Acriva Trinova IOL (VSY) or Acrysof IQ PanOptix IOL (Alcon), were enrolled in this prospective study. Visual and refractive outcomes, contrast sensitivity (CS), and defocus curve were assessed at 3 months after surgery. Patient satisfaction and incidence of photic phenomena were also evaluated. Results: The number of patients/eyes were 48/96 in the Trinova group and 31/62 in the PanOptix group. There were no significant differences between the groups for monocular and binocular corrected/uncorrected distance or intermediate (at 60 cm) and near visual acuities (VA) postoperatively. The Trinova group had statistically significantly better intermediate VA at 80 cm than the PanOptix group (p<0.05). The CS results of both groups were within the normal limits. In the binocular defocus curve of both IOLs, we observed a peak of good VA at 0.0 diopters defocus and a useful wide range for intermediate distances. The incidence of photic phenomena in the Trinova group was lower at postoperative 1 month (p<0.05) but this difference disappeared at 3 months. A total of 47 patients (97.9%) in the Trinova group and 30 patients (96.7%) in the PanOptix group stated that they would recommend the same IOL. Conclusion: Both trifocal IOLs provide good visual quality outcomes and patient satisfaction.

Bilateral Femtosecond Laser-Assisted Clear Lens Extraction with Trifocal Intraocular Lens Implantation for Presbyopia Correction: A Short-Term Observational Study in Chinese Adults.

Purpose: To observe the outcome of bilateral femtosecond laser-assisted clear lens extraction with trifocal intraocular lens (IOL) implantation for presbyopia correction and evaluate its feasibility in early presbyopic adults. Methods: Prospective case series of eyes with clear crystalline lenses that underwent femtosecond laser-assisted lens extraction and trifocal IOL (Acrysof IQ PanOptix, Model TFNT00, Alcon) implantation between 2021 and 2023 were followed up for at least 3 months after surgery. Outcome measures included monocular uncorrected visual acuity at near (UNVA, 40 cm), intermediate (UIVA, 60 cm), and distance (UDVA, 5 m), monocular manifest refraction, corrected distance visual acuity (CDVA), defocus curve assessment, and spectacle independence at both near and distance. Results: A total of 60 eyes from 30 consecutive patients were included, and their mean age was 50.4±6.5 years. After surgery, the mean UNVA (LogMAR) increased from 0.28±0.16 to 0.08±0.07, UIVA increased from 0.25±0.12 to 0.09±0.06, and UDVA increased from 0.27±0.21 to 0.01±0.08. The enhancements of UNVA, UIVA and UDVA were all significant (P < 0.05). The optometric results showed that the mean postoperative spherical equivalent (SE) was -0.21±0.24 D, and the mean postoperative CDVA (LogMAR) was -0.00±0.06. The preoperative spectacle independences at near and distance were 46.7% (14/30) and 56.7% (17/30), respectively, and both increased to 100% at 3 months after surgery. Conclusion: Satisfactory visual outcomes and safe surgical procedures were observed in this study, which demonstrate that bilateral femtosecond laser-assisted clear lens extraction with PanOptix IOL implantation could be a feasible approach for presbyopia correction in working-age Chinese patients.

Phacoemulsification with implantation of a trifocal intraocular lens in eyes with asteroid hyalosis and synchysis scintillans.

PURPOSE: To compare the visual outcomes in both eyes of patients who undergo phacoemulsification and trifocal intraocular lens (IOL) implantation and have asteroid hyalosis (AH) or synchysis scintillans (SS) in only one eye. METHODS: A retrospective comparative case series was performed. We evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), predictability, safety, efficacy, and satisfaction after implantation of the same model of trifocal IOL in both eyes (PhysIOL FineVision Pod-F and Micro-F and Rayner RayOne Trifocal). RESULTS: A total of 164 eyes of 82 patients (41 females, 50%) met the inclusion criteria. There were no statistically significant differences in sphere, cylinder, spherical equivalent, UDVA, UIVA, or UNVA between the groups. Postoperative CDVA was slightly better in the control group (logMAR 0.03) than in the AH/SS group (logMAR 0.04) (P: 0.014). There were no statistically significant differences in predictability, safety index, or efficacy index between the groups. Overall subjective satisfaction was good (98.2%). CONCLUSIONS: Visual outcomes and satisfaction are good after implantation of trifocal IOLs in eyes with AH or SS. Therefore, trifocal IOLs should not be ruled out in these patients when no other vitreoretinal disorder is present.

