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.

Observation on the tilt and decentration of multifocal intraocular lens with optic capture in Berger space for pediatric cataract.

PURPOSE: This study aimed to observe the tilt and decentration of multifocal intraocular lens (IOL) with optic capture in Berger space within 2 years after pediatric cataract surgery. METHODS: This is a prospective observational study. The implantation of multifocal IOL (Tecnis ZMB00) with optic capture in Berger space was performed on 33 patients (48 eyes) with pediatric cataract at Qingdao Eye Hospital. Tilt and decentration of IOL was measured using Scheimpflug system (Pentacam) at 1 month and 2 years postoperatively. RESULTS: All the multifocal IOLs were successfully implanted in Berger space with optic capture and no visually significant complications were detected during the follow-up. The mean tilt of IOLs was 2.779° ± 0.950° in the vertical plane and 2.399° ± 0.898° in the horizontal plane at 1 month postoperatively, and the mean length of the decentration was 0.207 ± 0.081 mm in vertical plane and 0.211 ± 0.090 mm in the horizontal plane. Compared with 1 month after surgery, the angle of tilt decreased by a mean of 0.192° and decentration increased by a mean of 0.014 mm at the vertical meridian at 2 years postoperatively (P = 0.37 and P = 0.27, respectively), meanwhile, tilt increased by 0.265° and decentration increased by 0.012 mm at the horizontal meridian (P = 0.11 and P = 0.22, respectively). CONCLUSIONS: The follow-up results suggest the tilt and decentration of multifocal IOL implantation with optic capture in Berger space remain stable in an acceptable range within 2 years after cataract surgery in children above the age of 5. TRIAL REGISTRATION: The study was approved by the Ethics Committee of Qingdao Eye Hospital, and registered on Chinese Clinical Trial Registry (ChiCTR identifier: 1900023155).

Influence of corneal astigmatism on near and far vision in eyes with bifocal intraocular lenses.

Here, we present a full wave propagation model that quantitatively assesses the effect of astigmatism on visual functions in eyes with diffractive bifocal IOLs. The proposed model with bifocal IOLs evaluated the image quality of each focus at varying degrees of corneal astigmatism with the metrics of modulation transfer function and light-in-the-bucket. The results show that corneal astigmatism alters the distance-near image quality balance. Positive (negative) astigmatism has more detrimental effects on far (near) vision. Additionally, bifocal IOLs are more vulnerable to corneal astigmatism, highlighting the need to consider multifocal toric IOLs with astigmatism greater than 1.0 D. The numerical results closely agreed with previous relevant clinical findings, suggesting the clinical usability of the presented method in predicting the postoperative visual function of patients.

Comparison of short-term clinical outcomes of a diffractive trifocal intraocular lens with phacoemulsification and femtosecond laser assisted cataract surgery.

PURPOSE: To evaluate short-term visual and refractive outcomes after implantation of a diffractive trifocal intraocular lens (IOL) in cataract patients with phacoemulsification (PHACO) and femtosecond laser assisted cataract surgery (FLACS). SETTING: Department of Ophthalmology, Shanghai Aier Eye Hospital, China. DESIGN: A retrospective, observational study. METHODS: Patients who underwent cataract surgery combined with Acrysoft IQ PanOptix trifocal IOL implantation were enrolled and divided into three groups: PHACO group, LAstig-FLACS group (astigmatism less then 1D) and HAstig-FLACS group (astigmatism more than 1D). Logarithm of the minimum angle of resolution (logMAR) visual acuity of uncorrected distance (UDVA), intermediate (UIVA), near visual (UNVA), defocus curve, surgically induced astigmatism (SIA) were evaluated in 1 months postoperatively and wavefront aberrations were evaluated in 6 months. RESULTS: 101 eyes of 60 patients were included with 31 eyes in PHACO group, 45 eyes in LAstig-FLACS group and 25 eyes in HAstig-FLACS group. Significant difference was found of internal Strehl Ratio (SR) between PHACO and LAstig-FLACS group (P = 0.026). In PHACO group, 79.31%, 86.21%, 72.41% of eyes gain visual acuity LogMAR 0.1 or more in UDVA, UIVA and UNVA, while 83.72%, 93.02%, 93.02% of those in LAstig-FLACS group and 92.00%, 84.00%, 76.00% in HAstig-FLACS group. CONCLUSIONS: Panoptix diffractive trifocal IOL provides satisfied visual outcome in no matter FLACS or PHACO. Besides, trifocal IOL implantation via FLACS can provide a better accumulative visual acuity outcome at all distance than PHACO in 1 month. Femtosecond laser assisted limbal relaxing incisions (FLLRIs) is an excellent way to reduce a patient's corneal astigmatism.

