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Abstract

Purpose: To evaluate the standard clinical outcomes, defocus curves, and satisfaction obtained with a new diffractive low addition trifocal intraocular lens (IOL). Methods: Thirty patients who were implanted with the Versario Multifocal 3F IOL (Valeant Med Sp.zo.o., Warsaw, Poland) were recruited for a prospective observational study at Qvision, Vithas Virgen del Mar Hospital, Almería, Spain. Variables for reporting standard outcomes were collected at the 1-month visit for monocular vision and the 3-month visit for binocular vision, including best spectacle refraction and corrected and uncorrected visual acuities at far, intermediate (67 cm), and near (40 cm) distances. In addition, monocular and binocular visual acuity defocus curves were measured and questionnaires for grading subjective visual quality, satisfaction, and visual function were supplied at the end of the follow-up. Results: Monocular corrected distance visual acuity decreased progressively from far (-0.05 logMAR) to near (0.25 logMAR) and improved approximately -0.1 logMAR along the defocus curve in binocular vision. The mean residual spherical equivalent (SE) was 0.15 ± 0.47 diopters (D), with 79% of eyes within ±0.50 D and 97% within ±1.00 D with the SRK/T formula. All of the visual function tasks improved after surgery, especially driving at night, which increased from 58 to 79 (P < .05). Of 27 patients, 84.4% were satisfied or very satisfied with their general vision. Conclusions: This new lens was similar in terms of visual performance and satisfaction to other trifocal IOLs. It can be classified as a trifocal extended depth of focus IOL because of the performance between extended depth of focus IOLs and medium-high addition trifocal IOLs. [J Refract Surg. 2019;35(4):214-221.].

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... Up to date, in the available literature there is only one study describing 3 months standard visual outcomes after implantation of new low addition (+3.00 diopters) Versario 3F (Bausch & Lomb) trifocal IOls (6) and the results were promising. It is known from other studies results that neuro-adaptation process lasts at least 6 months and has an important role in the improvement of visual outcomes and reduction of unwanted effects like glare and halo after implantation of multifocal IOLs (6,7,8,9,10). ...
... Up to date, in the available literature there is only one study describing 3 months standard visual outcomes after implantation of new low addition (+3.00 diopters) Versario 3F (Bausch & Lomb) trifocal IOls (6) and the results were promising. It is known from other studies results that neuro-adaptation process lasts at least 6 months and has an important role in the improvement of visual outcomes and reduction of unwanted effects like glare and halo after implantation of multifocal IOLs (6,7,8,9,10). It was the reason why we decided to analyse six months visual outcomes, patients' satisfaction and complications after bilateral implantation of Versario 3F trifocal intraocular lenses. ...
... The presented visual function outcomes six months after implantation of Versario intraocular lenses (IOLs) were promising and comparable with data presented by Fernandez et al. (6). ...
Preprint
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PurposeTo study visual outcomes after implantation of Versario intraocular lenses (IOLs) Patients and Methods In 20 selected patients (40 eyes) uneventful, bilateral cataract surgeries with implantation of trifocal Versario (IOLs) were performed. Designprospective case series. Six months after surgery the following parameters were analysed: binocular uncorrected visual acuities (log MAR): for distance (UDVA) at 4 m, for intermediate (UIVA) at 60, 70, 80 cm and for near (UNVA) at 40 cm, photopic defocus curve, mesopic and photopic contrast sensitivities (CSs), spectacle independence, visual function test questionnaire (modified VFQ-25), subjective symptoms and postoperative complications. ResultsSix months after surgery, the mean of binocular visual acuities were as follows: UDVA: -0.12 ± 0.08; UIVA (60 cm): +0.07 ± 0.10, (70 cm): +0.05 ± 0.11, (80cm): +0.07 ± 0.09; UNVA (40cm): +0.12 ± 0.08. CSs in mesopic and scotopic conditions for distance and photopic for near were between normal range of age- match healthy control. All patients were spectacle independent. General satisfaction was high and equal 9.37±0.83. No severe glare and halo were detected. There were no postoperative complications. Conclusions The bimanual MICS with the Versario lenses implantation was a safe and effective method for patients who want to be spectacle independent at different distances.
... One of the main factors for dissatisfaction after monofocal pseudophakic eyes is lack of accommodation. Previous studies demonstrated that this problem could be resolved using diffractive trifocal IOLs [2][3][4][5][6][7][8][9][10]. Diffractive trifocal IOLs provide effective near, intermediate and distance visual restoration, and have been widely used in patients who want to achieve spectacle independence after surgery. ...
... Diffractive trifocal IOLs provide effective near, intermediate and distance visual restoration, and have been widely used in patients who want to achieve spectacle independence after surgery. However, some possible optical side effects of trifocal IOLs have been reported, including halos and other dysphotopsias, reduced contrast sensitivity, and glare disability [3,[9][10][11], which can signi cantly affect visual quality and patient satisfaction [11,12]. ...
... In the RayOne and PanOptix IOL groups, the mean postoperative third-month monocular logMAR UDVA values were 0.07 ± 0.09 and 0.057 ± 0.06, respectively and the binocular logMAR UDVA values were 0.02 ± 0.04 and 0.01 ± 0.13, respectively. These results are similar to those previously reported for a variety of diffractive trifocal IOLs [2][3][4][5][6][7]14,15]. Concerning near vision, the mean monocular logMAR UNVA values were 0.07 ± 0.12 and 0.02 ± 0.05 and the binocular logMAR UNVA values were 0.02 ± 0.03 and 0.01 ± 0.04 in the RayOne IOL group and PanOptix IOL group, respectively. ...
Preprint
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Purpose To evaluate the clinical outcomes and visual quality of patients undergoing cataract surgery with the implantation of two different models of diffractive trifocal intraocular lenses (IOLs). Methods This randomized prospective comparative study included 60 eyes of 15 patients who scheduled to undergo bilateral cataract surgery with the implantation of two models of diffractive trifocal IOLs (RayOne Trifocal and AcrySof IQ PanOptix IOL). Monocular and binocular corrected and uncorrected distance visual acuity (CDVA, UDVA), intermediate visual acuity (DCIVA, UIVA) at 60 and 80 cm, near visual acuity (DCNVA, UNVA), and patient satisfaction were compared over a three-month follow-up. Results Each group comprised 30 eyes of 15 patients. No statistically significant differences were determined between the groups in terms of CDVA, UDVA, DCNVA and UNVA. The monocular and binocular UIVA values at 60 cm were better in the PanOptix IOL group (p=0.04 and p=0.01, respectively), and the DCIVA and UIVA values at 80 cm were better in the RayOne IOL group (p=0.01, p=0.047, p<0.001, and p=0.042, respectively). No statistically significant difference was found between the groups in relation to the frequency and severity of visual symptoms evaluated. Regarding discomfort, the RayOne IOL group had more bothersome halos and starbursts (p=0.026 and p=0.01, respectively). Conclusion Both IOLs provided very good restoration of visual acuity. However, with the AcrySof IQ PanOptix IOL, the likelihood of patients experiencing bothersome halos and starbursts was less. The RayOne Trifocal IOL might be a better choice for patients who require further intermediate vision. The study was registered under the World Health Organization international clinical trials registry platform: NCT04655274, 30/11/2020, prospectively registered.
... This was consistent with the high levels of refractive predictability achieved, with almost all eyes (99%) having a postoperative spherical equivalent within ±0.50 D. These results were consistent with or even better than those reported with other models of multifocal IOLs. [12][13][14][15][16][17][18][19] Likewise, the UDVA and CDVA outcomes obtained were also similar to those found with EDOF IOLs, confirming the excellent optical performance of this new presbyopia-correcting IOL for distance foci. 12,17,19,20 Manifest residual cylinders of 0.50 D or greater were found to have a significant impact on distance visual outcomes. ...
... These results are clearly better than those reported for EDOF IOLs, 12,17,19,20 and also for most multifocal IOLs previously evaluated. 9,[12][13][14][15]17,19,[25][26][27][28] Fernández et al 15 28 respectively. In our series, low contrast monocular UNVA was also found to be in the levels of photopic values reported for other multifocal IOLs, with only a loss of half of a logMAR line (0.05 logMAR) with the worsening of light conditions. ...
... These results are clearly better than those reported for EDOF IOLs, 12,17,19,20 and also for most multifocal IOLs previously evaluated. 9,[12][13][14][15]17,19,[25][26][27][28] Fernández et al 15 28 respectively. In our series, low contrast monocular UNVA was also found to be in the levels of photopic values reported for other multifocal IOLs, with only a loss of half of a logMAR line (0.05 logMAR) with the worsening of light conditions. ...