Clinical performance and shape analysis of trifocal intraocular lenses via scanning electron microscopy.

BACKGROUND: To evaluate visual performance after implantation of the TFNT (Acrysof Panoptix, Alcon, Fort Worth, Texas, USA) and CNWT (Clareon Panoptix, Alcon, Fort Worth, Texas, USA) intraocular lens (IOL), and compare the lens shape observed by scanning electron microscope (SEM). METHODS: Eighteen patients (18 eyes) received implantation of the CNWT and Twenty patients (20 eyes) received implantation of the TFNT. Exclusion criteria were previous ocular surgeries, ocular pathologies, or corneal abnormalities. Intervention or Observational Procedure(s): Postoperative examination at 1 months including manifest refraction; evaluation of refractive error, distance-corrected visual acuity (DCVA) at 5 m, 1 m, 70 cm, 50 cm, 40 cm, and 30 cm, slit-lamp examination; defocus curve testing; contrast sensitivity (CS) was performed. The lens shape of the TFNT and the CNWT was examined under SEM. RESULTS: Mean spherical equivalent was 0.11 ± 0.41 D (CNWT group) and 0.12 ± 0.34 D (TFNT group) 1 month postoperation. DCVA and defocus curve showed no significant difference between the two groups. CS was significantly higher in CNWT group than TFNT group at spatial frequencies of 6 cycles per degree (cpd). Observation of the IOL with a scanning electron microscope (SEM) revealed that CNWT group had improved diffraction structure and edge processing accuracy compared to TFNT group. CONCLUSION: There was no significant difference between the two groups in the defocus curve and visual acuity at all distances. CS was better in the CNWT group than in the TFNT group. IOL surface features may affect CS.

Comparison of short-term visual acuity and visual disturbance phenomena and spectacle independence after implantation of three different intraocular lenses / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the short-term postoperative visual acuity, visual disturbance phenomena, and spectacle independence rate in patients who underwent monocular implantation with trifocal, multifocal, or extended range of vision intraocular lens(IOL).METHODS: A retrospective analysis was conducted on 67 cataract patients(67 eyes)who underwent phacoemulsification cataract extraction combined with IOL implantation from March 2019 to December 2022. A total of 35 cases(35 eyes)received Symfony extended range of vision IOL implantation, 21 cases(21 eyes)received AcrySof IQ ReSTOR +3D multifocal IOL, and 11 cases(11 eyes)received AcrySof IQ PanOptix trifocal IOL. The preoperative uncorrected distance visual acuity(UDVA), uncorrected intermediate visual acuity(UIVA), and uncorrected near visual acuity(UNVA)and 3 mo postoperatively were documented. Moreover, defocus curves, visual disturbance phenomena, and spectacle independence rates were recorded at 3 mo postoperatively.RESULTS: At 3 mo postoperatively, no statistically significant differences were observed in UDVA among the three groups(P&#x0026;#x003E;0.05). A comparison of UIVA showed superior results in the Symfony and PanOptix groups compared to the ReSTOR group(all P&#x0026;#x003C;0.01). The UNVA of both the ReSTOR and PanOptix groups outperformed the Symfony group(all P&#x0026;#x003C;0.01). The defocus curves indicated that in the intermediate vision range(-1.00 to -1.50 D), the Symfony group exhibited better performance than the ReSTOR group(P&#x0026;#x003C;0.05); while in the near vision range(-2.50 to -3.50 D), the ReSTOR group was superior to the Symfony group(P&#x0026;#x003C;0.05). The PanOptix group demonstrated superior visual acuity in the near vision range(-2.00 to -3.50 D)compared to the Symfony group(P&#x0026;#x003C;0.05)and was also superior in the intermediate vision range(-1.00 to -2.00 D)compared to the ReSTOR group(P&#x0026;#x003C;0.05). No significant differences were observed in the incidence of glare or halo and binocular interference phenomena among the three groups(P&#x0026;#x003E;0.05). The PanOptix and ReSTOR groups exhibited a higher spectacle independence rate compared to the Symfony group(P&#x0026;#x003C;0.0167).CONCLUSION: Compared to Symfony extended range of vision IOL and ReSTOR multifocal IOL, PanOptix trifocal IOL offers a balanced approach to distance, intermediate, and near visual acuity, without a high incidence of glare and halo, and with a higher spectacle independence rate. Caution is still advised when considering monocular implantation with presbyopia-correcting IOLs.