Comparison of the formula accuracy for calculating multifocal intraocular lens power: a single center retrospective study in Korean patients.

This study evaluated the accuracy of newer formulas (Barrett Universal II, EVO 2.0, Kane, Hoffer QST, and PEARL-DGS) and the Haigis formula in Korean patients with the Alcon TFNT multifocal intraocular lens. In total, 3100 randomly selected eyes of 3100 patients were retrospectively reviewed. After constant optimization, the standard deviation (SD) of the prediction error was assessed for the entire group, and the root mean square error was compared for short and long axial length (AL) subgroup analysis. The Cooke-modified AL (CMAL) was experimentally applied to the Haigis formula. All the newer formulas performed well, but they did not significantly outperform the Haigis formula. In addition, all the newer formulas exhibited significant myopic outcomes (- 0.23 to - 0.29 diopters) in long eyes. Application of the CMAL to the Haigis formula with single constant optimization produced similar behavior and higher correlation with the newer formulas. The CMAL-applied triple-optimized Haigis formula yielded a substantially smaller SD, even superior to the Barrett and Hoffer QST formulas. The AL modification algorithms such as the CMAL used in newer formulas to cope with optical biometry's overestimation of the AL in long eyes seemed to overcompensate, particularly in the long eyes of the East Asian population.

Pupil versus 1st Purkinje capsulotomy centration with femtosecond laser: Long term outcomes with a sinusoidal trifocal lens.

PURPOSE: To assess the role of femtosecond laser-assisted capsulotomy centration in the long-term intraocular positioning of a multifocal intraocular lens. DESIGN: Prospective comparative study. METHODS: A total of 60 eyes of 30 patients underwent femtosecond laser-assisted Refractive Lens Exchange (RLE). For every patient, capsulotomy centration was randomly performed according to pupil centre (PC) in one eye and first Purkinje reflex (FPR) in the other. The intraocular lens (IOL) positioning, visual acuities, spherical equivalent, internal aberrometry and quality of vision were assessed and compared at 3 years' follow-up between groups (PC and FPR). RESULTS: Intraocular lens positioning showed a statistically significant difference between groups, with a closer centration to the visual axis in the FPR patients (p < 0.001). Internal aberrometry showed higher values in the PC capsulotomy centration group (p < 0.01). CONCLUSIONS: FPR centered capsulotomy is associated to a closer centration of the IOL to the visual axis.

Long-term Prevalence of Opacification of a Hydrophylic Acrylic Rotationally Asymmetric Refractive Multifocal Intraocular Lens.

PURPOSE: To determine the prevalence of opacification of a hydrophylic intraocular lens (IOL) with hydrophobic coverage and the percentage of explantations required, determining possible risk factors associated with these opacifications. METHODS: This ambispective study enrolled 575 eyes of 296 patients (age 36 to 87 years) that underwent cataract surgery between 2010 and 2017 with implantation of different models of Lentis Mplus IOLs: LS-312-MF30, LS-313-MF15, LS-313-MF30, LU-313-MF30, and LU-313-MF30T (Oculentis GmbH). Visual, refractive, and slit-lamp biomicroscopic changes were evaluated in a long-term follow-up. The percentage of cases with IOL opacification and the percentage of cases in which IOL explantation was required due to such opacifications were calculated at each visit. Five of the explanted IOLs from this series could be analyzed by scanning electron microscopy (SEM-EDX). RESULTS: IOL opacification developed in 63 eyes (11.0%). With 95% confidence, the prevalence of IOL opacification was between 842 and 1,401 cases per 10,000 eyes. The time elapsed between surgery and the presence of IOL opacification ranged between 0 and 9.3 years (mean: 4.7 ± 2.2 years). No significant differences in terms of IOL opacification rate were found according to gender (P = .378). No significant differences were found in arterial hypertension, diabetes, hypothyroidism, or hyperthyroidism rates between eyes with or without IOL opacification (P ≥ .053). IOL explantation was needed in 9 eyes (1.57%). SEM-EDX analysis confirmed the presence of rough areas on the IOL surface containing different components, such as calcium, phosphorous, copper, or nitrogen. CONCLUSIONS: The prevalence of opacification with time in Lentis Mplus IOLs is high, with no systemic risk factors associated with this complication, suggesting that it may be attributable to the material and/or the manufacturing process. [J Refract Surg. 2024;40(2):e98-e107.].