Article
Purpose: To evaluate the clinical outcomes including patient-reported outcome measures in a sample of eyes undergoing bilateral cataract surgery with implantation of a new model of presbyopia-correcting intraocular lens (IOL). Methods: This non-randomized prospective case series enrolled 206 eyes of 103 patients undergoing phacoemulsification cataract surgery with bilateral implantation of the TECNIS Synergy IOL (Johnson & Johnson Vision). High and low contrast visual acuity, refractive, defocus curve, and patient-reported visual performance (Catquest-9SF questionnaire) outcomes were evaluated during a 3-month follow-up. Results: A total of 96.1% (99 of 103) and 91.3% (94 of 103) of patients achieved binocular postoperative uncorrected distance (UDVA) and near visual acuity (UNVA) of 0.00 logMAR (20/20), respectively. Mean postoperative mesopic UNVA for both eyes was 0.14 ± 0.03 logMAR. Likewise, mean binocular UDVA and UNVA were 0.00 ± 0.03 and 0.04 ± 0.02 logMAR. An almost flat mean defocus curve was obtained, with visual acuities between 0.00 and 0.10 logMAR for most defocus levels in both eyes. A reduction of contrast led to a limited but statistically significant change in UNVA in both eyes (P < .001). The Rasch calibrated scoring of item 2 and the Rasch calibrated mean score of the Catquest-9SF questionnaire increased significantly with surgery (P < .001). Conclusions: This new presbyopia-correcting IOL provides a continuous range of functional focus, with a limited deterioration under mesopic conditions, which is perceived as a satisfactory outcome by the patient if proper patient selection is performed. [J Refract Surg. 2021;37(4):256-262.].
... Unfortunately, subjective refraction is not invariant, and there are random error sources attributed to the refraction process, such as depth of field [9], lens manufacturing [10], patient pupil diameter [9], the experience of the clinician in the refraction process [11], and patient's visual acuity (VA) [12,13] that might influence in the results of paired study designs of IOL power formulae comparison. In addition, studies with multifocal IOLs (MIOLs) have generally reported better predictability than with monofocal IOLs (mIOLs), which might be explained by a higher tolerance of far distance defocus with MIOLs during the subjective refraction [14]. ...
... Actually, instead of considering a disadvantage to use SRK-T in this study, we consider that it is an advantage because the SRK-T formula resulted in lower PE in the SG group, especially considering this is a vergence formula using two instead of three predictors as Haigis [21], and this could be more unexpected than the direct comparison of two modern formulas for which synthesis of evidence has not still published to demonstrate the superiority of one of them over the other [22,23]. Other interesting finding in our study was that only statistically significant differences were found for the mIOL group which could be explained by a higher tolerance of far distance defocus with MIOLs during the subjective refraction [14]. Our results provide evidence to suggest that in any study comparing IOL power calculation formulae, especially with mIOLs, the formula used for selecting the IOL power has higher probability to result in better predictability due to the fact that refraction cannot be considered as invariant. ...
Article
Full-text available
Purpose To assess the influence in paired design studies of formulae comparison for intraocular lens (IOL) power calculation of using a single formula for deciding the implanted power with monofocal (mIOL) and multifocal (MIOL) lenses. Design Retrospective observational. Methods Ninety-six right eyes were retrospectively analyzed. Eyes were assigned in two independent groups, SG and HG, depending on the formula used for deciding the implanted power, SRK-T (n = 54) and Haigis (n = 42), respectively. Median absolute prediction error (MedAE) was evaluated between independent samples (SRK-T in SG vs Haigis in HG) and between paired samples (SRK-T vs Haigis in both SG and HG). Percentages of eyes within a specific range of prediction error (PE) were also calculated for both, the standard steps and the clinically relevant steps. Results MedAE difference was lower than 0.09 D between both formulas for the comparison of independent samples in the mIOL (p = 0.62) and MIOL (p = 0.83) groups. However, paired samples resulted in better MedAE for SRK-T in the SG (0.14 D lower, p = 0.003) and for Haigis in the HG (0.07 D lower, p = 0.015), but only in the mIOL group. These small differences were also manifested, but not reaching statistical significance (p > 0.05), in the percentage of eyes achieving a specific range of PE, especially in the mIOL group. Conclusions A small superiority for the formula used for selecting the final implanted IOL power can appear in studies following current standards. These studies should clearly specify which formula was used for selecting the implanted power.
... The accuracy between the predicted and the postoperative spherical equivalent was -0.10 ± 0.41 D, with 80.9% of the eyes within ± 0.5 D and 97.1% within ± 1.0 D of the predicted value. These results were consistent with the data recently published with the Versario 3F (Valeant Med Sp.z o.o, Warsaw, Poland) or the PanOptix (Alcon Inc., Fort Worth, USA) multifocal IOLs with, respectively, 72% and 82% of the eyes within ± 0.5 D of planned correction [25,26]. ...
Article
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Background The aim was to evaluate the safety and efficacy of a trifocal intraocular lens (IOL) for the correction of presbyopia and to assess patient satisfaction. Methods Records from three centres were reviewed to select presbyopic patients having undergone bilateral refractive lens exchange and implantation of the AT LISA tri 839MP multifocal IOL. Postoperatively, monocular and binocular distance, intermediate and near visual acuities, corrected and uncorrected, and subjective refraction were measured. Patients also completed a quality of life questionnaire. Safety evaluation included IOL stability and postoperative complications. Results 72 eyes (36 patients) were analysed. No clinically significant difference between pre- and postoperative corrected distance visual acuity (CDVA) was found for monocular or binocular measurements. Mean postoperative monocular CDVA was 0.02 ± 0.04 logMAR. Mean refractive values all improved statistically significantly compared with preoperative baseline (p ≤ 0.0064). Overall, 82.4% of eyes had spherical equivalent within ± 0.5 D and 97.1% within ± 1.0 D of emmetropia with a mean accuracy of -0.10 ± 0.41 D. Spectacle independence for distance, intermediate and near visual acuity was 87.5%, 84.4% and 78.1% respectively, and 78.1% of patients were satisfied with their postoperative, spectacle-free vision. Eight eyes received Nd:YAG laser treatment. No other IOL-related safety issues were reported. Conclusion AT LISA tri 839MP multifocal IOL bilaterally implanted in presbyopic patients provided excellent distance, intermediate and near visual outcomes with very accurate correction of refraction. These results were associated with a high level of spectacle independence and patient satisfaction. Trial registration Trial registered on https://clinicaltrials.gov/ under the identification NCT03790592 (31/12/2018).
... Advances in optics in last years have led to the development of more sophisticated and efficacious intraocular lenses (IOL) to provide a completely functional visual restoration after cataract surgery. 1 A great variety of presbyopia-correcting IOLs are currently commercially available, including extended depth of field (EDOF) and optimized diffractive trifocal IOLs, that provide different levels of functional visual restoration for different patient's profiles, although with some similarities between specific designs. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Last developments on IOLs are mainly focus on finding the best compromise between the range of visual rehabilitation and the induction of postoperative photic phenomena and contrast sensitivity reduction. 20 One of these developments is the combination of an EDOF profile 21,22 with a Multifocal diffractive design 23 to theoretically obtain continuous high-contrast vision from far through near, under photopic conditions (85 cd/m 2 ), and subjective evaluation of the photic phenomena by means of the QoV (quality of vision) questionnaire. ...
Article
Full-text available
Purpose: To evaluate and compare the clinical outcomes after cataract surgery with implantation of three different types of trifocal diffractive intraocular lenses (IOLs). Setting: Hospital da Luz, Lisbon, Portugal. Design: Prospective comparative case series. Methods: 180 eyes of 90 patients undergoing phacoemulsification cataract surgery with implantation of one of these trifocal IOLs were enrolled: Tecnis Synergy (J&J Vision) (Synergy group, 30 patients), Acrysof PanOptix (Alcon) (PanOptix group, 30 patients), and POD F (PhysIOL) (Finevision group, 30 patients). The outcomes in terms of distance, intermediate and near visual acuity (VA), refraction, defocus curve, photic phenomena and spectacle independence were evaluated at 3-months follow-up. Results: No significant differences were found between groups in monocular distance-corrected intermediate (Synergy 0.04±0.11, PanOptix 0.05±0.09, Finevision 0.08±0.10; p=0.107) and near VA (0.01±0.08, 0.01±0.06, 0.04±0.10; p=0.186). Likewise, no significant differences among groups were found in binocular uncorrected distance (p=0.572), near (p=0.929) and intermediate VA (p=0.327). In contrast, significant differences between groups were found in the visual acuity for the vergence demands of -0.50, -1.00, -2.00, -3.50 and -4.00 D (p≤0.045). No significant differences among groups were found either in the frequency, severity and bothersomeness of different disturbing visual symptoms, including glare and haloes (p≥0.129). More than 96% of patients in all groups did not require the use of spectacles at any distance after surgery. Conclusions: The three trifocal IOLs evaluated provide an effective visual rehabilitation with minimal incidence of photic phenomena. A trend to obtain a wider range of functional focus was observed with the Tecnis Synergy IOL.
... 9,10,[12][13][14] Recently, a new trifocal IOL has been introduced in the market: the Versario 3F (Bausch & Lomb Surgical, Bridgewater, NJ). Clinical tests indicate that the new lens might be classified as a "trifocal extended depth of focus IOL because of the performance between extended depth of focus IOLs and mediumhigh addition trifocal IOLs." 15 The optical quality of an IOL can be assessed using optical and clinical methods; optical bench testing is complementary to clinical assessments because it is objective and independent of the patient. Therefore, in this study, we aim to assess the in vitro optical properties of this new lens, focusing on the spectral performance and, in particular, on the chromatic aberrations. ...
