Longitudinal Evaluation of Trifocal and Extended Depth of Focus Lenses Implantation using Standard Automated Perimetry Parameters

Purpose: To evaluate reliability and global indices parameters from standard automated perimetry (SAP) in normal eyes undergoing phacoemulsification cataract surgery with implantation of trifocal or extended depth of focus intraocular lens (IOL).Methods: Prospective comparative study. Comparison of trifocal IOL AcrySof IQ PanOptix® and extended depth of focus intraocular lens (EDOF) Tecnis Symfony® IOL. Patients underwent SAP pre- and postoperatively. Reliability indices (false negative rate - FN, false positive rate – FP), global indices (foveal sensitivity threshold, visual field index - VFI, standard pattern deviation – PSD, mean deviation MD) and test duration were analyzed.Results: A total of 23 eyes from 13 patients were in the trifocal IOL group and a total of 22 eyes from 14 patients were in the EDOF group The following results were obtained by analyzing pre- and postoperative SAP of EDOF IOL: the rate of change of FN was 1.95/1.41% (p=0.61); FP 1.64/1.27 (p=0.60); MD -1.60/-1.08dB (p=0.15); foveal sensitivity was 34.5/33.9dB (p=0.41); VFI 98.5/98.4% (p>0.99); PSD 1.85/1.86 (p=0.07); and for test duration 305.81/298.36s (p=0.35); all respectively. Analysis of pre- and postoperative parameters of trifocal IOL was: the rates of change of FN 1.22/1.83% (p=0.29); FP 1.65/1.48% (p=0.95); MD -1.55/-1.37dB (p=0.19) ; foveal sensitivity 33.9/34.9dB (p=0.47) ; VFI 98.6/98.3% (p=0.62); PSD 1.58/2.05 (p=0.02); and test duration 297.17/298.57s (p=0.87); all respectively. Conclusion: We identified a change in the PSD parameters in the trifocal IOL group. No other significant changes were identified in SAP parameters after implantation of trifocal AcrySof IQ PanOptix® and EDOF Tecnis Symfony® IOL. Longitudinal evaluation showed no changes in SAP after Trifocal and EDOF IOL implantation in normal subjects.

Short-Term Effect of Wearing of Extended Depth-of-Focus Contact Lenses in Myopic Children: A Pilot Study

This pseudo-experimental, prospective, and longitudinal pilot study was conducted to characterize the optical and visual changes occurring in the short-term wear of a hydrophilic contact lens (CL) based on extended focus technology (EDOF). A total of 30 eyes of 15 children (age, 6–16 years) were fitted with the EDOF CL Mylo (Mark’ennovy Care SL), performing an exhaustive follow-up for one month evaluating changes in visual acuity (VA), accommodation, binocularity, ocular aberrometry, visual quality, pupillometry, keratometry and biometry. Far and near VA with the CL improved progressively (p < 0.001), obtaining mean final binocular values of −0.08 ± 0.01 and −0.07 ± 0.01 LogMAR, respectively. There was a mean reduction in the accommodative LAG of 0.30 D (p < 0.001), without associated alterations in the magnitude of the phoria and fusional vergences (p ≥ 0.066). A controlled but statistically significant increase (p ≤ 0.005) of ocular high order aberration (HOA) root mean square (RMS), primary coma RMS, primary spherical aberration Zernike term and secondary astigmatism RMS was found with the CL wear. In conclusion, the EDOF CL evaluated provides adequate visual acuity and quality, with associated increased of several HOAs and a trend to reduction in the accommodative LAG that should be confirmed in future studies.