Visual and refractive outcomes after implantation of two models of trifocal intraocular lenses in eyes with previous corneal ablation to treat hyperopia.

BACKGROUND: To assess whether a trifocal intraocular lens (IOL) with neutral spherical aberration (SA) provides better visual and refractive outcomes than a trifocal IOL with negative SA after hyperopic corneal laser ablation. METHODS: This is a retrospective comparative study. Patients were classified according to the IOL implanted after cataract or clear lens phacoemulsification [group 1, PhysIOL FineVision Pod-F (negative SA); group 2, Rayner RayOne Trifocal (neutral SA)]. We evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), predictability, safety, efficacy, and satisfaction. RESULTS: 198 eyes of 119 patients met the inclusion criteria. Group 1 comprised 120 eyes and group 2 comprised 78 eyes. At completion, the refractive and predictability results were significantly better in group 1 than in group 2 for manifest refraction spherical equivalent (MRSE) (P < 0.001). Differences were not significant for UDVA (P = 0.647), CDVA (P = 0.343), UIVA (P = 0.059), UNVA (P = 0.382), binocular UIVA (P = 0.157), or binocular UNVA (P = 0.527). Safety and efficacy indices in refractive lens exchange (RLE) eyes were 0.96 and 0.91, and 0.89 and 0.93 in groups 1 and 2, respectively (P = 0.254 and 0.168). Patient satisfaction was similar in both groups (P > 0.05, all items). CONCLUSION: In eyes previously treated with hyperopic corneal ablation, implantation of a trifocal IOL with neutral SA provided better efficacy and safety outcomes but worse predictability outcomes than those obtained with a trifocal model with negative SA.

Clinical outcomes in eyes with diffractive continuous depth-of-focus intraocular lenses enhanced for near vision: comparison with trifocal intraocular lenses.

BACKGROUND: To prospectively evaluate visual functions and patient satisfaction after bilateral implantation of diffractive continuous depth-of-focus intraocular lens (CDF IOL) compared with trifocal IOLs. METHODS: This investigator-initiated study was approved by a certified local review board (registered: jRCTs032210305). CDF IOL (Synergy, J&J, group S) and trifocal IOL (AcrySof PanOptix, Alcon, group P) were implanted bilaterally in 30 patients each. Three months postoperatively, binocular outcomes of uncorrected (BUCVA) and distance-corrected (BDCVA) visual acuities at distances of 0.3, 0.4, 0.5, 0.7, and 5 m were measured. Contrast sensitivities were binocularly measured using CSV-1000 (2.5 m) and Pelli-Robson charts at distances of 0.4 and 1 m. Symptoms of glare, halo, starburst, and waxy vision, and satisfaction for near, intermediate, and far visions were assessed with questionnaires. Differences between the two groups were examined. RESULTS: Twenty-seven patients each completed the follow-up. The mean age of the group S was lower than that of the group P (P < 0.001). The BUCVA at 0.4 m was better in the S group, while the mean manifest refraction of the P group showed a significant hyperopic shift (P < 0.001). BDCVA was significantly better in the S group. The contrast sensitivity results at three distances showed no discernible differences. Although more patients in the S group reported significant glare and halo, their satisfaction with near vision was higher. CONCLUSIONS: The binocular visual function of patients with CDF IOLs was comparable to or better than that of patients with trifocal IOLs. The patients were satisfied with near vision, despite the enhanced glare and halo. Understanding the differences between the two types of presbyopia-correcting IOLs is important to ensure patient satisfaction. TRIAL REGISTRATION: This clinical trial was registered in the Japan Registry for Clinical Research (identifier: jRCTs032210305) on September 13, 2021.