Article
Full-text available
Purpose: To compare the chromatic performance of the Bausch & Lomb Versario 3F trifocal intraocular lens (IOL) with the PhysIOL FineVision MicroF trifocal IOL and the Johnson & Johnson Vision TECNIS Symfony ZXR00 extended range of vision (ERV) IOL. Methods: The through-focus energy efficiency (TF-EE) was measured in vitro with red (R), green (G), and blue (B) wavelengths and was used to obtain the focus powers and longitudinal chromatic aberrations (LCAs) for each IOL. Other metrics, derived from the RGB TF-EE curves, were assessed for a more complete description of the chromatic performance of the IOLs. Results: Both of the trifocal IOLs, although not specifically designed to tackle chromatic aberrations, showed acceptable LCA (≤0.50 D) in all foci with more balanced R and B efficiencies of their foci. Despite having the lowest TF-EE value at all foci, the Versario 3F demonstrated the most balanced chromatic performance with the smoothest energy transition among all foci and the smallest chromatic span. The Symfony lens effectively reduced LCA at distance and intermediate foci (≤0.36 D), despite the unbalanced and asymmetric R and B efficiencies at its foci. Conclusions: To fully describe the chromatic performance of an IOL it is necessary to take into account not only the LCA but also the RGB TF-EE and chromatic span. This comprehensive analysis suggests that, in comparison with the other IOLs under study, the Versario 3F lens might contribute to further mitigating the impact of chromatic aberration. Translational relevance: The in vitro bench testing of the optical properties of modern presbyopia-correcting intraocular lenses (more specifically in this work, the polychromatic through-focus energy efficiency and longitudinal chromatic aberration) provides objective and complementary information that helps to interpret the visual quality outcomes of pseudophakic patients obtained in clinics.
... Furthermore, it is important to note that unlike studies with monofocal IOLs on which 90% of the eyes in ±0.5 D is a very high percentage, for multifocal IOLs a 90% is usually reported. 29 Therefore, our results of predictability were in agreement with those usually reported for MIOLs. The most important differentiating factor of our study in comparison to the previous ones is the complete inclusion of photopic and mesopic, with and without glare. ...
Article
Purpose/Aim to assess, following the standards, the results of safety, efficacy and predictability for a trifocal intraocular lens and to evaluate contrast sensitivity and visual acuity defocus curve. Materials and Methods 50 subjects operated on cataract surgery or refractive lens exchange with a trifocal intraocular lens have been recruited for the study. The monocular uncorrected visual acuity (VA) at far, intermediate (67 cm) and near (40 cm) distances in addition to corrected VA at far and near distances was evaluated at 1 week, 1 month and 3 months after surgery. Postoperative refraction, binocular contrast sensitivity function (CSF) and binocular defocus curves were also collected at the 3 months follow-up visit. Results Mean uncorrected VA was 0.10, 0.07 and 0.05 logMAR at far, intermediate and near distances. Corrected distance VA at far and near distances was 0.04 and 0.02 logMAR. 90% and 100% achieved a spherical equivalent in ±0.50 D and ±1.00 D, respectively. CSF was above normal range for 12 and 18 cycles per degree (cpd) in all the conditions, inside the normal range in 1.5, 3 and 6 cpd and only decreased below normal range for 1.5 and 3 cpd in mesopic vision without glare. Conclusions The procedure achieved a safety, efficacy and predictability similar to those reported by previous studies. The CSF was generally enhanced after the procedure in comparison to those reported in non-operated subjects above 60 years old. Previous studies might underestimate the effective distance of the intermediate and near foci.
... A ccuracy in intraocular lens (IOL) power calculation has become a topic arousing great interest, because nowadays crystalline-lens replacement can be considered not only for the surgical treatment of an ocular disease but also for a refractive surgery procedure. 1 New formulas and updates to existing ones have been proposed recently, but refractive-status prediction errors greater than ± 0.50 diopters (D) still occur in a rather high percentage of cases-which ranges between 8% and 50% of the eyes, depending on the specific study or sample stratification, [2][3][4][5][6][7][8][9] -with the best accuracy obtained for multifocal IOL (mIOL) implantation procedures, and the vast majority of surgeons being clustered around 78%. 5,10 The major part of the methods for IOL power calculation is based on the vergence formula, and the main difference lies in the estimation of the effective lens position including from 2 up to 7 variables, some of them corresponding to eye parameters. 5,11 The wide range of the reported accuracy values can therefore be partly explained by the bias in accuracy of formulas according to eye parameters. ...
Article
Purpose: To develop a new method that makes it easy to detect accuracy deficiencies of any intraocular lens power calculation formulae and to test it on 9 different formulae. Setting: IOA, Madrid, Spain DESIGN:: Retrospective observational case series. Methods: This study's first stage included 3519 eyes from 3519 candidates to cataract surgery for which frequency distributions for the following biometric eye parameters were computed: axial length (AXL), anterior-chamber depth (ACD), lens thickness (LT), white-to-white (WTW) and mean corneal radius (Rm). The resulting data for each parameter were 5, 25, 75 and 95 percentile, which allowed us to define the corresponding normality range. In a second stage, the new graphic-representation method was tested for 9 different formulae in a sample of 70 eyes undergoing cataract surgery with multifocal intraocular lens (MIOL) implantation. Results: Normality ranges (defined as the 25-to-75-percentile interval) were 22.84 to 24.42 mm for AXL, 2.86 to 3.39 mm for ACD, 4.36 to 4.88 mm for LT, 11.64 to 12.19 mm for WTW and 7.52 to 7.87 mm for Rm, with lower sizes in women. No significant differences were found along the 9 formulae for percentage of eyes in ±0.50D (p=0.82) or ±1.00D (p=0.97). The new graphical method showed less accuracy in ±0.50 D for ACDs from 2.46 to 2.85 mm (5 to 25 percentile) for several formulae (p<0.05). Conclusions: 9 formulae showed non-significant differences in the general predictability for a sample of eyes candidates to MIOL implantation. Predictability in this sample decreased for short ACDs.
Article
Purpose: To report the 5-year visual, refractive and patient reported outcomes following implantation of a trifocal intraocular lens during cataract surgery SETTING:: Csolnoky Ferenc University Hospital, Veszprém, Hungary DESIGN:: Prospective, longitudinal, single centre, interventional study METHODS:: 100 eyes of 50 patients underwent bilateral implantation of a trifocal intraocular lens during cataract surgery. Preoperative corrected distance visual acuity (CDVA) and post-operative uncorrected distance visual acuity (UDVA), CDVA, uncorrected (UIVA) and corrected (CIVA) intermediate and uncorrected (UNVA) and corrected (CNVA) near visual acuity were collected. All subjects were seen at day one, 1, 3, 6,12, and 24 months and at year five. Contrast sensitivity, slit lamp photography and quality of vision questionnaire were performed at months 3, 6, 12, 24 and at year 5. Of these 50 patients 41 completed their 5 year follow up. Results: At year five, the mean postoperative UDVA was 0.02 ± 0.10 (logMAR). The mean CDVA was -0.04 ± 0.07. The mean UIVA was 0.04 ± 0.09. The mean CIVA was 0.00 ± 0.08. The mean UNVA was 0.09 ± 0.09. The mean CNVA was 0.05 ± 0.07. Mesopic and photopic contrast sensitivity values were in the upper third range of the age-matched normal values. Conclusions: Five years prospective study data shows that bilateral implantation of a diffractive refractive trifocal IOL with centralised diffractive rings provides good functional vision at all distances. There was high level of spectacle independence and patient satisfaction with minimal levels of dysphotopsia.
Article
Introduction Presbyopia is the progressive and irreversible loss of accommodation due to aging. It is one of the main causes of loss of quality of life in people from 45 years of age, due to the, often novel, dependence on spectacles. The eagerness to correct it by ophthalmologists driven by the desire of millions of people who suffer from it, has become one of the main drivers for the development of intraocular lens (IOL) technology over the last twenty years. Material and methods This review briefly presents the different alternatives that have allowed us to improve the crystalline lens surgical approach of presbyopia; from monofocal lenses and monovision technique, accommodation, refractive, and diffractive multifocal lenses, and finally the most recent focus or extended depth or focus/ field lenses known as EDOFs. Results Each IOL has its advantages, limitations and disadvantages. Furthermore, there is no single lens that suits the needs of all patients. Conclusions It is necessary to know the variety of lenses available, and to have an in-depth understanding of their optical properties, as well as the impact that these will have later on their clinical performance and on the visual quality of the patients. This should help us to select the best alternative for each of them.
Resumen Introducción La presbicia es la pérdida progresiva e irreversible de la acomodación debido al envejecimiento. Es una de las principales causas de disminución de la calidad de vida en personas a partir de los 45 años derivada de la, muchas veces novedosa, dependencia de las gafas. El afán por corregirla por parte de los oftalmólogos, impulsados por el deseo de millones de personas que la padecen, se ha convertido en uno de los principales motores de desarrollo de la tecnología de las lentes intraoculares (LIO) durante los últimos 20 años. Material y métodos Esta revisión repasa las distintas alternativas que han permitido ir mejorando el enfoque quirúrgico cristaliniano de la presbicia; desde las lentes monofocales y la técnica de la monovisión, a las lentes acomodativas, pasando por las lentes multifocales refractivas y difractivas y terminando con las más recientes lentes de foco o campo extendido conocidas como EDOF. Resultados Cada una de estas LIO tiene sus ventajas, limitaciones e inconvenientes; y además, no existe la lente que se adapte a las necesidades de todos los pacientes. Conclusiones Es necesario conocer la variedad de lentes disponibles, y comprender en profundidad tanto sus propiedades ópticas como el impacto que estas van a tener luego en su rendimiento clínico y en la calidad visual de los pacientes. Esto nos debería ayudar a poder seleccionar la mejor alternativa para cada uno de ellos.
