Visual outcome and optical quality after bilateral implantation of aspheric diffractive multifocal, aspheric monofocal and spherical monofocal intraocular lenses: a prospective comparison

·AIM: To evaluate the visual function after bilateral implantation of aspheric diffractive multifocal Tecnis ZMA00, aspheric monofocal ZA9003 versus spherical monofocal Akreos Adapt intraocular lenses (IOLs). ·METHODS: Tecnis ZMA00, Tecnis ZA9003 or Akreos Adapt IOLs were bilaterally implanted in 180 eyes from 90 patients. The following parameters were assessed 3 months postoperatively: monocular and binocular uncorrected visual acuity (UCVA) and distance-corrected visual acuity (DCVA) for distance, intermediate and near, spherical aberration (SA), contrast and glare sensitivity, near point refractive power, uncorrected and best corrected near stereoscopic acuity (NSA). Patient satisfaction was assessed by a questionnaire. ·RESULTS:Threemonthspostoperatively,themonocular and binocular UCVA and DCVA at near of Tecnis ZMA00 were significantly better than other two groups. The mean SA for 5.0mm optical zone in Tecnis ZMA00 and Tecnis ZA9003 was significantly lower than that in Akreos Adapt. Mean contrast sensitivity and glare sensitivity were better for Tecnis ZA9003 group than for other two groups. Patients with Tecnis ZMA00 had higher monocular and binocular near point refractive power and uncorrected NSA than monofocal groups. The patients in Tecnis ZMA00 had higher mean values for halo compared with other two groups. ·CONCLUSION: Tecnis ZMA00 provided better near VA and uncorrected NSA and higher near point refractive power than monofocal IOLs and patients were spectacle independent. The IOLs with Tecnis aspheric design improved contrast and glare sensitivity. Patients with Tecnis ZMA00 reported more disturbances on visual phenomena of halo. ·

Diffractive multifocal intraocular lens implantation in patients with monofocal intraocular lens in the contralateral eye

AIM:To evaluate clinical outcomes of unilateral implantation of a diffractive multifocal intraocular lens(IOL)in patients with contralateral monofocal IOL.METHODS:Twenty-two patients who already had implantation of a monofocal IOL in unilateral eye underwent implantation of a diffractive multifocal IOL in contralateral eye were enrolled.After 1,6,and 12 mo,uncorrected and distant corrected distant visual acuity(UCDVA and DCDVA),uncorrected and distant corrected intermediate-visual acuity(UCIVA and DCIVA),uncorrected and distant corrected near visual acuity(UCNVA and DCNVA),and contrast sensitivity were obtained.Halo/glare symptoms,spectacle dependence,and patient satisfaction were also evaluated.RESULTS:The mean age was 67.86±7.25 y and the average interval between two IOL implantations was 645.82±878.44 d.At 1 mo,binocular UCDVA was lower than 0.20 logMAR in 76%of patients(mean 0.12±0.13 logMAR),which increased to 90%by 6 and 12 mo.The binocular UCDVA was significantly better than the monocular results(P<0.05)at 1,6,and 12 mo.Additionally,UCNVA was lower than 0.40 logMAR in 82%of patients,increasing to 90%by 6 and 12 mo.Mean UCNVA in the multifocal IOL implanted eye was statistically significantly better than that in the monofocal IOL implanted eye(P<0.05)at 1,6,and 12 mo.About 5%of patients at 1 and 6 mo,reported"severe glare or halo".Patient satisfaction rates were 95%and 91%at 6 and 12 mo,respectively.CONCLUSION:Unilateral implantation of multifocal IOL in patients with a contralateral,monofocal IOL implantation results in high patient satisfaction rate,with low severe glare or halo rate during follow-up.It can represent a good option for patients who have previously had a monofocal IOL implantation regardless of two year interval duration between two IOL implantations.

