Comparison of Patient Outcomes following Implantation of Trifocal and Extended Depth of Focus Intraocular Lenses: A Systematic Review and Meta-Analysis
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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.Keywords:
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Visual performance based exclusively on high luminance and high contrast letter acuity measures often fails to predict individual performance at low contrast and low luminance. Here we measured visual acuity over a wide range of contrasts and luminances (low mesopic to photopic) for 17 young normal observers. Acuity vs. contrast functions appear to fit a single template which can be displaced laterally along the log contrast axis. The magnitude of this lateral displacement for different luminances was well predicted by the contrast threshold difference for a 4 min arc spot. The acuity vs. contrast template, taken from the mean of all 17 subjects, was used in conjunction with individual spot contrast threshold measures to predict an individual's visual acuity over a wide range of luminance and contrast levels. The accuracy of the visual acuity predictions from this simple procedure closely approximates test-retest accuracy for both positive (projected Landolt rings) and negative contrast (Bailey- Lovie charts).
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To evaluate best corrected visual acuity (BCVA) and photopic and mesopic contrast sensitivity in pseudophakic patients implanted either with the aspheric intraocular lens (IOL) designed to correct for corneal spherical aberration or with a conventional IOL.Three surgical centers participated this prospective randomized masked comparative study.Thirty eyes of 30 patients after aspheric lens implantation (Pfizer/Pharmacia Tecnis Z9000) were compared with 30 eyes of 30 age-matched patients after conventional lens implantation (Alcon AcrySof SA60AT). Two to three months after surgery, best spectacle corrected distance visual acuity was measured using the Early Treatment Diabetic Retinopathy Study chart. Contrast sensitivity was measured by sinusoidal grating charts for distance at photopic (85 cd/m(2)) and mesopic (6 cd/m(2)) luminance level with optical correction in place. Tested spatial frequencies were 1.5, 3, 6, 12, and 18 cycles per degree (cpd).The mean BCVA was -0.053 +/- 0.044 logMAR in eyes with the aspheric Tecnis IOL and 0.006 +/- 0.059 logMAR in eyes with the conventional AcrySof IOL (P=.0001). Eyes with the aspheric IOL showed better contrast sensitivity at spatial frequencies of 3 cpd (P<.05) and 6, 12, and 18 cpd (P<.01) in photopic and in mesopic conditions. Peak improvement occurred at 18 cpd and was 36% (0.29 log units) in photopic and 54% (0.27 log units) in mesopic conditions.The aspheric Tecnis IOL yielded better BCVA and better distance contrast sensitivity than the conventional IOL. The differences were clinically significant for higher spatial frequencies. The results give some suggestions for further studies.
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Objectives. To investigate how add power affects binocular distance visual acuity in subjects wearing simultaneous vision, balanced progressive, multifocal contact lenses. Methods. Twenty-five young normally sighted subjects were fit binocularly, according to the manufacturers’ fitting nomogram, with CooperVision Proclear Multifocal contact lenses. A multifactorial experimental design was used to study distance visual acuity measured to the single letter with repeated measures on add power (+1.00, +1.50, +2.00, +2.50), light level (photopic and mesopic), and Bailey-Lovie chart contrast (high and low). Results. The relationship between add power and visual acuity was analyzed by linear regression for each of the 4 test conditions. The corresponding mean decrease in equivalent Snellen visual acuity from 20/16 to 20/17 between the +1.00 and +2.50 add powers for the photopic light level, high contrast test condition was not significant (F = 3.068, P=0.083). However, the change in visual acuity from 20/24 to 20/27 between the same add powers for the low contrast, photopic test condition was significant (P=0.048), as was the loss in visual acuity from 20/24 to 20/28 for the high contrast, mesopic test condition (P=0.005) and the reduction from 20/45 to 20/61 for the low contrast, mesopic light level test condition (P=1.5 × 10−5). Pupil diameter averaged 3.9 ± 0.07 mm and 6.2 ± 0.12 mm under photopic and mesopic light levels, respectively. Conclusions. Distance visual acuity averaged better than 20/20 for all add powers under high contrast, high illumination test conditions and decreased by a small, but significant amount, under other testing conditions.