Article
Purpose: To compare the clinical outcomes obtained after implantation of 1 of 3 models of trifocal diffractive intraocular lenses (IOLs). Setting: Hospital da Luz, Lisbon, Portugal. Design: Prospective randomized comparative study. Methods: Ninety eyes of 45 patients undergoing cataract surgery with bilateral implantation of 1 of 3 models of trifocal diffractive IOLs were enrolled. The IOL models implanted were the FineVision POD F, RayOne Trifocal, or the Acrysof IQ PanOptix (30 eyes of 15 patients in each group). Visual acuity (VA), refraction, defocus curve, and contrast sensitivity outcomes were evaluated during a 3-month follow-up. Furthermore, the quality-of-vision (QoV) questionnaire (McAlinden et al.) was used to evaluate the frequency, severity, and discomfort of different visual symptoms. Results: No statistically significant differences were found between groups in distance, intermediate, and near VA (p≥0.112) and postoperative refraction (p≥0.059). Postoperative binocular uncorrected intermediate VA of 0.10 logMAR or better was found in 14 (93.33%) patients in the 3 groups. Postoperative binocular uncorrected near VA of 0.10 logMAR or better was found in 13 (86.67%), 14 (93.33%) and 13 (86.67%) patients in the PODF, RayOne, and PanOptix groups, respectively. No statistically significant differences were found between groups in scotopic contrast sensitivity with and without glare as well as in the QoV scores (p≥0.057), except for the difference between the PODF and RayOne groups in depth perception severity, which was less in the RayOne group (p=0.019). Conclusions: The 3 trifocal IOLs evaluated provided a complete visual restoration with good visual quality outcomes.
Article
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Purpose: To assess the impact of ocular biometric variables on the visual performance achieved with a low addition trifocal intraocular lens (MIOL). Methods: Retrospective observational study including 34 eyes. Preoperative measured variables included mean corneal power (Km), corneal regular astigmatism (RA), anterior chamber depth (ACD), axial length (AXL), total irregular astigmatism (IA), spherical aberration (SA) and distance from pupil center to vertex normal (µ). Same variables were retrieved from the three month visit follow-up in addition to the actual lens position (ALP), the calculated effective addition (EA), the IOL centration from vertex normal (d), and the visual acuity defocus curve. The area under the defocus curve was computed along the total curve (TAUC) and ranges for far (FAUC), intermediate (IAUC) and near vision (NAUC). The sample was split in two groups of 17 eyes with TAUCs above and below the mean, and the differences among groups for different ocular parameters were assessed. Results: The group of eyes above TAUC of 2.03 logMAR*m-1 showed significantly lower Km and greater AXL and SA. Km was negatively correlated with TAUC and NAUC. NAUC was negatively correlated with IA and positively with d. A multiple lineal regression model including Km, d, and IA predicted NAUC (r-square = 34%). No significant differences between IA and SA were found between preoperative and postoperative values but µ significantly decreased after surgery. Conclusions: The mean corneal power, irregular astigmatism, and centration from vertex normal should be considered for optimizing the near visual performance with this MIOL.
Article
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Purpose: To characterize the optical performance of two models of refractive bifocal intraocular lenses, with medium and high addition, using defocus curves. Methods: 20 eyes from 20 subjects were included in this study. 10 eyes underwent caratact surgery with an implant of a medium addition refractive bifocal intraocular lens (IOL) (Lentis LS-313 MF20) and the other 10 eyes underwent cataract surgery with an implant of a high addition refractive bifocal IOL (Lentis LS-313 MF30). Six weeks after surgery, subjective refraction and defocus curve were made. Results: Mean final residual refraction in spherical equivalent was +0.10±0.07D in the LS-313MF30 group and +0.12±0.10D in the LS-313MF20 group. Defocus curve showed a different optical performance in intermediate/near distance depending on the IOL model. The medium addition IOL provided good visual acuity (VA) at far and intermediate distance up to 50cms, and the high addition IOL provided better VA in near distance up to 25cms. Conclusions: The high addition intraocular lens provides better visual acuity in the spatial range from infinity to the point close to 25cm. The medium addition intraocular lens provides excellent visual acuity in far and intermediate vision. The defocus curve seems to be a valid and reproducible tool for evaluating the optical behavior of multifocal sector refractive lenses.
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Purpose: To evaluate clinical and visual outcomes, quality of near vision, and intraocular optical quality of patients bilaterally implanted with a trifocal PanOptix intraocular lens. Methods: In this prospective consecutive case-series study, 52 eyes of 26 bilateral patients (mean age, 60.2 ± 7.4 years) were implanted with the AcrySof IQ Panoptix intraocular lens. Visual acuity, defocus curve, contrast sensitivity (Pelli-Robson test), near activity visual questionnaire, and internal aberrations with Osiris were evaluated. A prototype light-distortion analyzer was used to quantify the postoperative light-distortion indices. The follow-up was 6 months after surgery. Results: Uncorrected, corrected distance, and uncorrected near visual acuities improved with the surgery (p ≤ 0.02). Distance corrected near visual acuity was 0.13 ± 0.10, 0.13 ± 0.13, and 0.13 ± 0.08 at 1, 3, and 6 months after surgery, respectively (p = 0.82). Distance corrected intermediate visual acuities were 0.09 ± 0.13, 0.13 ± 0.15, and 0.12 ± 0.12 at 1, 3, and 6 months, postoperatively. Binocular contrast sensitivity was 1.86 ± 0.15 Log Units. Defocus curve provided a visual acuity equal or better to 0.30 LogMAR between defocus levels of +0.50 to -3.00 D. The near activity visual questionnaire scores improved significantly with the surgery (p < 0.01). Conclusion: The AcrySof IQ Panoptix intraocular lens is able to restore visual function with an acceptable intermediate and near vision after cataract surgery with good contrast sensitivity and an improvement in the near activity visual questionnaire.
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Purpose To compare two different diffractive trifocal intraocular lens (IOL) designs, evaluating longer-term refractive outcomes, visual acuity (VA) at various distances, low contrast VA and quality of vision. Patients and methods Patients with binocularly implanted trifocal IOLs of two different designs (FineVision [FV] and Panoptix [PX]) were evaluated 6 months to 2 years after surgery. Best distance-corrected and uncorrected VA were tested at distance (4 m), intermediate (80 and 60 cm) and near (40 cm). A binocular defocus curve was collected with the subject’s best distance correction in place. The preferred reading distance was determined along with the VA at that distance. Low contrast VA at distance was also measured. Quality of vision was measured with the National Eye Institute Visual Function Questionnaire near subset and the Quality of Vision questionnaire. Results Thirty subjects in each group were successfully recruited. The binocular defocus curves differed only at vergences of −1.0 D (FV better, P=0.02), −1.5 and −2.00 D (PX better, P<0.01 for both). Best distance-corrected and uncorrected binocular vision were significantly better for the PX lens at 60 cm (P<0.01) with no significant differences at other distances. The preferred reading distance was between 42 and 43 cm for both lenses, with the VA at the preferred reading distance slightly better with the PX lens (P=0.04). There were no statistically significant differences by lens for low contrast VA (P=0.1) or for quality of vision measures (P>0.3). Conclusion Both trifocal lenses provided excellent distance, intermediate and near vision, but several measures indicated that the PX lens provided better intermediate vision at 60 cm. This may be important to users of tablets and other handheld devices. Quality of vision appeared similar between the two lens designs.
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Background Today, patients often expect to achieve spectacle independance after cataract surgery. New trifocal intraocular lenses have been developed to try and fullfill this demand. The purpose of this study is to report the short-term visual outcomes of a new trifocal intraocular lens (AcrySof PanOptix™). Methods Consecutive adult patients undergoing cataract surgery with bilateral implantation of the study intraocular lens in a private practice clinic were considered for inclusion. Exclusion criteria were the presence of other ocular pathologies or preoperative astigmatism >1.5 diopters (D). Patients with intraoperative complications were excluded from analysis. One month after surgery patients underwent: monocular defocus curve; monocular and binocular uncorrected visual acuity in photopic and mesopic conditions, for far (4 m), intermediate (60 cm) and near (33 cm) distances and binocular contrast sensitivity. Patients completed a visual satisfaction questionnaire between 9 and 12 months after surgery. ResultsOne hundred and sixteen eyes of fifty-eight patients receiving bilateral implantation of the study intraocular lens were analysed. Mean binocular uncorrected visual acuity in photopic conditions was 0.03 LogMAR for far, 0.12 for intermediate and 0.02 for near distances. All patients achieved a binocular uncorrected visual acuity better than 0.3 LogMAR (20/40 Snellen equivalent) for distance and near vision and 94.8% of patients for intermediate vision. Mesopic binocular uncorrected visual acuity values were similar to photopic values. The monocular defocus curves showed that the best visual acuity was reached at a vergence of 0.00D. Visual acuity dropped slightly at −1.00D and peaked again at −2.00D. Visual acuities better than 0.2 LogMAR were maintained between −2.50D and +0.50D. Contrast sensitivity was high and similar in photopic and mesopic conditions. As regards patient-evaluated outcomes, only 2 patients (3.4%) were fairly dissatisfied with their sight after surgery. Three patients (5.1%) reported the need for spectacle correction for certain activities. All other patients (94.8%) reported never using spectacle correction. Conclusions The PanOptix trifocal IOL provides good short-term visual outcomes, with good intermediate performance and excellent patient-reported satisfaction. The similar values achieved in mesopic and photopic conditions in binocular uncorrected visual acuity and contrast sensitivity suggest low pupillary dependence for light distribution. Trial registration numberISRCTN60143265, retrospectively registered on the 24th of April 2017.