Comparison on Visual Function after Implantation of an Apodized Diffractive Aspheric Multifocal or Monofocal Intraocular Lens

Purpose:To evaluate visual outcomes after implantation of an aspheric multifocal /intraocular lens.(MIOL).or an aspheric monofocal intraocular lens (IOL).Methods:This was a prospective nonrandomized study.During 3-months of post-operative follow-up,the following outcomes for SN6AD1 MIOL.(multifocal group).and SN60WF IOL (monofocal group) were compared:uncorrected (UDVA) and corrected (CDVA) distance visual acuity,uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity,Chinese character near visual acuity,uncorrected intermediate visual acuity (UIVA) under high (100% contrast) and low contrast.(10% contrast),UIVA for different IOL powers,and a quality-of-life questionnaire.Results:UNVA,DCNVA,and UIVA under high contrast in the multifocal group were significantly better than those in the monofocal group (P<0.05).UDVA,CDVA and UIVA under low contrast did not differ between groups at 63 cm and 100 cm (P >0.05).In most cases,Chinese character near visual acuity was significantly better in the multifocal group.(P < 0.05).UNVA and UIVA at 63 cm improved over time during 3 months post-operatively.Better UIVA was found in emmetropic and mild myopic eyes as compared to hyperopic ones.The patients in the multifocal group had a higher degree of satisfaction and performed better on near and intermediate tasks,although with greater complaints of visual disturbance.Conclusion:The SN6AD1 MIOL provides significantly better UNVA,DCNVA and UIVA under high contrast conditions,and better Chinese character near visual acuity.Patients receiving the SN6AD1 MIOL reported a better quality of vision in spite of more serious visual disturbances.Better UIVA was observed in emmetropic and mildly myopic eyes.

Objective electrophysiological contrast sensitivity with monofocal and multifocal intraocular lenses:a prospective clinical study

Background:To compare objective electrophysiological contrast sensitivity function(CSF)in patients implanted with either multifocal intraocular lenses(MIOLs)or monofocal intraocular lenses(IOLs)by pattern reversal visual evoked potentials(prVEP)measurements.Methods:Fourty-five cataract patients were randomly allocated to receive bilaterally:apodized diffractive-refractive Alcon Acrysof MIOL(A),full diffractive AMO Tecnis MIOL(B)or monofocal Alcon Acrysof IOL(C).Primary outcomes:1-year differences in objective binocular CSF measured by prVEP with sinusoid grating stimuli of 6 decreasing contrast levels at 6 spatial frequencies.Secondary outcomes:psychophysical CSF measured with VCTS-6500,photopic uncorrected distance(UDVA),and mesopic and photopic uncorrected near and intermediate visual acuities(UNVA and UIVA respectively).Results:Electrophysiological CSF curve had an inverted U-shaped morphology in all groups,with a biphasic pattern in Group B.Group A showed a lower CSF than group B at 4 and 8 cpd,and a lower value than group C at 8 cpd.Psychophysical CSF in group A exhibited a lower value at 12 cpd than group B.Mean photopic and mesopic UNVA and UIVA were worse in monofocal group compared to the multifocal groups.Mesopic UNVA and UIVA were better in group B.Conclusions:Electrophysiological CSF behaves differently depending on the types of multifocal or monofocal IOLs.This may be related to the visual acuity under certain conditions or to IOL characteristics.This objective method might be a potential new tool to investigate on MIOL differences and on subjective device-related quality of vision.