Screening of positive dysphotopsia before multifocal intraocular lens implantation.

PURPOSE: To assess the photic phenomena (PP) and positive dysphotopsia in candidates for presbyopia or cataract surgery and to evaluate their relationship with cataract grading systems. DESIGN: Retrospective observational. METHODS: Monocular data for 82 subjects measured during the preoperative screening were retrospectively retrieved from our database. The evaluated variables consisted of two methods for PP measurement: light distortion index (LDI) and parameters obtained from a simulator, both of which were combined with subjective bother related to PP. The cutoff for LDI that better predicted patients passing from slightly to moderately bothersome was estimated. The relationships between LDI and the following objective cataract grading methods were also assessed: objective scatter index (OSI), dysfunctional lens index (DLI), and Pentacam Nucleus Staging (PNS). RESULTS: LDI was the best method for measuring PP, which showed a significant correlation with the bothersome question (rho = 0.34, P = 0.002) and also with OSI (rho = 0.67, P < 0.0005), DLI (rho = -0.29, P = 0.007), and PNS (rho = 0.48, P < 0.0005). The number/percentage of patients who found it bothersome was as follows: "Not at all" (18/22%), "Slightly" (41/50%), "Moderately" (15/18.3%), and "Very" (8/9.7%). The cutoff value that predicted the transition from slightly to moderately bothersome was ≥15.20% according to LDI, which could be estimated with the following values for grading: ≥2.8 for OSI, ≤7.6 for DLI, and ≥2 for PNS. CONCLUSIONS: Patients reporting moderately or higher bothersome levels in the preoperative period and with LDI <15.20%, <2.8 for OSI, >7.6 for DLI, and <2 for PNS might deserve special attention in the multifocal intraocular lens selection.

Chord mu and chord alpha as postoperative predictors in multifocal intraocular lens implantation.

PURPOSE: With the aging population, the prevalence of presbyopia and the popularity of multifocal intraocular lenses is also growing worldwide. Unfortunately, in some cases, they are still associated with postoperative visual disturbances. Recent literature started to evaluate angle kappa- and angle alpha-derived metrics of chord mu and chord alpha as possible predictive values for visual outcomes after multifocal intraocular lens implantation but the published results are inconsistent between studies. Thus, this article aims to review the role of chord mu and chord alpha as postoperative predictors after multifocal intraocular lens implantation and lay the foundation for further research. METHODS: Relevant articles were identified using the following keywords: "presbyopia," "multifocal intraocular lens," "angle kappa," "angle alpha," "Chord mu," and "Chord alpha" up to June 2022. An attempt was made to present the majority of publications that addressed the topic. CONCLUSIONS: Chord mu and chord alpha have a predictive role on the outcomes after multifocal intraocular lens implantation but to a different extent. Cataract surgeons should take them into consideration and avoid implanting a multifocal intraocular lens for patients with speculated critical values of chord mu and alpha above 0.5-0.6 mm, depending on the device used for measurement and the multifocal intraocular lens implanted. Currently, chord alpha seems to be a more stable, more widely applicable, and reliable determinant in predicting postoperative outcomes and in patient selection prior to multifocal intraocular lens implantation when compared to chord mu. To draw conclusions on the topic, a controlled study is needed.

The influence of personality on the quality of vision after multifocal intraocular lens implantation.

OBJECTIVE: To assess the possible correlation between patients' personality traits and subjective perception of quality of vision (QoV), after multifocal intraocular lens (mIOL) implantation. METHODS: patients who had bilateral implantation of a non-diffractive X-WAVE or a trifocal lens were assessed 6 months postoperatively. Patients answered the NEO-Five Factor Inventory (NEO-FFI-20) questionnaire ("Big Five five-factor personality model") to examine their personality. Six months following surgery, patients were asked to fill a QoV questionnaire where they graded the frequency of 10 common visual symptoms. Primary outcomes were to evaluate the correlation between personality scores and the reported frequency of visual disturbances. RESULTS: The study comprised 20 patients submitted to bilateral cataract surgery, 10 with a non-diffractive X-WAVE lens (AcrySof® IQ Vivity) and 10 with a trifocal lens (AcrySof® IQ PanOptix). Mean age was 60.23 (7.06) years. Six months following surgery, patients with lower scores of conscientiousness and extroversion reported a higher frequency of visual disturbances (blurred vision, P = .015 and P = .009, seeing double images P = .018 and P = .006, and having difficulties focusing, P = .027 and P = .022, respectively). In addition, patients with high neuroticism scores had more difficulty focusing (P = .033). CONCLUSIONS: In this study, personality traits such as low conscientiousness and extroversion and high neuroticism significantly influenced QoV perception 6 months after bilateral multifocal lens implantation. Patients' personality questionnaires could be a useful preoperative assessment test to a mIOL.