Visual results and subjective satisfaction after implantation of two different trifocal diffractive intraocular lenses models (AcrySof IQ PanOptix and AT LISA tri 839 MP).

BACKGROUND: This study aimed to compare visual results following the implantation of two distinct diffractive trifocal IOLs utilizing various vision evaluation techniques and subjective satisfaction. METHODS: The study included 32 eyes receiving AcrySof IQ PanOptix implantation and 32 receiving AT LISA tri 839 MP. Post-operative examination at one year included uncorrected visual acuity (UCVA), distance-corrected visual acuity (DCVA) at 4 m, 80 cm, 60 cm, and 40 cm, Contrast sensitivity under photopic and mesopic conditions, and a questionnaire on subjective quality of vision, optical phenomena, and spectacle independence. RESULTS: The two groups were similar in baseline demographics, pre-operative visual, biometric data (except for axial length), and surgical paraments. The PanOptix outperformed the AT LISA tri in the intermediate range when using the standard visual acuity testing (UCVA: 0.23 ± 0.14 logMAR vs. 0.31 ± 0.17 logMAR, p = 0.04; BCVA: 0.21 ± 0.12 vs. 0.28 ± 0.14, p = 0.03) and in the intermediate and far range when using the interactive computer program (intermediate: UNVA "E" optotype test: 0.05 ± 0.12 vs. 0.12 ± 0.13, p = 0.03; Far: UNVA "E" optotype: 0.07 ± 0.12 vs. 0.13 ± 0.10, p = 0.05). In addition, the PanOptix group had higher contrast sensitivity under photopic and mesopic conditions with and without glare at all spatial frequencies. There was no difference in subjective outcomes between the groups. CONCLUSIONS: Patients who received PanOptix IOL had better visual outcomes for intermediate and far with higher contrast sensitivity under various conditions. Based on patients ' needs and demands, these results could support discussion when tailoring the optimal multifocal IOl.

Randomised placebo-controlled clinical trial evaluating the impact of a new visual rehabilitation program on neuroadaptation in patients implanted with trifocal intraocular lenses.

PURPOSE: To evaluate the efficacy of a new visual training program for improving the visual function in patients implanted with trifocal intraocular lenses (IOLs). METHODS: Randomised placebo-controlled clinical trial enrolling 60 subjects (age, 47-75 years) undergoing cataract surgery with implantation of trifocal diffractive IOL. Home-based active visual training was prescribed immediately after surgery to all of them (20 sessions, 30 min): 31 subjects using a serious game based on Gabor patches (study group) and 29 using a placebo software (placebo group). Visual acuity, contrast sensitivity (CS), and perception of visual disturbances (QoV questionnaire) were evaluated before and after training. Likewise, in a small subgroup, resting-state functional magnetic resonance imaging (rs-fMRI) analysis was performed. RESULTS: No significant differences were found between groups in compliance time (p = 0.70). After training, only significant improvements in monocular uncorrected intermediate visual acuity were found in the study group (p ≤ 0.01), although differences between groups did not reach statistical significance (p ≥ 0.11). Likewise, significantly better binocular far CS values were found in the study group for the spatial frequencies of 6 (p = 0.01) and 12 cpd (p = 0.03). More visual symptoms of the QoV questionnaire experienced a significant change in the level of bothersomeness in the study group. Rs-fMRI revealed the presence significant changes reflecting higher functional connectivity after the training with the serious game. CONCLUSIONS: A 3-week visual training program based on the use of Gabor patches after bilateral implantation of trifocal diffractive IOLs may be beneficial for optimising the visual function, with neural changes associated suggesting an acceleration of neuroadaptation. Trial registration ClinicalTrials.gov, NCT04985097. Registered 02 August 2021, https://clinicaltrials.gov/(NCT04985097 ).