Comparison of dynamic defocus curve Checkfor updates on cataract patients implanting extended depth of focus and monofocal intraocular

Background:The aim of the study was to compare the dynamic defocus curve on patients post-implantation of the extended depth-of-focus(EDOF)and monofocal intraocular lens(IOL).Methods:A total of 62 age-related cataract patients receiving phacoemulsification with implantation of TECNIS Symfony(ZXRoO)or monofocal IOLs were enrolled.The binocular static and dynamic defocus curves with corrected distance visual acuity were evaluated at one month postoperatively.Results:The ZXR00 group achieved signifcantly better intermediate(P=0.044)and near(P=0.017)visual acuity(VA)than the monofocal group.Two groups had similar uncorrected and corrected distance VA(P>0.05,respectively).The dynamic defocus curve revealed a smoother decline from 0.0 D to-2.0 D in the ZXRo0 group.Defocused dynamic VA in the ZXR00 group was significantly better(P<0.05)except at 0.0 D(P=0.724)and-0.5 D(P=0.176).The area under the curve(P=0.002)and corrected dynamic vision accommodation(P=0.001)derived from the dynamic defocus curves were better in the ZxRoo group.A positive correlation was observed between defocused dynamic and static VA in both groups(P<0.001).Multiple linear regression analysis indicated that defocused static VA and cor-rected dynamic vision accommodation were significant influential factors for the defocused dynamic VA from-1.0 D to-3.0 D(P<0.05).Conclusions:The EDOF IOL provided similar distant vision,better intermediate and near vision,and a better overall dynamic defocus curve than the monofocal IOL.The dynamic defocus curve may be comprehensively applied to evaluate the all-distance dynamic visual performance post-cataract surgery.

Predictive factors for photic phenomena after refractive,rotationally asymmetric,multifocal intraocular lens implantation

AIM： To investigate the independent factors associated with photic phenomena in patients implanted with refractive,rotationally asymmetric,multifocal intraocular lenses（MIOLs）.METHODS： Thirty-four eyes of 34 patients who underwent unilateral cataract surgery,followed by implantation of rotationally asymmetric MIOLs were included.Distance and near visual acuity outcomes,intraocular aberrations,preferred reading distances,preoperative and postoperative refractive errors,mesopic and photopic pupil diameters,and the mesopic and photopic kappa angles were assessed.Patients were also administered a satisfaction survey.Photic phenomena were graded by questionnaire.Independent-related factors were identified by correlation and bivariate logistic regression analyses.RESULTS： The distance from the photopic to the mesopic pupil center（pupil center shift） was significantly associated with glare/halo symptoms [odds ratio（OR）=2.065,95% confidence interval（CI）=0.916-4.679,P=0.006] and night vision problems（OR=1.832,95% CI=0.721-2.158,P=0.007）.The preoperative photopic angle kappa was significantly associated with glare/halo symptoms（OR=2.155,95% CI=1.065-4.362,P=0.041）.The photopic angle kappa was also significantly associated with glare/halo symptoms（OR=2.155,95% CI=1.065-4.362,P=0.041） and with night vision problems（OR=1.832,95% CI=0.721-2.158,P=0.007） in patients implanted with rotationally asymmetric MIOLs.CONCLUSION： A large pupil center shift and misalignment between the visual and pupillary axis（angle kappa）may play a role in the occurrence of photic phenomena after implantation of rotationally asymmetric MIOLs.

Visual function and higher order aberration after implantation of aspheric and spherical multifocal intraocular lenses:a meta-analysis

AIMTo assess the visual outcomes of aspheric multifocal intraocular lenses (IOLs) compared with spherical multifocal IOL after cataract surgery.

Accuracy of eight intraocular lens power calculation formulas for segmented multifocal intraocular lens