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Background Independence from all optical aids, and freedom from unwanted symptoms, following cataract and lens surgery remains the ultimate goal of both patient and surgeon. The development of trifocal IOL technology provides an ever-increasing range of options. The purpose of our study is to understand the predictability, safety and efficacy of a new trifocal intraocular lens (IOL) following cataract or refractive lens exchange (RLE) surgery. Methods This was a retrospective consecutive case series of patients undergoing cataract extraction or RLE followed by implantation of the Alcon IQ Panoptix IOL. Pre and postoperative refractive and visual parameters were recorded and evaluated. As the cohort followed a normal distribution, standard parametric tests were used. Paired t-test was used to compare the difference between target and postoperative refractive errors. The incidence of intraoperative and postoperative complications was also reported. ResultsThe IOL was implanted in 66 eyes of 33 patients. Mean postoperative spherical equivalent (SE) refraction was -0.08 ± 0.25 dioptres (D). This was not significantly different from the target refraction (p = 0.841). Sixty-five percent of patients were within ± 0.25 D of the target SE refraction with 100% within ± 0.50 D of intended correction. Mean postoperative uncorrected distance visual acuity (UDVA) was 0.01 ± 0.10 LogMAR. All patients achieved an unaided distance acuity of 20/40 or better postoperatively. Binocularly, 100% saw 0.20 LogMAR or better at near without correction and 88.9% achieved this level for uncorrected intermediate visual acuity. No intraoperative complications were noted. Five patients complained of moderate haloes in the early postoperative period. Conclusion The AcrySof IQ Panoptix IOL provides functional uncorrected visual acuity at distance, intermediate and near positions. Our results remain equivalent with existing trifocal IOL outcomes and provide surgeons with a further IOL alternative for the patient motivated to obtain true spectacle independence. Surgeons should consider individual reading and working requirements when counselling patients preoperatively to optimise postoperative patient satisfaction.
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Background To evaluate the clinical outcomes after the implantation of a new trifocal diffractive intraocular lens (IOL) combined with Enhanced depth of focus (EDOF) technology. Methods The study enrolled 80 eyes of 40 patients who underwent cataract surgery with bilateral implantation of a diffractive trifocal IOL (Reviol Tri-ED) designed with a combination of enhanced depth of focus. Mean age was 52.09 ± 11.32 years (range from 45 to 70 years). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), corrected intermediate visual acuity (CIVA), uncorrected near visual acuity (UNVA), corrected near visual acuity (CNVA), keratometry (K), and manifest refraction spherical equivalent (MRSE) were evaluated pre- and postoperatively. The contrast sensitivity, defocus curves, and a questionnaire evaluating individual satisfaction were also estimated. ResultsThere was a significant improvement in UDVA, CDVA, UNVA, CNVA, CIVA postoperatively. The defocus curve confirmed good visual acuity also in the intermediate distance. The postoperative MRSE was ranged from −0.75 to 0.75 diopters. Contrast sensitivity also significantly improved postoperatively. The patient satisfaction was high. Conclusion The new trifocal EDOF IOL provides visual improvement for far, intermediate, and near distances with a high level of visual quality and patient satisfaction.
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Purpose. To evaluate visual, refractive, and contrast sensitivity outcomes, as well as the incidence of pseudophakic photic phenomena and patient satisfaction after bilateral diffractive trifocal intraocular lens (IOL) implantation. Methods . This prospective nonrandomized study included consecutive patients undergoing cataract surgery with bilateral implantation of a diffractive trifocal IOL (AT LISA tri 839MP, Carl Zeiss Meditec). Distance, intermediate, and near visual outcomes were evaluated as well as the defocus curve and the refractive outcomes 3 months after surgery. Photopic and mesopic contrast sensitivity, patient satisfaction, and halo perception were also evaluated. Results. Seventy-six eyes of 38 patients were included; 90% of eyes showed a spherical equivalent within ±0.50 diopters 3 months after surgery. All patients had a binocular uncorrected distance visual acuity of 0.00 LogMAR or better and a binocular uncorrected intermediate visual acuity of 0.10 LogMAR or better, 3 months after surgery. Furthermore, 85% of patients achieved a binocular uncorrected near visual acuity of 0.10 LogMAR or better. Conclusions. Trifocal diffractive IOL implantation seems to provide an effective restoration of visual function for far, intermediate, and near distances, providing high levels of visual quality and patient satisfaction.
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To report the item specific responses of the VF-14 in a population of patients undergoing cataract surgery in their first eye and to determine whether or not the VF-14 can be reduced without compromising its performance as an index of cataract related visual impairment. The item specific responses to the VF-14 were analysed before (771 patients) and 4 months after (552 patients) cataract surgery in one eye to determine if the VF-14 index can be reduced without compromising its performance. Patients studied were selected from a cross sectional longitudinal study of patients undergoing cataract surgery in 72 ophthalmologist's offices located in three metropolitan regions of the United States. Pairwise correlations between items in the VF-14 were all less than 0.6, indicating that no items could be removed solely on the basis of redundancy. 10 items correlated moderately with change in trouble, and 11 correlated moderately with change in satisfaction (r >0.15) at 4 months after cataract extraction. Eleven items demonstrated an effect size >0.4 at 4 months. These 11 items were either important for detecting cataract related functional disability or for quantifying the extent to which cataract impaired function. Additionally, 11 items were needed to detect adequately individuals with functional impairment. Three items (recognising people, cooking, and reading large print) were less responsive to cataract extraction and were more strongly associated with ocular comorbidities. While previous reports indicate that the VF-14 can be significantly shortened, our analysis only justifies removing three items. While the resulting VF-11 has properties similar to the VF-14, the limited time savings do not justify altering this already validated instrument.
Article
Purpose: To evaluate and compare the performance of two diffractive trifocal and one extended depth of focus (EDOF) intraocular lenses (IOLs). Methods: In this 6-month, single-center, prospective, randomized, comparative study, patients undergoing routine cataract surgery were randomized to receive one of two trifocal IOLs (AcrySof IQ PanOptix; Alcon Laboratories, Inc., Fort Worth, TX, or FineVision Micro F; PhysIOL SA, Liège, Belgium) or an EDOF IOL (TECNIS Symfony; Abbott Medical Optics, Inc., Abbott Park, IL). There were 20 patients in each group. The primary outcome was binocular and monocular uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuity. The secondary outcomes were quality of vision and aberrometry. Results: There was no statistically significant difference between groups in either monocular (P = .717) or binocular (P = .837) UDVA. Monocular and binocular UNVA were statistically and significantly better for both trifocal lenses than for the EDOF IOL (P = .002). The percentage of patients with J2 UNVA was 52.5% monocularly and 70% binocularly for the TECNIS Symfony IOL, 81.5% monocularly and 100% binocularly for the AcrySof IQ PanOptix IOL, and 82.5% monocularly and 95% binocularly for the FineVision Micro F IOL. There was no significant difference in binocular UIVA between groups; VA was better than 0.6 in 55%, 53%, and 35% of patients with the TECNIS Symfony, AcrySof IQ Pan-Optix, and FineVision Micro F IOLs, respectively. Overall, 90% patients achieved spectacle independence. There were no differences in visual symptoms and aberrometry among groups. Conclusions: All three IOLs provided good visual acuity at all distances, a high percentage of spectacle independence, and little or no impact of visual symptoms on the patients' daily functioning. Near vision was statistically better for both trifocal IOLs compared to the EDOF IOL. [J Refract Surg. 2018;34(8):507-514.].
Article
Purpose/Aim: To evaluate the impact of ocular parameters on the visual performance achieved with the multifocal intraocular lens (IOL) Bi-Flex M 677MY. Materials and Methods: 26 subjects were included in the current study. Several physiological variables were retrieved from the 3-month follow-up visit, including pupil diameter and distance from pupil center to the vertex normal of the anterior cornea (µ). These variables were also obtained in the preoperative visit. Binocular and monocular visual acuity defocus curves were measured at 1 and 3 months after surgery, respectively. The area under the monocular defocus curve was computed along the total curve (TAUC, +1.00 to −4.00 D) and for the ranges of far (FAUC, +0.50 to −0.50 D), intermediate (IAUC, - 1.00 to −1.50 D) and near vision (NAUC, −2.00 to −4.00 D). Correlations between these areas and the postoperative physiological variables were assessed. Results: The mean µ was reduced from 0.21 mm to 0.10 mm after surgery, as well as pupil diameters, either photopic (−7.4%) and mesopic (−8.1%) (p < 0.05). The mean AUCs were 2.08 ± 0.74 for TAUC, 0.57 ± 0.17 for FAUC, 0.16 ± 0.09 for IAUC and 0.81 ± 0.29 for NAUC. Significant correlations were found between NAUC and Km (r = −0.39, p = 0.05) as well as between IAUC and temporal decentration of the lens from vertex normal (ρ = −0.41, p = 0.04). Conclusions: The performance at near with the IOL evaluated improved in eyes with less corneal power. On the other hand, a slight temporal IOL decentration from vertex normal also improved intermediate visual acuity. The binocular defocus curve was similar to other trifocal IOLs.