Multifocal intraocular lens implantation in children with unilateral congenital cataracts.

PURPOSE: To evaluate the vision recovery, reconstruction of binocular visual function, and influencing factors after multifocal intraocular lens implantation in children with unilateral congenital cataracts. SETTING: University hospital. DESIGN: Prospective clinical study. METHODS: In the prospective clinical study, 55 children aged 3 to 14 with unilateral congenital cataracts received multifocal intraocular lenses (TECNIS ZMB00) posterior optic capture from 2019 to 2022. Corrected distance visual acuity (CDVA; 5 m), distance-corrected intermediate visual acuity (DCIVA; 66 cm), distance-corrected near visual acuity (DCNVA; 33 cm), stereoscopic vision, visual quality (objective scatter index [OSI] and modulation transfer function [MTF]), axial length (AL), keratometry (K), and contrast sensitivity (CS), as well as postoperative occlusion compliance were evaluated before and after surgery. RESULTS: At the final follow-up, 90.91% (50/55) patients showed significant improvement in visual acuity (VA) after surgery. CDVA, DCIVA and DCNVA were 0.23 ± 0.17, 0.39 ± 0.15, and 0.44 ± 0.15 logMAR, respectively. 69.09% (38/55) patients achieved good VA (better than 0.3 logMAR).52.76% (25/48) patients had a positive Titmus test. OSI and MTF were 1.24 ± 0.91 and 42.45 ± 12.30, respectively. 73.68% (28/38) of the patients (better than 0.3 logMAR) underwent strict occlusion therapy. Postoperative VA is correlated with preoperative CDVA ( r = -0.829, P < .001), corneal astigmatism ( r = 0.384, P = .036), △AL (difference between the cataract eyes and contralateral eyes, r = -0.490, P = .006), and occlusion compliance ( r = -0.806, P < .001). CONCLUSIONS: Multifocal intraocular lens implantation could obtain relatively satisfactory VA (CDVA, DCIVA and DCNVA) and the binocular visual function of children with unilateral congenital cataracts. Postoperative VA is related to preoperative VA, corneal astigmatism, △AL, and occlusion compliance.

Illumination levels in commonly used ophthalmic devices.

Pupil diameter is a key parameter for corneal and multifocal intraocular lens surgery. Many devices are dedicated to measure the pupil size, but do not specify the illumination during capture. The aim of this study was to present illumination levels in routinely used ophthalmic devices which present pupil sizes. To obtain measurements, the lux meter was placed in the chin rest in the corneal plane and the room was completely dimmed. Ten measurements were taken for each device. The illumination levels for white and red Placido disk corneal topographers were 1253.1 ± 0.2 and 329.0 ± 0.2 lux, respectively (both photopic conditions). Scheimpflug corneal tomography should be considered as a mesopic measurement (14.5 ± 0.1 lux). Optical coherence tomography and autorefractometry are scotopic measurements (0.4-0.6 lux). We postulate that producers should provide illumination levels of their devices measuring pupil size. Moreover, when mentioning a pupil size, one should consider presenting to what lighting conditions it refers to.

Association of Patient Satisfaction with Cataract Grading in Five Types of Multifocal IOLs.