AIM:To evaluate the accuracy of eight different intraocular lens(IOL)power calculation formulas for a segmented multifocal IOL.METHODS:A total of 53 eyes of 41 adult cataract patients who underwent phacoemulsification and implantation with the SBL-3 segmented multifocal IOL between January 1,2017 and January 31,2019 were included in this retrospective study.Preoperative biometry measurements were obtained using an IOL Master.Manifest refraction was performed at least 4 wk postoperatively.Accuracy of the eight formulas[Barrett Universal II,Emmetropia Verifying Optical(EVO),Haigis,Hill-RBF 2.0,Hoffer Q,Holladay 1,Kane,and SRK/T]was analyzed.RESULTS:Using current lens constants,all formulas exhibited errors of slight myopic shift in refractive prediction.The Barrett Universal II formula had a significantly lower median absolute error(MedAE)than did Holladay 1(P=0.02),Kane(P=0.001)and Hill-RBF 2.0(P<0.001)formulas.The Haigis formula had a lower MedAE value than did the Hill-RBF 2.0 formula(P=0.005).Differences in MedAE values among SRK/T,EVO and Hoffer Q formulas were not significant.After optimizing lens constants,the MedAE values of all formulas were reduced;significant changes were noted for EVO(P=0.022),Haigis(P=0.048);Hill-RBF 2.0(P=0.014),Holladay 1(P=0.045)and Kane(P=0.022)formulas.All formulas performed equally well after optimization of lens constants(P=0.203).CONCLUSION:All eight formulas tend to result in a myopic shift when using current lens constants.Optimized lens constants improve the accuracy of these formulas among adult Chinese patients.

Visual performance with accommodating and multifocal intraocular lenses

AIM： To compare the visual functional outcomes with accommodating and multifocal intraocular lenses（IOLs）.METHODS： Our retrospective comparative study included 51 patients（60 eyes） received implantation of an accommodating IOL（Tetraflex;16 patients,20 eyes）,a refractive multifocal IOL（Re Zoom;18 patients,20 eyes）,or a diffractive multifocal IOL（ZMA00;17 patients,20 eyes）.Subjective refraction,visual acuity,contrast sensitivity（CS）,intraocular aberration,and subjective photic phenomena were detected at 3mo after surgery.RESULTS： The spherical equivalent in the three groups was-0.38±0.54 D,0.14±0.56 D,and 0.35±0.41 D,respectively.No statistically significant differences were found in uncorrected and corrected distance visual acuity and uncorrected intermediate visual acuity among the groups（P=0.39）.The Re Zoom group had significantly better distance-corrected intermediate visual acuity than the ZMA00 group（P=0.003）.The ZMA00 group had significantly better near visual acuity than the other groups（P〈0.05）.Better contrast sensitivity values were observed in the Tetraflex group under most of the spatial frequencies conditions（P=0.025）.The total aberration was lowest in the ZMA00 group（P=0.000）,and the spherical aberration was highest in the Tetraflex group（P=0.000）.The three groups had similar frequency of ghosting and glare,and the Tetraflex group had a low rate of halos（P=0.01）.CONCLUSION： Both accommodating and multifocal IOLs can successfully restore distance and uncorrected intermediate visual acuities.Tetraflex accommodating IOLs perform better in CS and with less halos of photic phenomena.Re Zoom refractive multifocal IOLs havebetter performance in distance-corrected intermediate visual acuity than ZMA00 diffractive multifocal IOLs,and the latter achieved better near visual acuity and efficiently decreased the optical aberration.

Potential of video games for the promotion of neuroadaptation to multifocal intraocular lenses: a narrative review

Multifocal intraocular lenses(IOLs) are currently usually implanted for the treatment of cataracts because they have been proved to be superior to monofocal IOLs with respect to spectacle independence. In turn, they are associated with a higher prevalence of dysphotopsia symptoms that is one of the most common causes of patient dissatisfaction. Neuroadaptation seems to play a major role in the optimal adaptation to multifocal IOLs. In this context, the development of strategies that facilitate the neuroadaptation process to multifocality might be an effective strategy to reduce patients' dissatisfaction. Video games have been proved to be effective for the improvement of visual acuity and for the promotion of neuroplasticity in elderly subjects and other populations with cortical-related visual impairment. This narrative review highlights the physiological potential of video games as a perceptual strategy to improve visual acuity and promote neuroplasticity in patients using multifocalIOLs, although research is still needed to confirm these benefits in this specific population, with only one comparative study to this date providing evidence of them.