Article
Purpose: To compare the visual performance after bilateral implantation of a diffractive bifocal or trifocal intraocular lens (IOL) from the same manufacturer using the same IOL platform. Methods: This prospective, non-randomized, controlled study involved patients who had cataract surgery with bilateral implantation of bifocal or trifocal IOLs. The near, intermediate, and distance visual acuities, defocus curve, optical quality including modulation transfer functions and higher-order aberrations, National Eye Institute Visual Functioning Questionnaire-14, patient satisfaction, spectacle independence, and perception of visual disturbances were assessed in all patients. Results: Fifty eyes (25 patients) were implanted with a diffractive trifocal IOL (AT LISA tri 839MP; Carl Zeiss Meditec, Jena, Germany) and 60 eyes (30 patients) with a diffractive bifocal IOL (AT LISA 809M; Carl Zeiss Meditec). The follow-up was 3 months. No statistically significant difference was found in distance or near visual acuity between the two groups (P ≥ .05). Uncorrected, corrected, and distance-corrected intermediate visual acuities were significantly better in the trifocal IOL group (P < .01). In the binocular defocus curve, the visual acuity was also significantly better for defocus of -1.00 to -2.00 diopters in eyes with trifocal IOL implantation (P < .01). Similar halos and glare were present in the two groups. The levels of overall satisfaction were similarly high between groups. Conclusions: Diffractive trifocal IOLs can provide significantly better intermediate vision and equivalent distance and near visual performance compared to bifocal IOLs and do not induce extra qualitative vision disturbances. [J Refract Surg. 2018;34(4):273-280.].
Article
Importance: Quality of vision after multifocal intraocular lens (IOLs) implantation in relation to patient satisfaction. It is important to include the evaluation of visual quality and patient satisfaction in clinical practice. Background: To evaluate and compare quality of life and patient satisfaction after implantation of three types of diffractive- refractive and apodized-diffractive bifocal and trifocal multifocal IOLs. Design: Comparative, prospective, case series, randomized PARTICIPANTS: 104 eyes of 52 patients METHODS: 104 eyes of 52 patients underwent phacoemulsification surgery with bilateral implantation of one of three multifocal IOLs: AT LISA 809M (Carl Zeiss Meditec) (AT LISA group, 38 eyes), AT LISAtri 839MP (Carl Zeiss Meditec) (AT LISAtri group, 32 eyes), and ReSTOR SN6AD1 (Alcon) (ReSTOR group, 34 eyes). Main outcomes measured: Contrast sensitivity, photopic phenomena, patient satisfaction and quality of life criteria were evaluated during a 12-month follow-up. Results: ≥ 88% of patients were satisfied with near and intermediate visual outcomes. Better distance corrected intermediate visual acuity at 90cm was detected for AT LISA tri group (p<0.04). No statistically significant differences were found among groups in postoperative contrast sensitivity analyses (p≥0.053). There were no significant differences in spectacle dependence scores for far, intermediate and near vision among the groups (p≥0.180). The addition of an intermediate focus did not statistically affect halo and glare size and intensity (p≥0.256) or subjective impact (p≥0.077). Patient satisfaction was consistently high for all groups (p≥0.154). Conclusions and relevance: Contrast sensitivity outcomes and patient satisfaction remained high in the trifocal group when compared to the bifocal IOL groups.
Article
Purpose: To assess photopic and mesopic vision in patients implanted with the Bi-Flex® M 677 MY bifocal intraocular lens (IOL). Methods: In this prospective clinical study, 25 patients with cataract in both eyes were subjected to cataract surgery and bilateral implantation of the Bi-Flex® M 677MY (Medicontur, Hungary) IOL. Three months after surgery, high-contrast photopic uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were determined. Intermediate at 65 cm (DCIVA) and near at 40 cm (DCNVA) visual acuity were also measured, both with best distance correction. The CSV-1000 test chart was used to assess contrast sensitivity (CS). Defocus curves were constructed under photopic and mesopic conditions, determining binocular best-corrected visual acuity over the range +1.50 D to -4.00 D in 0.50-D steps. A KR-1W Wavefront Analyzer was used to measure pupil size and aberrometric outcomes. Presence and type of dysphotopsia were evaluated with the Likert scale. Results: Mesopic mean pupil diameter was 4.58 ± 0.73 mm. The mean values at 3 months were UDVA 0.03 ± 0.09, CDVA -0.05 ± 0.06, DCIVA 0.20 ± 0.07, and DCNVA 0.11 ± 0.08. Mean CS for the 4 frequencies examined were 1.66 ± 0.16, 1.75 ± 0.14, 1.39 ± 0.22, and 0.96 ± 0.19. Significant differences were observed in defocus curves for photopic and mesopic conditions. A significant correlation between pupil diameter and the dysphotopic photopic was found (r = 0.62; p = 0.02). Conclusions: The evaluated progressive apodized diffractive design IOL provides effective restoration of visual function in far and near vision distance with an adequate intermediate visual quality between -1.00 and -1.50 focus.
Article
Purpose: To compare the accuracy of intraocular lens (IOL) calculation formulas (Barrett Universal II, Haigis, Hoffer Q, Holladay 1, Holladay 2, Olsen, and SRK/T) in the prediction of postoperative refraction using a single optical biometry device. Design: Retrospective consecutive case series. Participants: A total of 13 301 cataract operations with an AcrySof SN60WF implant and 5200 operations with a SA60AT implant (Alcon Laboratories, Inc., Fort Worth, TX). Methods: All patients undergoing cataract surgery between July 1, 2014, and December 31, 2015, with Lenstar 900 optical biometry were eligible. A single eye per patient was included in the final analysis, resulting in a total of 18 501 cases. We compared the performance of each formula with respect to the error in predicted spherical equivalent and evaluated the effect of applying the Wang-Koch (WK) adjustment for eyes with axial length >25.0 mm on 4 of the formulas. Results: For the SN60WF, the standard deviation of the prediction error, in order of lowest to highest, was the Barrett Universal II (0.404), Olsen (0.424), Haigis (0.437), Holladay 2 (0.450), Holladay 1 (0.453), SRK/T (0.463), and Hoffer Q (0.473), and the results for the SA60AT were similar. The Barrett formula was significantly better than the other formulas in postoperative refraction prediction (P < 0.01) for both IOL types. Application of the WK axial length modification generally resulted in a shift from hyperopic to myopic outcomes in long eyes. Conclusions: Overall, the Barrett Universal II formula had the lowest prediction error for the 2 IOL models studied.
Article
Purpose: To evaluate and compare the visual outcomes and ocular optical performance of the PanOptix trifocal intraocular lens (IOL) and Symfony extended range of vision IOL. Methods: Sixty-eight eyes of 34 patients were divided into 2 groups: 20 patients with the PanOptix IOL and 14 patients with the Symfony IOL. Binocular uncorrected distance visual acuity, best-corrected distance visual acuity (BCDVA), distance-corrected intermediate visual acuity (DCIVA) at 80 and 60 cm, and distance-corrected near visual acuity (DCNVA) at 40 cm were evaluated. Additionally, preferred reading distance with best-corrected distance and visual acuity at that distance, binocular defocus curves, mesopic and photopic contrast sensitivity, photic phenomena, and monocular total higher order aberrations (HOAs) were also measured. Results: The visual outcomes for PanOptix and Symfony IOL groups, respectively, were as follows: BCDVA: -0.03 ± 0.03 and -0.02 ± 0.03 logMAR; DCIVA at 80 cm: 0.06 ± 0.06 and 0.06 ± 0.04 logMAR; DCIVA at 60 cm: 0.06 ± 0.10 and 0.05 ± 0.04 logMAR; DCNVA: 0.04 ± 0.06 and 0.20 ± 0.07 logMAR (p<0.001). Similar preferred reading distanceswere found for both groups (37.0 ± 4.6 and 38.9 ± 5.7 cm, respectively). The visual acuities at those distances were 0.09 ± 0.08 and 0.19 ± 0.08 logMAR (p<0.001), respectively. The defocus curves showed significantly better outcomes for the PanOptix IOL from -2.0 to -4.0 D (p<0.001). No significant differences were found for contrast sensitivity, halometry, or HOAs between the groups. Conclusions: The PanOptix and Symfony IOLs showed comparable visual performance at distance and intermediate. However, the PanOptix IOL provided better near and preferred reading distance VAs and showed a more continuous range of vision than the Symfony IOL.
Article
Multifocal intraocular lenses (MfIOLs) are increasingly used in the management of pseudophakic presbyopia. After MfIOL implantation, most patients do not need spectacles or contact lenses and are pleased with the result. Complications, however, may affect the patient's quality of life and level of satisfaction. Common problems with multifocal lenses are blurred vision and photic phenomena associated with residual ammetropia, posterior capsule opacification, large pupil size, wavefront anomalies, dry eye, and lens decentration. The main reasons for theseare failure to neuroadapt, lens dislocation, residual refractive error, and lens opacification. To avoid patient dissatisfaction after MfIOLs implantation, it is important to considerer preoperatively the patient's life style, perform an exhaustive examination including biometry, topography and pupil reactivity, and explain the visual expectations and possible postoperative complications .