Comparison of Five Presbyopia-Correcting Intraocular Lenses: Optical-Bench Assessment with Visual-Quality Simulation.

Presbyopia correction through implantation of a trifocal intraocular lens (IOL) is a modality offered to both cataract and refractive-lens exchange patients. To maximize postoperative satisfaction, IOL selection needs to be made based on patients' requirements aligned with the available technology. Five Trifocal IOLs were assessed in this study, and their differentiating features were identified: Triumf POD L GF, AT Lisa Tri, Tecnis Synergy, AcrySof IQ PanOptix, and Acriva Trinova Pro C. The optical quality was assessed using the modulation-transfer-function principle. Simulated defocus curves were derived from a non-linear formula. Far-focus simulated visual acuity (simVA) was 0.03 logMAR or better for all the studied IOLs, showing minimal differences. However, each IOL's intermediate focus position differed across a range from 61 cm to 80 cm; and for the near focus, it was 36 cm to 44 cm. Triumf demonstrated improved intermediate point at the expense of the near focus resulting in a lower predicted near VA. PanOptix exhibited the shortest range of vision without a clear distinction between intermediate and near-point. The remaining lenses presented three foci of comparable optical quality and, thus, simVA performance. Each model, however, revealed a different aperture-change response. Trinova function improved at intermediate but was worse at near for larger pupils. The opposite was observed for AT Lisa. Synergy's optical quality change was predominantly associated with lower pupil diameter. In conclusion, the trifocal IOLs can be differentiated according to their secondary-foci position, light-energy distribution, and pupil-size-related behavior. The observed differences may translate directly into a clinical effect showing that the trifocal IOLs vary in their ability to deliver optimal vision at different distances, with some providing improved intermediate while others favor reading distance. The knowledge gained through this objective testing can support IOL selection, postoperative patient counselling and increase the chance of spectacle independence after surgery.

Visual and patient-reported outcomes of a diffractive trifocal intraocular lens in highly myopic eyes: a prospective multicenter study.

BACKGROUND: To investigate the visual and patient-reported outcomes of a diffractive trifocal intraocular lens (IOL) in highly myopic eyes. METHODS: Patients with planned cataract removal by phacoemulsification and implantation of a trifocal IOL (AT LISA tri 839MP) were enrolled in the prospective, multicenter cohort study. Patients were allocated into three groups according to their axial length (AL): control group, AL < 26 mm; high myopia group, AL 26-28 mm; extreme myopia group, AL ≥ 28 mm. At 3 months post-surgery, data for 456 eyes of 456 patients were collected, including visual acuity, defocus curve, contrast sensitivity (CS), visual quality, spectacle independence, and overall satisfaction. RESULTS: After surgery, the uncorrected distance visual acuity improved from 0.59 ± 0.41 to 0.06 ± 0.12 logMAR (P < 0.001). In all three groups, about 60% of eyes achieved uncorrected near and intermediate visual acuity of 0.10 logMAR or better, but significantly fewer eyes in the extreme myopia group achieved uncorrected distance visual acuity of 0.10 logMAR or better (P < 0.05). Defocus curves revealed that the visual acuity was significantly worse in the extreme myopia group than others at 0.00, - 0.50, and - 2.00 diopters (P < 0.05). CS did not differ between the control and high myopia groups but was significantly lower in the extreme myopia group at 3 cycles per degree. The extreme myopia group also had greater higher-order aberrations and coma, lower modulation transfer functions and VF-14 scores, more glare and halos, worse spectacle independence at far distance, and consequently lower patient satisfaction than others (all P < 0.05). CONCLUSIONS: In eyes with a high degree of myopia (AL < 28 mm), trifocal IOLs have been shown to provide similar visual outcomes to those in non-myopic eyes. However, in extremely myopic eyes, acceptable results may be obtained with trifocal IOLs, but a reduced level of uncorrected distance vision is expected.