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To compare the impairment in visual function caused by glare with 2 acrylic intraocular lenses (IOLs) with different modified optic edges.Hayashi Eye Hospital, Fukuoka, Japan.Fifty-four patients had implantation of an IOL with a textured edge (Alcon MA60AC) in 1 eye and an IOL with a round-anterior, sloped-sided edge (AMO AR40e) in the opposite eye. Visual acuity was measured at 5 contrast visual targets (100%, 25%, 10%, 5%, and 2.5%) (contrast visual acuity) under photopic and mesopic conditions with and without a glare source approximately 1 month after surgery using the Contrast Sensitivity Accurate Tester (Menicon CAT-2000).The mean mesopic contrast visual acuity at moderate- to low-contrast visual targets was significantly worse in the presence of a glare source in both groups, whereas photopic contrast visual acuity did not change significantly. There were no significant differences between the 2 groups in the mean visual acuity or in photopic or mesopic lighting contrast visual acuity with and without a glare source. Furthermore, there was no significant difference in loss of contrast visual acuity in the presence of glare.Mesopic contrast sensitivity with both acrylic IOLs was impaired significantly in the presence of glare, but the impairment of contrast sensitivity from glare was approximately the same between eyes with a textured-edge IOL and eyes with a round-anterior, sloped-sided edge IOL.
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Summary We evaluated contrast sensitivity and glare in 64 pseudophakic eyes. An ultraviolet‐absorbing intraocular lens (IOL) was implanted in 32 eyes and a noncyanopsia yellow‐tinted IOL was implanted in 32 eyes. The latter lens was designed to effectively absorb light below a wavelength of 500 nm. Contrast sensitivity was measured at a pupil diameter of 3 mm using an artificial pupil. The implanted yellow‐tinted IOL showed improved contrast sensitivity in the middle spatial frequencies of 6 and 12 c/deg in photopic and mesopic vision. In addition, the yellow‐tinted IOL decreased the effect of central glare on the contrast sensitivity.
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Objective To compare the contrast sensitivity (CS) of different aspheric implanted intraocular lenses.Methods Ninety patients were randomized to receive three types of IOL:an aspheric IOL with a modified anterior surface (AMO Tecnis ZA 9003,30 eyes,Group A),an aspheric IOL with a modified posterior surface (Alcon IQ SN60WF,30 eyes,Group B) and an IOL with spherical surface (AMO AR40e,30 eyes as control group).All the operations were finished by one experienced operator.The contrast sensitivity (CS) under mesopic (3 cd/m2) and photopic (85 cd/m2) condition with 4 different spatial frequencies of 3,6,12,18 cycles per degree (c/d) were performed 6 months postoperatively.Results The patients of two aspheric intraocular lenses groups had better contrast sensitivity after operation than the patients with spherical lenses.There was a significant difference between the two aspheric groups and the spherical group under the low spatial frequencies of 3,6 c/d (P ＜0.05).With a glare source of 85cd/m2,the patients with spherical lenses had lower contrast sensitivity under the spatial frequency of 18c/d but two aspheric groups.Conclusions The two aspheric intraocular lenses are better for the quality of vision for patients compared with the traditional spherical lenses.