Comparison of Patient Outcomes following Implantation of Trifocal and Extended Depth of Focus Intraocular Lenses: A Systematic Review and Meta-Analysis

Purpose. The purpose is to compare the outcomes of implantation of trifocal intraocular lenses (TIOLs) and extended depth of focus (EDOF) intraocular lenses (IOLs). Methods. A comprehensive search of PubMed, Cochrane Library, EMBASE, and ClinicalTrial.gov was conducted in March 2020 to identify relevant studies. A meta-analysis of the results was performed. Patients implanted with EDOF IOLs or TIOLs in previous studies were included. The primary outcomes of the study were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), and defocus curve. Results. TIOLs and EDOF IOLs provided comparable binocular UDVA (MD = -0.01, 95% CI: -0.04, 0.03, logMAR). However, EDOF IOLs provided better UIVA (MD: -0.08, 95% CI: -0.14, -0.01, logMAR) and worse UNVA (MD: 0.10, 95% CI: 0.06, 0.14, logMAR) than TIOLs. Fewer patients achieved spectacle independence after implantation of EDOF IOLs (RR: 0.74, 95% CI: 0.63, 0.87) than after implantation of TIOLs, especially for near vision (RR = 0.82, 95% CI: 0.68, 0.99). There was no statistically significant difference in contrast sensitivity (CS) under photopic or mesopic conditions with both IOLs. Patient satisfaction after implantation of both IOLs was high. Conclusion. EDOF IOLs and TIOLs provide comparable distance vision. However, EDOF IOLs provide better intermediate vision and worse near vision than TIOLs. The advantages of EDOF IOLs over TIOLs in terms of CS, aberrations, and visual disturbance are not significant. Patients are satisfied with both types of IOLs.

One-year post-operative comparison of visual function and patient satisfaction with trifocal and extended depth of focus intraocular lenses

Purpose To evaluate visual performance with trifocal and extended depth of focus IOL at 1 year post-operatively. Setting BMI Southend Hospital. Design Cohort study. Methods An age-matched cohort of forty subjects bilaterally implanted with the AT LISA 839MP trifocal IOL (20 patients, 40 eyes) and the Tecnis Symfony extended depth of focus IOL (20 patients, 40 eyes) were assessed at 3–6 months and 12–18 months post-operatively. Primary outcome measures were distance (6 m), intermediate (70 cm), near visual acuity (40 cm), and analysis of defocus profiles. Secondary outcomes included contrast sensitivity, Radner reading performance, quality of vision and assessment of halos. Results Distance visual acuity (VA) and defocus areas were similar ( p = 0.07). No significant difference in intermediate VA was noted but the intermediate area of focus was greater in the EDoF (0.31 ± 0.12 LogMAR*m−1) compared to the trifocal (0.22 ± 0.08LogMAR*m−1) ( p = 0.02). However, all near metrics were significantly better in the trifocal group. 80% of trifocal subjects were spectacle independent compared to 50% EDoF subjects. Quality of vision questionnaire found no significant differences between groups, however halo scores were greater at 3–6 months in the trifocal group ( p < 0.01) but no differences were noted at 12–18 months. Conclusions Near vision is significantly better for the trifocal, thus greater levels of spectacle independence. The range of intermediate vision was greater for the EDoF but no difference in intermediate VA. In the early period, differences in contrast sensitivity and halo size/intensity were noted, however, by one-year these measures were not significantly different.

Functional visual acuity after implantation of diffractive extended depth-of-focus intraocular lenses using an echelett optics

Background The prospective comparative case series aimed to evaluate all-distance visual acuity, contrast sensitivity, and functional visual acuity (FVA) of eyes with diffractive extended depth-of-focus (EDOF) intraocular lenses (IOLs) using an echelett optics and monofocal IOLs with the same platform. Methods Diffractive EDOF and monofocal IOLs were implanted in 27 eyes of 27 patients each. At 3 months after implantation, all-distance visual acuities at distances of 0.3, 0.5, 0.7, 1, 2, 3, and 5 m were measured under distance-corrected. Static visual function was also examined using photopic contrast sensitivity and area under the logarithmic contrast sensitivity function (AULCSF). Dynamic visual function was examined with FVA, and mean FVA value, visual maintenance ratio (VMR), mean response time, and number of blinks were evaluated. These outcomes were compared between the two IOLs. Results The mean distance-corrected visual acuities were better at distances of 0.7 m or nearer in eyes with EDOF IOLs. There was no difference in the contrast sensitivities (P > 0.22). In the FVA results, no difference was found in mean FVA and VMR (P > 0.68). Conclusion The static and dynamic evaluations of postoperative visual functions demonstrated that the visual function of eyes with EDOF IOLs under photopic and distance-corrected conditions was comparable to eyes with monofocal IOLs.