Astigmatic correction with implantation of a light adjustable vs monofocal lens: a single site analysis of a randomized controlled trial

AIM: To evaluate the light adjustable lens (LAL) vs a standard monofocal lens in achieving target astigmatic refraction and improving postoperative uncorrected distance visual acuity (UDVA).METHODS: This randomized controlled clinical trial included 40 patients with pre-existing astigmatism and visually significant cataract. Twenty-eight patients received the LAL and 12 control patients received a monofocal intraocular lens (IOL) after cataract extraction at a single institution. The patients with the LAL underwent adjustment by ultraviolet (UV) light postoperatively plus subsequent lock-in procedures and all patients returned to clinic for follow up of study parameters at 6, 9, and 12mo. Manifest refraction, distance visual acuity, and adverse events were recorded at each visit. RESULTS: The mean cylinder before adjustment in eyes with the LAL was -0.89±0.58 D (-2.00 to 0.00 D) and -0.34±0.34 D (-1.25 to 0.00 D) after lock-in (P=1.68×10^-8). The mean cylinder in patients with the monofocal lens was -1.00±0.32 D (-1.50 to -0.50 D) at 17-21d postoperatively, which was statistically different from the LAL cylinder post lock-in (P=1.43×10^-6). UDVA in the LAL group was 20/20 or better in 79% of patients post lock-in with good stability over 12mo compared with 33% of the control patients with UDVA of 20/20 or better.CONCLUSION: These results demonstrate that the LAL is more effective in achieving target refractions and improving postoperative UDVA in patients with pre-existing corneal astigmatism than a standard monofocal lens.

A comparison of visual outcomes in three different types of monofocal intraocular lenses

AIMTo compare the visual outcomes (distance and near) in patients opting for three different types of monofocal intraocular lens (IOL) (Matrix Aurium, AcrySof single piece, and AcrySof IQ lens).METHODSThe present study is a cross-sectional analysis of secondary clinical data collected from 153 eyes (52 eyes in Matrix Aurium, 48 in AcrySof single piece, and 53 in AcrySof IQ group) undergoing cataract surgery (2011-2012). We compared near vision, distance vision, distance corrected near vision in these three types of lenses on day 15 (±3) post-surgery.RESULTSAbout 69% of the eyes in the Matrix Aurium group had good uncorrected distance vision post-surgery; the proportion was 48% and 57% in the AcrySof single piece and AcrySof IQ group (P=0.09). The proportion of eyes with good distance corrected near vision were 38%, 33%, and 15% in the Matrix Aurium, AcrySof single piece, and AcrySof IQ groups respectively (P=0.02). Similarly, The proportion with good “both near and distance vision” were 38%, 33%, and 15% in the Matrix Aurium, AcrySof single piece, and AcrySof IQ groups respectively (P=0.02). It was only the Matrix Aurium group which had significantly better both “distance and near vision” compared with the AcrySof IQ group (odds ratio: 5.87, 95% confidence intervals: 1.68 to 20.56).CONCLUSIONMatrix Aurium monofocal lenses may be a good option for those patients who desire to have a good near as well as distance vision post-surgery.

A systematic review of pseudophakic monovision for presbyopia correction

A systematic review of the recent literature regarding pseudophakic monovision as a reliable methods for presbyopia correction was performed based on the PubMed, MEDLINE, Nature and the American Academy of Ophthalmology databases in July 2015 and data from 18 descriptive and 12 comparative studies were included in this narrative review. Pseudophakic monosvision seems to be an effective method for presbyopia with high rates of spectacles independence and minimal dysphotopsia side- effects, that should be considered by the modern cataract surgeons.

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.

The effects of premium intraocular lenses on presbyopia treatments

Background:Presbyopia has become a global disease affecting the world's aging population.Among various treatments,cataract extraction and intraocular lens(IOL)implantation have become the most popular and common methods of presbyopia correction.During the twentieth century,IOLs have underwent significant innovation and advancements to meet the patients'high demands for functional vision at all distances.Main Text:To meet the increasing needs for excellent near and intermediate vision for daily activities,some premium IOLs with more than one focus have been developed,for example,the refractive MfIOLs,diffractive MfIOLs,extended depth of field(EDOF)IOLs,and accommodating IOLs(AIOLs)were introduced to meet this need.In addition,the add-on MfIOLs have been explored as promising supplementary IOLs for pseudophakic presbyopia.When selecting the MfIOLs,the IOLs'features,patients’characteristics,preoperative eye conditions,and treatment expectations should be considered.Conclusions:In this review,we focus on the multifocal IOLs(MfIOLs)commonly used for presbyopia correction and systematically summarized their optical designs and clinical outcomes.More evidence-based studies are required to provide guidelines for MfIOL selection,provide maximum visual benefits,and develop personalized visual solutions in the future.