Key words:
Aspheric intraocular lenses; Contrast sensitivity; Cataract
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Objective We compared spherical aberration and contrast sensitivity in spherical intraocular lens eyes and aspherical intraocular lens eyes in order to obtain an Objective Evalution of the optical quantity of these two kind IOLs eyes.Methods This prospective study included 60 patients(60 eyes),divided in 2 groups equal.In group 1 one eye was planted with spheical iols and the other group were planted with aspherical iols.The spherical iols were Acrysof SN60.(Alcon co,ltd)and the aspherical iols were Acrysof SN60WF.Before the surgery,cornea curvation、 Q-value 、eyes abbreationswere measured by ocular anterior segment diagnosis systerm(Orbscan II,Baush Lomb Co ltd)and a Hartmann-shack-type aberrometer(Zywave,Baush Lomb Co ltd)at 6.0 mm pupil diameter or more and assessment of photopic and mesopic contrast sensitivities were measured by Optec-6500 Contrast Sensitivity Tester.Three months after cataract surgery,abbreations 、Q-value and assessment of photopic and mesopic contrast sensitivities were measured again.The RMS value of total abbreations,total high order abbreations and spherical abbreations in each group were compared.Assessment of photopic and mesopic contrast sensitivities were measured respectively.Results Visual accurity were increased greatly post-op.The RMS value of total abbreations,total high order abbreations and spherical abbreations of each group were decreased than that of pre-op.(P0.01)Visual accurity were same between spherical iol eyes and aspherical iol eyes in daytime(P0.05).The SN60WF IOL eyes provided significantly better contrast sensitivity at almost all spatial frequencies under photopic conditions and mesopic conditions in comparison with the SN60 IOL eyes.When patient's pupil were dilated to 6.0 mm,total high order abbreations and spherical abbreations in aspherical iol eyes were lower than that of spherical iol eyes(P0.05).Conclusion Visual accurity and visual quantity were increased and total abbreations were decreased after the surgeries,total high order abbreations were decreased.In dark conditions(such as in darkroom or keep a big pupil),total abbreations and high order abbreations of aspherical iol eyes were lower than that of spherical iols eyes.The contrast sensitivity at some spatial frequencies of aspherical iol than that of the spherical IOL.The aspherical iol can improve the visual quality.
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We evaluated contrast sensitivity and glare in 64 pseudophakic eyes. An ultraviolet-absorbing intraocular lens (IOL) was implanted in 32 eyes and a noncyanopsia yellow-tinted IOL was implanted in 32 eyes. The latter lens was designed to effectively absorb light below a wave-length of 500 nm. Contrast sensitivity was measured at a pupil diameter of 3 mm using an artificial pupil. The implanted yellow-tinted IOL showed improved contrast sensitivity in the middle spatial frequencies of 6 and 12 c/deg in photopic and mesopic vision. In addition, the yellow-tinted IOL decreased the effect of central glare on the contrast sensitivity.
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To assess contrast sensitivity and patient reported outcomes after uncomplicated cataract surgery with a new bi-aspheric diffractive trifocal intraocular lens (IOL) implantation.Twenty-five patients who underwent bilateral implantation with the Asqelio Trifocal TFLIO130C IOL (AST Products Inc., Billerica, MA, USA) were analyzed at 6 months post-surgery. Binocular contrast sensitivity with and without glare was measured under photopic conditions (85 cd/m2) and mesopic conditions (3 cd/m2). Patients were asked to complete the Catquest-9SF patient outcomes questionnaire and a visual symptoms questionnaire.Photopic contrast sensitivity values were either within or above normal levels without glare; when glare was induced, the mean sensitivity values dropped just below normal range. Mesopic contrast sensitivity values were above or within normal range both with and without glare, except for 12 cpd with glare, where the mean fell just below the normal range. Differences in binocular contrast sensitivity threshold values with and without glare were significant for all spatial frequencies tested under both photopic and mesopic conditions (p<0.05). The Catquest-9SF questionnaire outcomes showed that 88% of patients were either satisfied or very satisfied with their sight after the surgery, and in all cases, the results indicated no difficulty in performing different daily activities. The visual symptoms questionnaire indicated no relevant visual symptoms regarding frequency, intensity, or bothersomeness after implantation of the trifocal IOL.This novel bi-aspheric diffractive trifocal IOL provides good contrast sensitivity outcomes under bright and dim lighting conditions. Patients were satisfied with the surgery, with no relevant visual symptoms.
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