INTRODUCTION: This study investigated patient satisfaction levels in five premium intraocular lenses (IOLs). A secondary aim was to determine whether patient satisfaction was associated with the cataract grade before lens surgery. METHODS: In this multicenter prospective comparative study, 164 patients from diverse backgrounds underwent cataract surgery and were assigned for identical bilateral implantation of multifocal IOLs. In addition to visual performance, quality of life was measured using the National Eye Institute Refractive Error Quality Of Life Instrument (NEI-RQL 42) scoring questionnaire. The Sirius Scheimpflug Analyzer was used to evaluate the posterior cornea and aberrations. Finally, the association of patient satisfaction reports with the Pentacam Cataract Grading Scale (PCGS) and Lens Opacities Classification System (LOCS III) was evaluated. RESULTS: A considerable subjective improvement was observed in uncorrected far, near (40 cm), and intermediate (60 cm) visual acuity in the five groups (P values < 0.001). A significant difference was observed in mesopic and photopic contrast sensitivity between Symfony, Trinova, and AT LISA at the spatial frequency of 12 cycles per degree, favoring Symfony (P < 0.001). PanOptix users had considerably lower mean coma values (P < 0.001), while AT LISA users had lower mean spherical aberrations (P = 0.009) compared to the other groups. No additional safety concerns relating to IOLs were recorded. Mean satisfaction had a high correlation with LOCS and Pentacam Nuclear Staging (PNS) in each lens group, e.g., correlation coefficient and P value for AT LISA were respectively r = 0.99, P < 0.001 and r = 0.97, P = 0.004. CONCLUSION: Despite discrepancies between groups of lenses, most patients who received multifocal IOLs reported satisfaction at more than 3 years after the initial operation. A growing number of patients with cataracts are seeking spectacle-free vision with presbyopia-correcting IOLs. Hence, the high satisfaction rate among patients with cataract could indicate the value of offering a wider range of available lenses.

Outcomes and predictive factors in multifocal and extended depth of focus intraocular lens implantation.

PURPOSE OF REVIEW: Options for addressing presbyopia with intraocular lens (IOL) implantation have become more varied and sophisticated. We reviewed recent literature on multifocal and extended depth of focus (EDOF) IOLs in order to provide insight on their respective advantages, with emphasis on the visual outcomes of each design. RECENT FINDINGS: Increased patient age, spectral domain optical coherence tomography (SD-OCT) abnormalities, abnormal optical axis measurements, and better preoperative visual acuity have been implicated as predictors of worse postoperative vision or visual quality in multifocal IOLs. Despite differences in objective outcomes, patient-reported outcomes such as satisfaction are consistently similar between multifocal and EDOF IOLs. EDOFs may have slightly lower rates of spectacle independence than trifocals, but there is more support for their use in the setting of with other ocular conditions. SUMMARY: Multifocal and EDOF IOLs are both viable options for patients who wish to preserve near vision. Given their similar objective performance in many aspects, enabling patients to make informed decisions based on their expectations and visual requirements is critical to postoperative satisfaction. Evidence for advanced technology IOL implantation in pediatric patients remains inconclusive.

Complications of foldable intraocular lenses requiring explantation or secondary intervention: 2022 survey with update of long-term trends.

PURPOSE: To assess the complications that resulted in the explantation or secondary intervention with foldable intraocular lenses (IOLs). SETTING: University setting, Salt Lake City, Utah. DESIGN: Survey study. METHODS: For the 25th consecutive year, surgeons were surveyed regarding complications associated with foldable IOLs requiring explantation or secondary intervention over the 2022 calendar year. These forms were made available online using the ASCRS and ESCRS websites and a fax-on-demand service. Surgeons completed 1 survey for each foldable IOL requiring explantation or secondary intervention. Further analysis determined complication trends related to specific IOL styles, materials, and types over the past 16 years (2007 to 2022). RESULTS: 103 completed surveys were returned in 2022 contributing to a total of 1627 tabulated surveys since 2007. In the 2022 survey, dislocation/decentration continued to be the most common complication overall. Glare/optical aberrations was a common complication associated with multifocal IOLs continuing a 16-year trend. In addition, hydrophilic acrylic IOLs as well as some silicone lenses in eyes with asteroid hyalosis demonstrated calcification as the most common complication necessitating explantation. CONCLUSIONS: Dislocation/decentration remains the leading cause of explantation in most IOL types. Glare/optical aberrations continue to be an associated complication of multifocal IOLs suggesting this ongoing issue has yet to be resolved with this type of IOL. In addition, calcification of hydrophilic acrylic lenses and silicone lenses is a rare event but continues to occur.

Impact of posterior vitreous detachment on visual acuity after the implantation of a diffractive multifocal intraocular lens.

