This study used a short quality of vision (QoV) questionnaire (19 items) to assess patient-reported outcomes based on presence of visual disturbances and lifestyle activities, choice of IOL, and spectacle independence. Complete spectacle independence was achieved by 96% of patients with only 1 patient (1/27) reporting the use of spectacles for far distance. In all, 93% of patients reported experiencing an optical phenomena (89% halos, 11% glare, 7% double vision, 4% each ghosting and distorted vision).10 Although the reported incidence for far distance halos was high, patients reported that it was not bothersome. In all, 81% of patients responded that they would choose the same IOL again and would recommend it to others. For daily life activities, patients rated (score range: 1 = good to 6 = bad) a good mean score for the quality of uncorrected vision of 2.1 ± 0.54 for distance activities (car driving, TV, theatre, among others), and of 1.8 ± 0.10 for near and intermediate distance (cooking, computer, musical instrument, newspaper).10
Lawless et al (2017),17 in a retrospective case series study (n = 33), reported excellent unaided vision at all distances with PanOptix (Table (Table2).2). An uncorrected VA of 20/40 Snellen equivalent or better was achieved by all patients for distance and near positions and by 88.9% of patients for the intermediate position.17 In all, 78.8% of patients achieved UDVA of 0.01 ± 0.10 logMAR (∼20/20 Snellen equivalent UDVA or better) and 85.2% achieved a mean UNVA of 0.11 ± 0.04 logMAR. Halos of moderate severity were reported by 15% of patients in the early postoperative period but it did not impair their activities, and the complaints diminished by the subsequent postoperative visits (between 4 weeks and 3 months).17
Garcia-Perez et al (2017)19 reported excellent visual outcomes in patients (n = 58) implanted with PanOptix during the 1-month follow-up (Table (Table2).2). Monocular and binocular VA was measured at 33 cm (for near) and at 60 cm (for intermediate). No significant differences in distance, intermediate, or near VA and distance CS (P > 0.05 for all spatial frequencies measured using the functional acuity contrast test [Test SV-1000] of the CC-100 (HW 5.0 Series system) in mesopic and photopic conditions were noted, supporting the fact that the visual performance of PanOptix is consistent across different levels of illumination. All patients achieved a binocular uncorrected VA better than 0.3 logMAR (20/40 Snellen equivalent) for distance and near vision, and 94.8% of patients did so for intermediate vision. The monocular defocus curves showed that VA better than 0.2 logMAR was maintained between −2.50 and +0.50 D. Overall, 94.8% of patients in this study achieved complete spectacle independence; 3 (5.1%) patients reported using spectacles for some activities.19
The study used the Catquest 9-SF questionnaire to evaluate patient satisfaction. A high level of satisfaction was observed: 84.5% patients reported no difficulties and 15.5% reported some difficulties related to vision in their daily lives; >79% of patients reported having no difficulties in performing all tasks. Driving at night was the most challenging activity with 25.9% of patients citing difficulty as occasional or often; 32.8% reported seeing halos often or always with low illumination and 10.3% reported glare. One case of posterior capsule opacification (PCO) was reported and was scheduled for neodymium-doped yttrium aluminum garnet (Nd:YAG) capsulotomy.19
Extended Depth of Focus (EDOF) IOL TECNIS Symfony (Abbott Medical Optics, Santa Ana, CA) was launched in 2014.
AcrySof IQ PanOptix Model TFNT00 (Alcon Laboratories, Fort Worth, TX) is a quadrifocal, presbyopia-correcting IOL first launched in Europe in 2015, that uses the ENhanced LIGHT ENergy (ENLIGHTEN; Alcon Laboratories, Fort Worth, TX) optical technology. It only became available in the USA in September 2019.
-The PanOptix IOL is designed to have an intermediate focal point of 60 cm (arms-length), a more natural and comfortable working distance to perform functional tasks on computers, laptops, mobiles, among others.
– non-apodized
– high (88%) utilization of light energy
-low dependence on pupil size in all lighting conditions
-a more comfortable near-to-intermediate range of vision than traditional trifocal IOLs.
FineVision Micro F (PhysIOL, Liege, Belgium) was first trifocal IOL introduced in Europe in 2010 but is not available in the USA as of 2019. Has an intermediate focal point of 80 cm.
AT LISA tri 839MP (Carl Zeiss Meditec AG, Jena, Germany) is second trifocal IOLs introduced in Europe in 2012 but is not available in the USA as of 2019. Has an intermediate focal point of 80 cm.
J Refract Surg. 2019 Sep 1;35(9):559-564. doi: 10.3928/1081597X-20190806-01.
Comparison of Mix-and-Match Implanted Bifocal IOLs and Bilateral Implanted Trifocal IOLs After Femtosecond Laser-Assisted Cataract Surgery.
From Ankara Yildirim Beyazit University, Department of Ophthalmology, Ankara, Turkey (NY); and Bayindir Hospital, Department of Ophthalmology, Ankara, Turkey (YAA, OD).
Abstract
PURPOSE:
To compare the visual performance of mix-and-match implanted bifocal intraocular lenses (IOLs) and bilateral implanted trifocal IOLs from the same manufacturer with the same IOL platform after femtosecond laser-assisted cataract surgery (FLACS).