Clinical outcomes of a new diffractive multifocal intraocular lens

AIM：To evaluate clinical outcomes after implantation of a new diffractive aspheric multifocal intraocular lens（IOL） with ＋3.00 addition power.METHODS：This is a retrospective,consecutive case series of cataract patients who underwent bilateral implantation of the Optiflex MO/HF D012（Moss Vision Inc.Ltd,London,UK） multifocal IOL.Patients followed for 6 mo were included in the study.Data on distance,intermediate and near visual acuity,refractive error [manifest spherical equivalent（MSE）],contrast sensitivity,adverse events,subjective symptoms,spectacle independence and patient satisfaction [visual function questionnaire（VFQ）-25 questionnaire] were retrieved from electronic medical records and analyzed.RESULTS：Forty eyes of 20 patients with a mean age of 66.7±8.5 y（range：53-82） were included in the study.Mean uncorrected distance,near and intermediate visual acuity remained stable through postoperative visits and was 0.19±0.19 log MAR,Jaeger 4 and Jaeger 3 respectively at the 6 mo visit.At the end of postoperative 6 mo,MSE was-0.14±0.42 diopters（D） and 98% of the eyes were within 1.00 D of target refraction.Postoperative low contrast（10%） visual acuity remained stable（P=0.54） through follow up visits with a mean of 0.35±0.17 log MAR at the 6 mo visit.There were no reported adverse events.None of the patients reported subjective symptoms of halo or glare.Spectacle independence rate was 90%.Mean VFQ-25 questionnaire score was 93.5±6.12.CONCLUSION：The Optiflex MO/HF-DO12 IOL was safely implanted and successfully restored distance,intermediate and near visual acuity without impairing contrast sensitivity.High levels of spectacle independence were achieved at all distances including intermediate distance.

A new treatment option for the resistant spasm of accommodation:clear lens extraction and multifocal intraocular lens implantation

Dear Editor,We write you to present a 20-year-old man with resistant spasm of accommodation without any organic cause treated with clear lens extraction（CLE）with phacoemulsification and multifocal intraocular lens（IOL）implantation.

Combination of Toric and multifocal intraocular lens implantation in bilateral cataract patients with unilateral astigmatism

AIM： To assess the binocular visual function in bilateral cataract patients with unilateral astigmatism after combined implantations of Toric with multifocal intraocular lens （IOL）, and to compare with that of Toric and monofocal IOL implantation.METHODS： All the 30 patients with unilateral astigmatism suffered bilateral cataract were randomly divided into two groups： Toric plus multifocal IOL group and Toric plus monofocal IOL group. Uncorrected and corrected visual acuity at distance （5.0 m）, intermediate distance （0.6 m）, and near （0.33 m）, contrast sensitivity, and stereopsis were assessed 6mo after surgery. Patients were also surveyed for visual disturbances and spectacle dependence.RESULTS： Binocular uncorrected visual acuity （LogMAR） of Toric/multifocal IOL eyes at distance, intermediate, near were 0.05±0.05, 0.24±0.10, and 0.14±0.06 respectively. The values of Toric plus monofocal IOL eyes were 0.06±0.07, 0.26±0.08, and 0.37±0.10 respectively. These values did not indicate significant differences between two groups with exception of near visual acuity. In the photopic condition （with or without glare）, the contrast sensitivity of multifocal IOL eyes was significant lower than the monofocal IOL eyes in 18 cpd. In the mesopic condition, the contrast sensitivity of multifocal group was significant lower than monofocal group in 12 cpd, and in mesopic glare condition, this significant difference was found both in 6 cpd and 12 cpd. The stereopsis of Toric/multifocal IOL eyes decreased slightly （100±80 seconds of arc, t=2.222, P=0.136）. Mean near vision for patient satisfaction was statistically significantly higher in Toric/multifocal IOL group patients versus than that in Toric/monofocal IOL group （80% vs 25.5%, P=0.000）. Visual disturbance was not noticed in either group.CONCLUSION： Although the combination of Toric and multifocal IOL implantation results in compromising stereoacuity, it can still provide patients with high levels of spectacle freedom and good overall binocular visual acuity.