Evaluation of Life Quality of Patients Submitted to Cataract Surgery with Implantation of Trifocal Intraocular Lenses.

This study aimed to evaluate the quality of life and the satisfaction level of Brazilian and Chinese patients who underwent cataract surgery for Acysof IQ PanOptix Model TFNT00 (Alcon Laboratories, Fort Worth, TX, USA) implantation. This retrospective study enrolled 51 patients from China and 51 patients from Brazil. At the 3-month follow-up, uncorrected distance visual acuity (UDVA) at 5 m, uncorrected intermediate visual acuity (UIVA) at 60 cm, and uncorrected near visual acuity (UNVA) at 40 cm were evaluated; Catquest 9SF and the Near Activity Visual Questionnaire (NAVQ) were administered to the patients. The results revealed that the Brazilian patients gained better UDVA and UNVA (p < 0.001), while the Chinese patients gained better UIVA (p = 0.001). With regards to the patients' overall satisfaction with their current vision, the Brazilian patients scored higher (p = 0.002). In situations related to distant and near vision, the Brazilian patients scored higher, while in situations related to intermediate vision, the Chinese patients scored higher. No differences were found between the gender or age subgroups, but the normal axial length (AL) subgroup showed the highest level of satisfaction (p = 0.002). The patients implanted with TFNT00 IOL obtained excellent objective and subjective outcomes in both cultures. The Brazilian patients showed higher satisfaction with their distant and near vision, while the Chinese patients were more satisfied with their intermediate vision.

Visual Outcomes With Intraocular Trifocal Lens Implant.

BACKGROUND: Cataract surgery has become one of the most common surgeries in the world with one in every four surgeries performed being a cataract extraction and the numbers are expected to increase by 16 percent in the USA alone by 2024 as compared to the current statistics. The aim of the study is to analyze the visual outcomes of intraocular lens implants for various visual ranges. METHODS: This non-comparative interventional study was conducted at the Ophthalmology department of Al Ehsan Eye Hospital from Jan to Dec 2021. It included patients who underwent uneventful phacoemulsification with an intraocular lens implant and analysis of the visual outcomes for uncorrected distance (UDVA), uncorrected intermediate distance (UIVA), and uncorrected near distance (UNVA). RESULTS: Independent sample t-test was applied to observe the mean values of recorded far vision on the 1stday, 1 week, and 1 month after the trifocal intraocular lens implantation. It showed a significant difference with a p-value of 0.00 on 1st day, 1 week, and 1 month after was 0.3±0.1, 0.17±0.09, and 0.14±0.08 respectively. Mean improvement in near vision after 1 month was N6 with S.D 1.03 and in intermediate vision was N8±1.4 respectively. CONCLUSIONS: Trifocal Intraocular lens implantation offers an improved vision for near, intermediate, and distant visual ranges without the need for correction.

Analysis of the quality and reliability of trifocal intraocular lens videos on YouTube.