PURPOSE: To investigate the effect of posterior vitreous detachment (PVD) on visual acuity (VA) after implantation of a diffractive multifocal intraocular lens (mIOL). SETTING: Eye Clinic, Okayama, Japan. DESIGN: Retrospective case series. METHODS: This study evaluated 475 eyes of 475 patients who underwent cataract surgery with a TECNIS Multifocal ZLB00 lens implant between November 2017 and October 2019. Patient eyes were classified into the complete PVD group (PVD group) or the control group with no PVD/partial PVD (non-PVD group) and divided into 3 age categories: 65 to 69, 70 to 74, and 75 to 79 years. The postoperative VA of the PVD and non-PVD groups was compared between and within groups by age. RESULTS: Distance-corrected near VA (DCNVA) was significantly worse in the PVD group than in the non-PVD group in all age categories ( P ≤ .029). In the PVD group, both corrected distance VA (CDVA) and DCNVA were significantly worse in the 75 to 79 years age group than in the 65 to 69 and 70 to 74 years age groups ( P ≤ .034). CDVA and DCNVA in the non-PVD group did not differ significantly between age categories. CONCLUSIONS: The results of this study suggest that complete PVD worsens near VA in eyes with a diffractive mIOL. Furthermore, eyes with complete PVD may show an age-related decline in both CDVA and DCNVA. In particular, eyes ≥75 years of age with complete PVD have a poor visual prognosis and should be given careful consideration when deciding whether to implant a diffractive mIOL.

Angle Kappa Influence on Multifocal IOL Outcomes.

PURPOSE: To characterize angle kappa and study the relationship between preoperative angle kappa and postoperative refractive accuracy, visual outcomes, and patient satisfaction in a large population of eyes with multifocal intraocular lens (MIOL) implantation. METHODS: A comprehensive electronic medical record chart review of 26,470 consecutive eyes that underwent immediate sequential bilateral cataract or refractive lens exchange with MIOLs was conducted. The primary outcome measures were postoperative monocular uncorrected distance visual acuity (UDVA), manifest refraction sphere and cylinder, spherical equivalent (SEQ), defocus equivalent (DEQ), subjective quality of vision at near, intermediate, and distance, and the likelihood of recommending the procedure. Relationships between preoperative angle kappa and postoperative outcomes were assessed with Pearson correlations. RESULTS: Angle kappa followed a right-skewed normal distribution (R2 = 0.99) with a mean ± standard deviation of 0.64 ± 0.27 mm. No clinically meaningful relationship was found between preoperative angle kappa and postoperative sphere, cylinder, SEQ, and DEQ, all with R2 ⩽ 0.0005. Similarly, there was no clinically meaningful relationship between preoperative angle kappa and postoperative UDVA (R2 = 0.001), postoperative satisfaction for near, intermediate, and distance vision (all R2 ⩽ 0.0023), or for recommending the MIOL surgery to friends and relatives (R2 = 0.0000). CONCLUSIONS: Preoperative angle kappa does not have a predictive clinical impact on postoperative MIOL visual outcomes, refractive accuracy, or subjective patient satisfaction. Angle kappa as a single variable cannot be used to determine MIOL candidacy. [J Refract Surg. 2023;39(12):840-849.].

Comparison of the optical behaviour of five different multifocal diffractive intraocular lenses in a model eye.

The purpose of this study was to investigate and compare the optical performance of five trifocal intraocular lenses (IOLs) following the ISO 11979-2 standards, analysing the impact of tilt and decentration. Five different diffractive trifocal IOLs were evaluated in this experimental study: Acriva Trinova (VSY-Biotechnology) (AT), FineVision HP (PhysIOL) (FVHP), AT LISA tri 839 MP (Zeiss) (ATLT), PanOptix TFNT00 IOL (Alcon) (PO), and Tecnis Synergy (J&J Vision) (TS). In-vitro optical quality analysis of them was performed with the Lambda PMTF system that has an aberration neutral cornea model (Lambda-X Ophthalmics). Measurements were performed on-axis, with 5º of IOL tilt and with 0.5 mm of IOL decentration using 543-nm monochromatic light. Finally, IOL dimensions and diffractive disk profile inspection was performed using the VisIOLA system (Rotlex). On-axis measurements showed a far through-focus MTF > 0.3 at 3 mm aperture, except for TS. FVHP and PO showed better far MTFs for larger apertures (3.75 mm and 4.5 mm) while AT showed good intermediate and near vision for such apertures. With 5º of IOL tilt, the better optical performance at all distances was found with AT for medium-sized pupils (3 mm) and an important reduction of MTF was found for ATLT and PO, especially in the intermediate focus. The induction of 0.5 mm of IOL decentration especially affected the intermediate focus of ATLT and TS and the far focus of FVHP and PO. IOL dimensions and diffractive profile were consistent with those described by the manufacturer. In conclusion, there are differences in the optical performance according to the pupil aperture of the five trifocal IOLs evaluated and this should be considered in clinical practice when selecting the most appropriate implant in each specific case. IOL tilt and decentration can affect significantly in most of the designs evaluated the performance of the IOL at intermediate vision range. It should be noted that measurements were made with an aberration-free cornea, being necessary future studies analysing the impact of different levels of corneal aberrations.