Article
Purpose: To assess the accuracy of 7 intraocular lens (IOL) power formulas (Barrett Universal II, Haigis, Hoffer Q, Holladay 1, Holladay 2, SRK/T, and T2) using IOLMaster biometry and optimized lens constants. Setting: Public hospital ophthalmology department. Design: Retrospective case series. Methods: Data from patients having uneventful cataract surgery with Acrysof IQ SN60WF IOL implantation over 5 years were obtained from the biometry and patient charts. Optimized lens constants were calculated for each formula and used to determine the predicted refractive outcome for each patient. This was compared with the actual refractive outcome to give the prediction error. Eyes were separated into subgroups based on axial length (AL) as follows: short (≤22.0 mm), medium (>22.0 to <24.5 mm), medium long (≥24.5 to <26.0 mm), and long (≥26.0 mm). Results: The study included 3241 patients. The Barrett Universal II formula had the lowest mean absolute prediction error over the entire AL range (P < .001, all formulas) as well as in the medium (P < .001, all formulas), medium-long (P < .001, except Holladay 1 and T2), and long AL (P < .001, except T2) subgroups. No statistically significant difference was seen between formulas in the short AL subgroup. Overall, the Barrett Universal II formula resulted in the highest percentage of eyes with prediction errors between ±0.25 diopter D, ±0.50 D, and ±1.00 D. Conclusion: In eyes with an AL longer than 22.0 mm, the Barrett Universal II formula was a more accurate predictor of actual postoperative refraction than the other formulas. Financial disclosure: None of the authors has a financial or proprietary interest in any material or method mentioned.
Article
Purpose To evaluate the accuracy of 9 intraocular lens (IOL) calculation formulas using 2 optical biometers. Setting Private practice, Saint Joseph, Michigan, USA. Design Retrospective consecutive case series. Methods Nine IOL power formula predictions with observed refractions after cataract surgery were compared using 1 IOL platform. The performance of each formula was ranked for accuracy by machine and by axial length (AL). The Olsen was further divided by a preinstalled version (OlsenOLCR) and a purchased version (OlsenStandalone). The Holladay 2 was divided by whether a refraction was entered (Holladay 2PreSurgRef) or not (Holladay 2NoRef). The OLCR device used in the study was the Lenstar L5 900 and the PCI device, the IOLMaster. Results The formulas were ranked by the standard deviation of the prediction error (optical low-coherence reflectometry [OLCR], partial coherence interferometry [PCI]) as follows: OlsenStandalone (0.361, 0.446), Barrett Universal II (0.365, 0.387), OlsenOLCR (0.378, not applicable), Haigis (0.393, 0.401), T2 (0.397, 0.404), Super Formula (0.403, 0.410), Holladay 2NoRef (0.404, 0.417), Holladay 1 (0.408, 0.414), Holladay 2PreSurgRef (0.423, 0.432), Hoffer Q (0.428, 0.432), and SRK/T (0.433, 0.44). Conclusions The formulas gave different results depending on which machine measurements were used. The Olsen formula was the most accurate with OLCR measurements, significantly better than the best formula with PCI measurements. The Olsen was better, regardless of AL. If only PCI measurements (without lens thickness) were available, the Barrett Universal II performed the best and the Olsen formula performed the worst. The preinstalled version of Olsen was not as good as the standalone version. The Holladay 2 formula performed better when the preoperative refraction was excluded. Financial Disclosure Neither author has a financial or proprietary interest in any material or method mentioned.
Article
Purpose: To evaluate and compare the clinical outcomes with an aspheric monofocal intraocular lens (IOL) and an extended range of vision (ERV) IOL based on achromatic diffractive technology. Methods: This was a prospective comparative study including 80 eyes undergoing cataract surgery with implantation of the monofocal Tecnis ZCB00 IOL (Abbott Medical Optics Inc., Santa Ana, CA) (monofocal group: 30 eyes of 15 patients) or the ERV Tecnis Symfony IOL (Abbott Medical Optics, Inc.) (ERV group: 50 eyes of 25 patients). Visual, refractive, contrast sensitivity, defocus curve, ocular optical quality (Optical Quality Analysis System; Visiometrics SL, Terrassa, Spain), and quality of life (National Eye Institute Refractive Error Quality of Life Instrument 42 Questionnaire) outcomes were evaluated during a 3-month follow-up. Results: Significantly better postoperative uncorrected monocular and binocular distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuities were found in the ERV group (P ≥ .013). Postoperative spherical equivalent was within ±1.00 diopters in 94% and 100% of eyes in the ERV and the monofocal groups, respectively. Binocular UIVA and UNVA of 0.20 or better (Snellen 20/30) were observed in all cases in the ERV group and in 13.3% and 6.7% of eyes of the monofocal group, respectively. No significant differences among groups were observed in contrast sensitivity (P ≥ .156) or ocular optical quality parameters (P ≥ .084). In the monocular defocus curve, all visual acuities were better in the ERV group (P ≤ .002), except for the +0.50-diopter defocus level (P = .367). Significantly better scores were obtained for dependence on correction (P = .003) and suboptimal correction (P = .038) subscales in the ERV group. Conclusions: The extended range of vision IOL provides better distance, intermediate, and near visual acuity than the aspheric monofocal IOL, while maintaining the same level of visual quality. [J Refract Surg. 2016;32(7):436-442.].
Article
Purpose: To compare visual outcomes, rotational stability, and centration in a randomized controlled trial in patients undergoing cataract surgery who were bilaterally implanted with two different trifocal intraocular lenses (IOLs) with a similar optical zone but different haptic shape. Methods: Twenty-one patients (42 eyes) with cataract and less than 1.50 D of corneal astigmatism underwent implantation of one FineVision/MicoF IOL in one eye and one POD FineVision IOL in the contralateral eye (PhysIOL, Liège, Belgium) at IOA Madrid Innova Ocular, Madrid, Spain. IOL allocation was random. Outcome measures, all evaluated 3 months postoperatively, included monocular and binocular uncorrected distance (UDVA), corrected distance (CDVA), distance-corrected intermediate (DCIVA), and near (DCNVA) visual acuity (at 80, 40, and 25 cm) under photopic conditions, refraction, IOL centration, haptic rotation, dysphotopsia, objective quality of vision and aberration quantification, patient satisfaction, and spectacle independence. Results: Three months postoperatively, mean monocular UDVA, CDVA, DCIVA, and DCNVA (40 cm) under photopic conditions were 0.04 ± 0.07, 0.01 ± 0.04, 0.15 ± 0.11, and 0.16 ± 0.08 logMAR for the eyes implanted with the POD FineVision IOL and 0.03 ± 0.05, 0.01 ± 0.02, 0.17 ± 0.12, and 0.14 ± 0.08 logMAR for those receiving the FineVision/MicroF IOL. Moreover, the POD FineVision IOL showed similar centration (P> .05) and better rotational stability (P < .05) than the FineVision/MicroF IOL. Regarding halos, there was a minimal but statistically significant difference, obtaining better results with FineVision/MicroF. Full spectacle independence was reported by all patients. Conclusions: This study revealed similar visual outcomes for both trifocal IOLs under test (POD FineVision and FineVision/MicroF). However, the POD FineVision IOL showed better rotational stability, as afforded by its design. [J Refract Surg. 2016;32(6):394-402.].
Article
Purpose: To compare the visual results and patient satisfaction after bilateral implantation between a bifocal and a trifocal intraocular lens (IOL). Methods: This study is a prospective, randomized, controlled study involving bilateral implantation of one of two multifocal IOLs. Patients were assessed for uncorrected and distance-corrected near (33 cm), intermediate (66 cm), and distance visual acuity. Distance contrast sensitivity under photopic (85 cd/m(2)) conditions with and without glare was also measured. Using a subjective questionnaire, patient satisfaction, spectacle independence, and the perception of glare and halo phenomena were evaluated at the final follow-up; a defocus curve analysis was conducted. Results: Fifteen patients (30 eyes) were implanted with the FineVision IOL (PhysIOL, Liége, Belgium) and 12 patients (24 eyes) received the Tecnis ZMB00 IOL (Abbott Medical Optics, Santa Ana, CA). The average follow-up was 6 months. The mean binocular uncorrected visual acuity was 0.02 ± 0.04 logMAR in the FineVision group and 0.04 ± 0.05 logMAR in the Tecnis group and the mean binocular uncorrected near visual acuity was 0.01 ± 0.00 logMAR in both groups. In the intermediate range of the defocus curve, there was a statistically significant difference between the two IOLs (P < .05). Contrast sensitivity was within normal limits under photopic conditions in both groups. Conclusions: Both the Tecnis and FineVision IOLs provide a satisfactory range of vision, including a high level of uncorrected distance, intermediate, and near acuity and improved contrast sensitivity under photopic conditions. [J Refract Surg. 2016;32(3):146-151.].
Article
Purpose: To evaluate clinical outcomes after the implantation of a diffractive trifocal intraocular lens (IOL). Setting: Nine European ophthalmology centers. Design: Prospective noncomparative interventional multicenter study. Methods: The trifocal diffractive AT LISA tri 839MP IOL was implanted in eyes with bilateral cataract. Monocular and binocular visual performance was assessed as was the level of perceived photic phenomena, patient satisfaction, and spectacle dependence 1 month and 3 months postoperatively. Results: The IOL was implanted in 208 eyes of 104 patients. The mean binocular uncorrected distance visual acuity improved from 0.44 logMAR ± 0.30 (SD) to 0.02 ± 0.10 logMAR and 0.03 ± 0.09 logMAR at 1 month and 3 months, respectively (P < .01). The mean binocular uncorrected intermediate visual acuity (80 cm) improved from 0.51 ± 0.30 logMAR to 0.09 ± 0.13 logMAR and 0.10 ± 0.15 logMAR at 1 month and 3 months, respectively (P < .01). The mean binocular uncorrected near visual acuity improved from 0.67 ± 0.31 logMAR to 0.16 ± 0.14 logMAR and 0.15 ± 0.14 logMAR, respectively (P < .01). Among the more frequently perceived photic phenomena were halos; however, approximately 75% of patients were not bothered by them. More than 90% of patients were satisfied with the outcome. Spectacle independence at all distances was higher than 90%. Conclusion: This IOL provided excellent visual outcomes and high refractive predictability at all distances, including intermediate, leading to high levels of patient satisfaction and spectacle independence. Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned.