OBJECTIVE: This study analyzed the quality and reliability of videos on YouTube as educational resources on trifocal intraocular lenses (IOL). METHODS: This study is a retrospective, cross-sectional and record-based study. An online YouTube search was performed using the terms "trifocal lens implants" and "trifocal IOL," and a total of 229 videos were recorded. Eighty-six videos that met the study criteria were included. All videos were evaluated with DISCERN, Journal of the American Medical Association (JAMA), and Global Quality Score (GQS) scores. RESULTS: The mean DISCERN, JAMA, and GQS scores were 37.79±11.92, 2.01±0.87, and 2.17±1.01, respectively. Of all the videos, 39 (45%) were uploaded by physicians, and 47 (55%) were uploaded by non-physicians. While the length of the videos (length) was significantly greater in the physician group (P=0.02), the age of the videos (age) was significantly higher in the non-physician group (P=0.02). However, the differences between the two groups in terms of other general characteristics, DISCERN, JAMA and GQS scores were not significant. CONCLUSIONS: Our finding suggests that trifocal IOL-related YouTube™ videos are of low quality and reliability, thus inadequate for patient information.

Clinical efficacy of femtosecond laser-assisted cataract surgery combined with PanOptix trifocal intraocular lens implantation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the clinical efficacy of femtosecond laser-assisted cataract surgery combined with PanOptix trifocal intraocular lens implantation.METHODS:The retrospective study enrolled 22 cases(26 eyes)of cataract patients who underwent femtosecond laser-assisted cataract surgery combined with PanOptix trifocal intraocular lens implantation from August 2020 to August 2021. Follow-up to 3mo after surgery, the changes of far, intermediate and near visual acuity, aberration, Strehl ratio(SR)and modulation transfer function cutoff(MTF-cutoff)frequency were compared. Defocus curve at 1mo postoperatively was made, and the visual quality and satisfaction were evaluated after 3mo of surgery.RESULTS: The visual acuity of all patients was better than 0.1(LogMAR)at the far, intermediate and near distance at 1d, 1wk, 1 and 3mo postoperatively, and it was significantly improved compared with those before surgery(all P&#x0026;#x003C;0.01). The defocus curve transitioned smoothly between +0.5 and -3.0D at 1mo after surgery, and visual acuity was better than 0.63. The total aberration and spherical aberration in the whole eye were significantly lower after surgery than before, and the SR and MTF-cutoff were significantly improved at 1d and 1wk after surgery(all P&#x0026;#x003C;0.05). With high satisfaction and good visual quality, patients could watch at far, intermediate and near distance without wearing glasses at 3mo after surgery.CONCLUSION: Femtosecond laser-assisted cataract surgery combined with PanOptix trifocal intraocular lens implantation gave patients a comfortable and satisfactory full-course vision.

Stereopsis and visual acuity: Bilateral trifocal versus blended extended depth of focus and diffractive bifocal intraocular lenses.

Purpose: To compare stereopsis and visual acuity (VA) between bilateral implantation of trifocal intraocular lenses (IOL) and blended implantation of an extended depth of focus (EDOF) IOL with a bifocal IOL. Methods: This is a non-randomized, prospective comparative study included 74 eyes of 37 patients who underwent phacoemulsification and bilateral implantation of AT LISA tri 839MP IOL (bilateral group; 21 patients) or blended implantation of Tecnis Symfony ZXR00 and Tecnis ZLB00 IOL (blended group; 16 patients). The primary outcomes were stereoacuity and binocular VA. The secondary outcomes were visual defocus curve, quality of life, and patient satisfaction. Follow-up was performed 3 months after the surgery. Results: The mean near stereoacuity was 49.76 ± 22.67 and 120.63 ± 90.94 seconds of arc (arcsec) in the bilateral and blended groups, respectively (P < 0.001). Near stereoacuity was positively correlated with VA difference of two eyes (r = 0.896, P < 0.001). The mean binocular uncorrected visual acuity at 40 cm, 80 cm, 5 m, and corrected distance visual acuity at 5 m of the bilateral and blended groups was not statistically significant different. The bilateral group had better VA at a vergence from -2.5 to -4.0 D. Both groups obtained high quality of life and patient satisfaction scores. Conclusion: The bilateral and blended groups achieved good binocular VA, quality of life, and high patient satisfaction. However, the near stereoacuity of the blended group was worse.