Comparative analysis of visual quality between unilateral implantation of a trifocal intraocular lens and a rotationally asymmetric refractive multifocal intraocular lens

·AIM:To compare visual quality after unilateral cataract surgery with implantation of trifocal intraocular lens(IOL)and asymmetric refractive multifocal IOL.·METHODS:The prospective nonrandom,comparative study consisted of 60 eyes of 60 patients suffering unilateral cataract surgery with implantation of two different IOLs:AT LISA tri 839 MP(30 eyes;Carl Zeiss Meditec,Germany)and LS-313 MF30(30 eyes;Oculentis GmbH,Germany).Visual acuity,refractive outcome,contrast sensitivity,defocus curves,quality of vision,and optical phenomena were evaluated at3 mo postoperatively.·RESULTS:There were no statistical differences between groups in uncorrected distance visual acuity(P=0.13)and uncorrected near visual acuity(P=0.54).In contrast,uncorrected intermediate visual acuity was better in trifocal group compared to the refractive multifocal group(P=0.02).No significant statistical between-group difference was detected in cylinder(P=0.43).Compared to trifocal group,spherical refraction and spherical equivalent in refractive multi focal group were more myopic(P<0.01).Under photopic conditions,no significant statistical differences were found between groups in contrast sensitivity at 3 and 6 cycles per degree(cpd).The refractive multifocal group performed better at 12 and 18 cpd than the trifocal group(P=0.01,P=0.034,respectively).The questionnaires of quality of vision and optical phenomena showed no differences between groups.·CONCLUSION:Trifocal IOL is superior to refractive multifocal IOL in intermediate visual acuity.Rotationally asymmetric refractive multifocal IOL is more myopic in automated refraction and significantly better for the photopic contrast sensitivity at high frequency.

Secondary positioning of rotationally asymmetric refractive multifocal intraocular lens in a patient with glaucoma:A case report

BACKGROUND Asymmetric multifocal intraocular lenses(IOLs)are now widely used in the modern cataract surgery,providing a good level of visual performance over a range of distances and high postoperative patient satisfaction.We report a case of improved visual quality after shifting the near segment of an asymmetrical multifocal IOL to the superotemporal placement in the dominant eye of a glaucoma patient.CASE SUMMARY A 72-year-old woman with bilateral glaucoma underwent phacoemulsification in the dominant eye(left eye)with implantation of an asymmetrical multifocal IOL.Postoperative uncorrected distance visual acuity(UDVA)was 0.0 logMAR(20/20 Snellen)and uncorrected near visual acuity(UNVA)was 0.1 logMAR(20/25 Snellen).Two weeks later,the patient presented to our clinic with decreased vision due to migration of lens epithelial cells to IOL anterior surface and edema of corneal endothelial cells.Anterior capsule polishing and superotemporal placement of near segment[+3.00 diopter(D)addition(add)]of IOL were performed.As a result,UDVA at the first week and first year after reposition was 0.0 logMAR(20/20 Snellen),and compared with 0.3 logMAR(20/40 Snellen)in the first week,the UNVA was improved to 0.0 logMAR(20/20 Snellen)one year after surgery.CONCLUSION The postoperative inflammatory reaction and lens epithelial cells proliferation were obvious in this glaucoma patient.Capsule polishing and rotation of the lens were beneficial to the patient,which not only enhanced the patient's vision,but also improved the patient's satisfaction.Therefore,glaucoma patients need to be cautious of implanting multifocal IOLs.Placement of a near segment of an asymmetrical multifocal IOL in the dominant eye should be performed on an individual basis.