METHODS:
This prospective, comparative, non-randomized study included patients who underwent FLACS (LenSx; Alcon Laboratories, Inc., Fort Worth, Texas) with bilateral implantation of bifocal IOLs (ReSTOR +2.50 D/+3.00 D; Alcon Laboratories, Inc.) or trifocal IOLs (PanOptix; Alcon Laboratories, Inc.). Visual acuities, manifest refraction, defocus curve, contrast sensitivity, quality of life measured by the Visual Function Index (VF-14), and spectacle independence were assessed at 6 months after surgery.
RESULTS:
A total of 70 eyes of 35 patients were included in this study. There was no difference in patient demographics and preoperative measurements between groups (P > .05). There was no difference in uncorrected distance visual acuity and corrected distance visual acuity outcomes between groups (P > .05), but uncorrected intermediate visual acuity and uncorrected near visual acuity outcomes were significantly better in the PanOptix group (P < .01). Correspondingly, the binocular defocus curve of the PanOptix IOLs showed significantly better visual acuity between -1.00 and -3.00 diopters compared to the ReSTOR IOLs (P < .05). The PanOptix group showed higher contrast sensitivity scores than the ReSTOR group for 12 and 18 spatial frequencies in photopic conditions and for 18 spatial frequencies in mesopic conditions (P < .05). The average VF-14 score was similar between groups (P = .78). None of the patients required spectacles.
CONCLUSIONS:
Bilateral implanted PanOptix IOLs seem to provide better intermediate and near vision, defocus curve, and contrast sensitivity compared to mix-and-match implanted ReSTOR IOLs. However, similar vision-related quality of life and spectacle independence were achieved with both IOLs. [J Refract Surg. 2019;35(9):559-564.]
Correlation and predictability of ocular aberrations and the visual outcome after quadrifocal intraocular lens implantation: a retrospective longitudinal study.
Author information
- 1
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan. ao6u.3msn@hotmail.com.
- 2
- Department of Optometry, College of Medicine and Life Science, Chung Hwa University of Medical Technology, Tainan, Taiwan. ao6u.3msn@hotmail.com.
- 3
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
- 4
- Department of Optometry, Chung Shan Medical University, Taichung, Taiwan.
- 5
- Department of Optometry, Yuanpei University of Medical Technology , Hsinchu, Taiwan.
- 6
- Department of Exercise and Health Promotion, Chung Chou University of Science and Technology, Changhua, Taiwan.
- 7
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
- 8
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.
- 9
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.
- 10
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan.
- 11
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan.
- 12
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.
- 13
- Department of Chinese Medicine, Chang Gung University, Taoyuan, Taiwan.
Abstract
BACKGROUND:
To evaluate the correlating and predicting factors of visual outcome after implantation of newly developed diffractive quadrifocal intraocular lens (IOL).
METHODS:
A retrospective longitudinal study was conducted. Patients who underwent diffractive quadrifocal IOL implantation with a follow-up period longer than six months and records of wavefront aberrometer within one week perioperatively were enrolled. Accordingly, a total of 73 eyes from 73 patients were included. The postoperative distance and near visual acuity, ocular aberrations and postoperative symptoms were collected. The correlation and predictability between ocular aberrations and the postoperative visual outcome were evaluated.
RESULTS:
The corrected distance visual acuity (CDVA) one month postoperatively was significantly better than the preoperative status, and insignificant improvement was found six months postoperatively. Preoperative Tracey refraction spherical equivalent (TRSE), angle alpha, and spherical aberration (SA) were significantly correlated with postoperative CDVA and near corrected visual acuity (NCVA). For postoperative ocular aberrations, TRSE, angle alpha, and SA were significantly correlated with CDVA six months postoperatively and NCVA, while the trefoil, internal higher order aberration (HOA) and total HOA were associated with NCVA. Preoperative angle alpha could predict all postoperative visual performances, while postoperative TRSE and angle alpha could predict the CDVA six months postoperatively and NCVA. A large angle alpha is associated with visual disturbance and dissatisfaction.
CONCLUSION:
The angle alpha preoperatively and postoperatively was correlated with the postoperative vision and could predict visual outcome in patients who had diffractive quadrifocal IOL implanted. Furthermore, the majority of ocular aberrations were also associated with certain postoperative vision.
Notes:
1. Retrospective
2. The grammar of the article needs correcting.
3. Limitations:
-retrospective & absence of preoperative NCVA Near Corrected Visual Acuity
-no control group, and so whether the correlation between ocular aberrations and visual acuity is specific to the diffractive quadrifocal IOL or is universal for all IOLs cannot be evaluated
-no measurement of contrast sensitivity, defocus curve and modulation transfer function
4. Conclusions:
–Since the angle alpha is the difference between the visual axis and the center of limbus, a larger angle alpha may lead to poor centration of multifocal IOL, and the decentration of IOL can impair the postoperative visual performance as well as elevate the HOA and SE after cataract surgery [23–25].
–Spherical Aberrations SA showed a universal correlation to both the postoperative far and near visual acuities, which may because of the SA-related halo and glare [30, 31].
—residual SA was associated with a worse visual outcome in other types of IOL [32], which could yield a similar correlation in the diffractive quadrifocal IOL.
–corneal Higher-Order Aberrations HOA was correlated with the CDVA,
–trefoil and internal HOA were associated with the NCVA: etiology remains to be elucidated.
–Interestingly, the total HOA was only correlated with the NCVA, which may be due to the different effects of HOAs that lead to non-significant results