Deposit Effects on Plate-haptic Rotationally Asymmetric Refractive Multifocal Intraocular Lens with +1.5D Addition Power.

OBJECTIVE: To evaluate the optical performance of plate-haptic rotationally asymmetric refractive multifocal intraocular lenses (IOLs) with +1.5 D addition power by reproducing calcium deposition using rabbit eyes. METHODS: Five IOLs (LS-313 MF15 [Santen/Teleon], W-60R [Santen], NS1 [KOWA], SY60WF [Alcon], and NS-60YS [NIDEK]) with varying water content were randomly implanted in rabbit eyes. Cell proliferation in the lens capsule and deposits on the IOL surface were confirmed with a slit lamp. The surface deposits were stained with alizarin red, and IOL transmittance was measured with a spectrophotometer. IOL storage solutions were analyzed using inductively coupled plasma mass spectrometry to confirm the presence of calcium. RESULTS: Slit-lamp observations revealed abundant cellular proliferation on all IOLs. Granular deposits, unlike proliferating cells, were observed on LS-313 MF15 lenses two months after surgery, increasing over time, and stained red. The transmittance of LS-313 MF15 decreased in correlation with the stained area. Calcium was detected in all IOL storage solutions; however, deposits were confirmed only on the LS-313 MF15 surface, indicating decreased transmittance. CONCLUSION: These findings can facilitate predicting deposition on IOLs in clinical settings and selecting IOL materials for long-term stability. The long-term use of LS-313 MF15 IOLs requires further verification to avoid post-surgical extraction.

Tear Film Stability Affects Visual Acuity After Implantations of Monofocal and Multifocal Intraocular Lenses: An Evaluation by Objective Scatter Index.

Purpose: To assess the impact of tear film on postoperative visual acuity after cataract surgery to implant an intraocular lens (IOL). Methods: Tear break-up time (TBUT), Schirmer I test, objective scatter index (OSI), and uncorrected distance visual acuity (UCDVA), intermediate visual acuity (UCIVA), and near visual acuity (UCNVA) were collected 6 months after cataract surgery. Results: Fifteen eyes with monofocal (Mo-) IOLs and 15 eyes with multifocal (Mu-) IOLs from 30 subjects were included. The Mu-IOL group exhibited higher baseline OSI (1.92 ± 0.69, P < 0.001). Negative correlations-both groups: tear film-related OSI (TF-OSI) and TBUT/Schirmer I test; Mo-IOL: TBUT and logMAR UCDVA-and positive correlations-both groups: TF-OSI and baseline OSI, baseline OSI/TF-OSI and logMAR UCDVA; Mu-IOL: baseline OSI/TF-OSI and logMAR UCIVA/UCNVA-were found. Linear regression showed associations between TF-OSI and TBUT (Mo-IOL: R2 = 0.455, P = 0.006; Mu-IOL: R2 = 0.454, P = 0.006)/Schirmer I test (Mo-IOL: R2 = 0.527, P = 0.002; Mu-IOL: R2 = 0.266, P = 0.049). Multiple regression showed associations between baseline OSI (Mo-IOL: R2 = 0.309, P = 0.032; Mu-IOL: R2 = 0.305, P = 0.033)/TF-OSI (Mo-IOL: R2 = 0.332, P = 0.025; Mu-IOL: R2 = 0.523, P = 0.002)/TBUT (Mo-IOL only: R2 = 0.315, P = 0.029) and logMAR UCDVA. Conclusions: TF-OSI reflects the UCDVA performance in eyes with IOLs and facilitates a better understanding of the effects of the tear film. Translational Relevance: TF-OSI offers a developmental and objective approach to assessing the changing visual performance caused by tear film after cataract surgery and IOL implantation in clinical practices.