The Preliminary Clinical Observation of Array Multifocal Intraocular Lens Implantation

Purpose : To evaluate the clinical effects of implantation of Array multifocal intraocular lenses.Methods : Thirty-one cases (37 eyes) of cataract patients, including 15 males(19 eyes)and 16 females(18 eyes), were involved in this study. All patients underwent standard phacoemulsification with Array multifocal intraocular lens implantation. The complications during operation, postoperative distant visual acuity, near visual acuity,corneal curvature and visual symptoms were observed.Results : the mean value of best postoperative visual acuity was recorded as follows: uncorrected distant visual acuity was 0. 8, the best-corrected distant visual acuity was 0.9, uncorrected near visual acuity was 0. 5, near visual acuity with distant-corrected was 0.6, the best-corrected near visual acuity wss 0.9. The astigmatism of cornea was less than 1.5 D pre-operatively and post-operatively. One patient complained of glare. Conclusion : Array multifocal intraocular lens can provide good distant and near visual acuity. With observation of more cases and follow-up of longer time, we can draw a further conclusion. Eye Science 2001; 17 : 57 - 60.

Surgical outcome comparisons of multifocal IOLs of Lentis Comfort LS-313 MF15 and Tecnis Eyhance DIB00V

AIM:To compare the surgical outcomes of a multifocal intraocular lens(IOL;Lentis Comfort LS-313 MF15)with those of an enhanced monofocal IOL(Tecnis Eyhance DIB00V).METHODS:This retrospective study included patients who underwent cataract surgery with LS-313 MF15 or Eyhance IOL implantation.Data regarding patient demographics,surgical records,and ophthalmic examination before the cataract surgery and one and three months postoperatively were collected.Visual acuities,refractive values,defocus curves,contrast sensitivities and subjective symptoms were evaluated.RESULTS:Among the 71 eyes(47 patients)included in this study,32 eyes(20 patients)underwent LS-313 MF15 IOL implantation,and 39 eyes(27 patients)underwent Eyhance IOL implantation.No significant differences were observed in age,axial length,or refractive error between the two groups preoperatively.Furthermore,the distancecorrected and uncorrected distance visual acuities one month postoperatively did not differ between the groups,and both groups had sufficient visual acuities at the distances of 5,1 m,70,50,and 30 cm.Other ophthalmic data,including subjective symptoms based on the 14-item Visual Function Index Questionnaire,monocular defocus curves,contrast sensitivities,and halo and glare,did not differ between the groups three months postoperatively.Moreover,both groups had good outcomes.The spherical equivalent one month postoperatively was significantly myopic in the LS-313 MF15 group compared with that in the Eyhance group(P=0.033);however,this difference was not observed three months postoperatively(P=0.471).CONCLUSION:Comparison of the surgical outcomes of LS-313 MF15 with those of Eyhance with different optical properties reveal that both IOLs show good postoperative outcomes,with no significant differences being noted between the two IOLs.

Evaluation of refractive correction for standard automated perimetry in eyes wearing multifocal contact lenses

AIM：To evaluate the refractive correction for standard automated perimetry（SAP）in eyes with refractive multifocal contact lenses（CL）in healthy young participants.METHODS：Twenty-nine eyes of 29 participants were included.Accommodation was paralyzed in all participants with 1%cyclopentolate hydrochloride.SAP was performed using the Humphrey SITA-standard 24-2 and 10-2 protocol under three refractive conditions：monofocal CL corrected for near distance（baseline）;multifocal CL corrected for distance（m CL-D）;and m CL-D corrected for near vision using a spectacle lens（m CL-N）.Primary outcome measures were the foveal threshold,mean deviation（MD）,and pattern standard deviation（PSD）.RESULTS：The foveal threshold of m CL-N with both the24-2 and 10-2 protocols significantly decreased by 2.2-2.5 d B（P〈0.001）,while that of m CL-D with the 24-2 protocol significantly decreased by 1.5 d B（P=0.0427）,as compared with that of baseline.Although there was no significant difference between the MD of baseline and m CL-D with the24-2 and 10-2 protocols,the MD of m CL-N was significantly decreased by 1.0-1.3 d B（P〈0.001）as compared with that of both baseline and m CL-D,with both 24-2 and 10-2 protocols.There was no significant difference in the PSD among the three refractive conditions with both the 24-2 and 10-2 protocols.CONCLUSION：Despite the induced mydriasis and the optical design of the multifocal lens used in this study,our results indicated that,when the dome-shaped visual field test is performed with eyes with large pupils and wearing refractive multifocal CLs,distance correction without additional near correction is to be recommended.