Article
Purpose: To compare visual outcomes in patients with cataract surgery and bilateral implantation of a trifocal or bifocal intraocular lens (IOL). Setting: University Eye Clinic Maastricht, the Netherlands. Design: Prospective randomized clinical trial. Methods: Eyes with cataract and less than 1.0 diopter (D) of corneal astigmatism were randomized to receive bilateral implantation of Finevision Micro F trifocal IOLs or Acrysof IQ Restor +3.0 bifocal IOLs. Outcome measures were monocular and binocular uncorrected distance (UDVA), uncorrected intermediate (UIVA), and uncorrected near (UNVA) visual acuities; refractive outcomes; binocular defocus curve; contrast sensitivity; reading speed; patient satisfaction; and spectacle independence. Results: Six months postoperatively, the mean binocular UDVA, UIVA, and UNVA in 56 eyes of 28 patients were 0.01 logMAR ± 0.11 (SD), 0.32 ± 0.15 logMAR, and 0.15 ± 0.13 logMAR in the trifocal group (n = 15) and 0.00 ± 0.09 logMAR, 0.28 ± 0.08 logMAR, and 0.12 ± 0.08 logMAR in the bifocal group (n = 13), respectively. The trifocal group showed a more continuous defocus curve and better results at -1.0 D of defocus (P < .01). The mean mesopic contrast sensitivity was higher in the bifocal group (P = .02). Complete spectacle independence was reported by 80% of trifocal patients and 50% of bifocal patients. There were no significant differences in refractive outcomes, reading speed, or patient satisfaction. Conclusion: This study showed noninferiority of visual outcomes with the trifocal IOL compared with the bifocal IOL, although the defocus curve was better at an intermediate distance with the trifocal IOL. Financial disclosure: Dr. Bauer received study grants from Alcon Laboratories, Inc., Carl Zeiss Meditec AG, and Physiol S.A. and a lecture fee from Alcon Surgical, Inc. Dr. Nuijts is a consultant to Alcon Surgical, Inc., Théa Pharma GmbH, and ASICO LLC; he has received study grants from Acufocus, Inc., Alcon Surgical, Inc., Carl Zeiss Meditec AG, Ophtec BV, and Physiol S.A. No other author has a financial or proprietary interest in any material or method mentioned.
Article
Purpose To evaluate the visual, refractive, contrast-sensitivity, and aberrometric outcomes during a 1-year follow-up after implantation of a trifocal intraocular lens (IOL). Setting Premium Clinic, Teplice, Czech Republic. Design Prospective case series. Methods This study included eyes of patients having cataract surgery with implantation of the trifocal IOL model AT Lisa tri 839MP. Distance, intermediate (66 and 80 cm), and near (33 and 40 cm) vision; contrast sensitivity; aberrometric outcomes; and the defocus curve were evaluated during a 12-month follow-up. The level of posterior capsule opacification (PCO) was also evaluated. Results In 120 eyes (60 patients), 1 month postoperatively, an improvement was observed in all visual parameters (P ≥03) except corrected near and intermediate visual acuities (both P ≤.05). From 1 month to 12 months postoperatively, small but statistically significant changes were observed in uncorrected and corrected distance and near visual acuities (all P ≥;.03) and in uncorrected intermediate visual acuity (P =.01). In the defocus curve, no significant differences were found between visual acuities corresponding to defocus levels of -1.0 diopter (D) and -2.0 D (P =.22). The level of ocular spherical aberration decreased statistically significantly at 6 months (P <.001). Ocular and internal higher-order aberrations increased minimally but significantly from 6 to 12 months postoperatively (P <.001). The mean 12-month PCO score was 0.32 ± 0.44 (SD). Four eyes (3.3%) required neodymium:YAG capsulotomy. Conclusion The trifocal IOL provided complete and stable visual restoration after cataract surgery during a 12-month follow-up, with good levels of visual quality. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
Article
Purpose To compare the visual outcomes after cataract surgery with bilateral implantation of 1 of 2 diffractive trifocal intraocular lenses (IOLs). Setting Two clinical centers, Lisbon, Portugal. Design Prospective comparative case series. Methods Phacoemulsification with bilateral implantation of a Finevision Micro F IOL (Group 1) or an AT Lisa tri 839 MP IOL (Group 2) was performed. Over a 3-month follow-up, the main outcome measures were uncorrected distance visual acuity (UDVA), corrected monocular and binocular distance visual acuity, uncorrected intermediate visual acuity at 80 cm, distance-corrected intermediate visual acuity (DCIVA), uncorrected near visual acuity at 40 cm, distance-corrected near visual acuity (DCNVA), spherical equivalent (SE) refraction, defocus curves, contrast sensitivity, presence of dysphotopsia, and use of spectacles. Results Each group comprised 30 eyes (15 patients). The mean values at 3 months were UDVA, 0.03 logMAR ± 0.08 (SD) (Group 1) and 0.08 ± 0.12 (Group 2) (P = .765); DCIVA, 0.04 ± 0.07 logMAR and 0.18 ± 0.18 logMAR, respectively (P = .048); DCNVA, 0.03 ± 0.06 logMAR and 0.11 ± 0.08 logMAR, respectively (P = .032); SE, −0.25 ± 0.30 diopter (D) and −0.02 ± 0.39 D, respectively (P = .087). There was no significant difference in contrast sensitivity or dysphotopic phenomena between groups. Conclusions Both trifocal IOL models provided excellent distance, intermediate, and near visual outcomes. Monocular DCIVA and DCNVA appeared slightly better in Group 1. Predictability of the refractive results and optical performance were excellent, and all patients achieved spectacle independence.
Article
To evaluate refractive and visual parameters related to distance, intermediate, and near vision after cataract surgery and the optical quality of a new diffractive trifocal intraocular lens (IOL). Vissum Instituto Oftalmologico de Alicante, Alicante, Spain. Case series. Patients had bilateral refractive lens exchange and multifocal diffractive IOL (AT Lisa tri 839 MP) implantation. A complete ophthalmology examination was performed preoperatively and postoperatively. The follow-up was 6 months. The main outcome measures were uncorrected distance (UDVA) and corrected distance (CDVA), intermediate, and near visual acuities; keratometry; manifest refraction; and aberrations (total, corneal, internal). The study comprised 60 eyes of 30 patients (mean age 57.9 years ± 7.8 [SD]; range 42 to 76 years). There was significant improvement in UDVA, uncorrected intermediate visual acuity, uncorrected near visual acuity, CDVA, and distance-corrected intermediate and near visual acuity. The postoperative refractive status was within the range of +1.00 to -1.00 diopter. Total internal aberrations decreased significantly (P<.001). The trifocal IOL improved near, intermediate, and distance vision in presbyopic patients. The use of 3 foci provided significant intermediate visual results without sacrificing near or distance vision. No author has a financial or proprietary interest in any material or method mentioned.
Article
To evaluate the Visual Function Index (VF-14) questionnaire for its effectiveness in assessing visual function in patients with longstanding exudative age-related macular degeneration (AMD). Observational case series. The records of 167 consecutive patients with recent neovascularization related to AMD between June 1990 and December 1994 at the Helsinki University Eye Clinic were analyzed in 1999. Of 121 patients still living, 74 (61%) attended the reexamination. After exclusions, data from 62 patients were analyzed. The VF-14 score, plus global assessment scores of satisfaction with vision and quality of vision, in which patients graded the subjective level of difficulty with their vision, best-corrected visual acuity (BCVA), contrast sensitivity, the area of the AMD lesion, and the shortest distance and direction from the center of the fovea to the edge of the subfoveal lesion, were analyzed. The VF-14 score correlated significantly with BCVA (P <.01), contrast sensitivity (P <.01), and global assessment scores (P <.01), showing stronger correlations with global assessment scores than did BCVA. In multivariate regression analysis, the global assessment scale of overall quality of vision and BCVA in the better eye were significant predictors (P <.001) of the variability in the VF-14 score. The VF-14 reflects visual function of patients with late AMD more effectively than BCVA measurement alone. The VF-14 can thus be used to compare the visual handicap of late AMD patients with that of patients with other eye diseases.
Ophthalmic optics-chart displays for visual acuity measurement-printed
ISO 10938:2016. Ophthalmic optics-chart displays for visual acuity measurement-printed, projected and electronic. https:// www.iso.org/standard/63691.html. Published October 2010.
Refractive Analysis v.1.0.0. A Matlab toolbox for the analysis of refractive results in anterior segment surgery
  • M Rodriguez-Vallejo
Rodriguez-Vallejo M. Refractive Analysis v.1.0.0. A Matlab toolbox for the analysis of refractive results in anterior segment surgery. http://test-eye.com/index.php/en/refractive-analysis. Published 2018.