Rainbow halos occur less following implantation of extended range of vision one-piece intraocular lenses vs diffractive bifocal intraocular lenses

AIM:To evaluate clinical outcomes following implantation of an extended range of vision intraocular lens(IOL),the ZXR00,and a diffractive multifocal IOL with+2.75 diopters(D)add power,the ZKB00.METHODS:Totally 30 patients who underwent either bilateral implantation of the ZXR00 IOL with intended emmetropia(ZXR00 emmetropia group:20 eyes)and intended micromonovision(ZXR00 monovision group:20 eyes),or bilateral implantation of the ZKB00 IOL with intended emmetropia(ZKB00 group:20 eyes)were included in this study.Visual acuity at 4 m,80,and 40 cm;and the types of halos(misty,fine,and rainbow)were analyzed at one and three months after surgery.RESULTS:There were no significant differences in distance visual acuity among the three groups.The mean uncorrected intermediate visual acuity was better in the ZXR00 emmetropia and monovision groups(0.02 logMAR and 0.02 logMAR,respectively)than in the ZKB00 group(0.14 logMAR).The mean uncorrected near visual acuity was worse in the ZXR00 emmetropia group(0.26 logMAR)than in the ZXR00 monovision and ZKB00 groups(0.12 logMAR and 0.10 logMAR,respectively).There was an increased incidence of rainbow halos in the ZKB00 group vs in either ZXR00 group(P=0.033).CONCLUSION:Implantation of the ZXR00 IOL with intended micromonovision provide superior visual acuity than implantation of the ZXR00 IOL with intended emmetropia.The ZXR00 IOLs tend to show a lower incidence of rainbow halos than did the ZKB00 IOL.

Encouraging Visual Outcome of a New Accommodative Intraocular Lens: A Retrospective Long-Term Study with a Mean Follow-Up of 5.3 Years

Purpose: To assess the visual outcome after implantation of the new Hydrophylic IOL type 41 B/G accommodating intraocular lens (AIOL). Methods: The presented lens was implanted during cataract surgery. All patients were offered follow-ups, allowing two postoperative measurements to be performed at 3 months and between 2020 and 2021. The mean time between lens implantation and last follow-up was 5.3 years (min. 1 year, max. 10 years). Excluded were patients with age-related macular degeneration or amblyopia. Patients with a foreign lens implanted into the second eye were included in a separate control group. Corrected distance (CDVA) and uncorrected distance visual acuity (UDVA) at 5 m, and corrected near (CNVA) and uncorrected near visual acuity (UNVA) at 40 cm were assessed. Furthermore, the postoperative spherical equivalent (SE), the dependence on spectacles and the occurrence of optical phenomena were evaluated. Results: The final study cohort consists of 65 patients with 119 implanted AIOLs. Significantly better visual results were obtained in both postoperative follow-ups compared with the preoperative results. The mean values of the last follow-up for the UNVA, CNVA, UDVA, and CDVA were 0.107 ± 0.10;0.039 ± 0.08;0.097 ± 0.11;and 0.040 ± 0.09 logMAR, respectively. Visual outcomes remained on a high level for up to 10 years and showed significantly better results compared to the control group. Postoperative SE was significantly improved. Nearly 70% of patients were no longer dependent on glasses. Furthermore, the occurrence of disturbing optical phenomena was denied by all patients. Conclusion: The results of this AIOL are particularly promising, especially since gratifying visual results could still be measured 10 years after implantation.