Measurement of change in angle kappa and its correlation with ocular biometric parameters pre- and post-phacoemulsification

Purpose: Angle kappa has been considered to play a role in causing glare and haloes despite accurate centration during implantation of multifocal intraocular lenses following phacoemulsification. There is a lack of substantial data regarding whether angle kappa is a constant entity or changes following ocular surgical procedures. To answer this question, in this prospective observational study, we measured change in angle kappa following phacoemulsification, and studied the ocular biometric parameters correlating with this change. Methods: Angle kappa was measured objectively using synoptophore. Ocular Biometric parameters (Anterior Chamber Depth, Corneal White?to?White measurement, Lens Thickness, and Axial Length) using LenStar LS 900 Haag Streit Anterior Segment imaging system. outcome measures were a quantitative change in angle kappa from the preoperative value by one degree or more and observation of correlation between change in angle kappa and ocular biometric parameters. The Wilcoxin Signed Rank Test was used to determine the difference between pre?operative and post?operative measurements for angle kappa. A p?value of less than 0.05 was considered statistically significant. Pearson's correlation coefficient was employed to find the relationship between preoperative ocular biometric parameters and a change in angle kappa. A linear regression model was used to derive an equation considering corneal white?to?white measurement as the predictor and change in angle kappa as the outcome measure. Results: A significant change in angle kappa was recorded, and a significant correlation was found with corneal white to white measurements. This change could be predicted preoperatively, for a known corneal white to white measurement using the standard equation y=mx+c. Conclusion: This study explains the possible cause of dissatisfaction among seemingly ideal patients who undergo multifocal IOL implantation and the potential for better decision? making during patient selection for multifocal IOL implantation.

Post-small incision lenticule extraction phacoemulsification with multifocal IOL implantation: A case report

A 54-year-old patient presented with cataract, 5 years after undergoing SMILE for high myopia in both eyes. He was motivated in achieving spectacle free vision and his post SMILE-induced aberrations were minimal, due to which he was found suitable for a trifocal IOL implant. Of the various methods considered, the IOL power predicted by a novel combined telecentric keratometry and swept source OCT-based method was finally selected. One month post-operatively, the patient achieved a binocular UDVA of 20/20p and near vision of N.6, suggesting that newer IOL formulae could be superior in providing satisfactory outcomes in post refractive patients.

Study on visual quality and patient satisfaction after astigmatic multifocal intraocular lens implantation / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the postoperative visual quality and patient satisfaction of AT LISA Toric 909MP(909M)astigmatic corrected multifocal IOL and AT TORBI 709M(709M)astigmatic corrected single-focus IOL after phacoemulsification.<p>METHODS: Patients with age-related cataract and corneal astigmatism(>1.0D)were enrolled and accepted phacoemulsification combined with implantation of intraocular lens(IOL)in our hospital during December 2017 and December 2018. Forty cases(56 eyes)were divided into two groups according to which IOL they chose, multiple focal astigmatism(909M)group included 23 cases(35 eyes), single focal astigmatism(709M)group included 17 cases(21 eyes). Three months postoperatively, the visual acuity, defocus curve, residual astigmatism degree, rotational stability of the IOL, postoperative visual quality analysis and patient satisfaction were evaluated.<p>RESULTS: At 3mo postoperatively, uncorrected distance visual acuity(UDVA)and corrected distance acuity in the two groups were significantly improved(<i>P</i><0.05). The defocus curve showed that 909M group had two visual acuity peaks at 0D and -2.5D, and a low peak at -1D, 709M group had the visual peak only at 0D. Spectacle independency was achieved by 91%(21/23)of patients in the 909M group and 18%(3/17)in the 709M group.<p>CONCLUSION: Both of the 909M and 709M had good correction effect for cataract combined with astigmatism. It provided better rotational stability. In addition, 909M provided excellent distance, near visual outcomes, and acceptable intermediate vision. At the same time, it improved the spectacle independency and satisfaction of cataract patients combined with astigmatism.

Clinical outcomes after femtosecond laser assisted cataract surgery with implantation of the tecnis symfony intraocular lens / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the clinical outcomes in terms of vision across distances(near, intermediate and far), contrast sensitivity and subjective patient satisfaction after femtosecond laser-assisted cataract surgery(FLACS)with implantation of an extended range of vision(ERV)intraocular lens(IOL).<p>METHODS: Forty patients(55 eyes)underwent bilateral or monocular FLACS with implantation of the ERV IOL Tecnis Symfony(Johnson & Johnson Vision)were enrolled. Uncorrected distance(UDVA), intermediate(UIVA)and near visual acuities(UNVA)were evaluated at 3mo after surgery, as well the defocus curve, contrast sensitivity, patient satisfaction and spectacle independence.<p>RESULTS:No severe complications occurred. All eyes showed a central position of the IOL in the capsular bag without tilting at 3mo after surgery. 3mo postoperative mean logMAR visual acuity at 5 m, 67 cm and 40 cm were -0.04 ±0.08, -0.17±0.22, 0.37±0.17, respectively. All patients obtained satisfactory UDVA and UIVA, as well as functional UNVA, meeting the needs of daily life. Spectacle independence rate was 94.55%. Contrast sensitivity results did not differ from those obtained with monofocal aspheric lenses. Likewise, no moderate and severe photic phenomena were reported. Mean patient satisfaction scores with distance, intermediate and near vision were 9.0, 9.0, and 7.0, respectively.<p>CONCLUSION: FLACS with implantation of the ERV IOL TECNIS Symfony provides a successful visual restoration at far, intermediate distance and a functional-range near vision acuity, with minimal level of disturbing photic phenomena, and high rates of spectacle independence and patient satisfaction.

Visual Outcome and Patient Satisfaction after Implantation of Multifocal IOLs: Three-Month Follow-Up Results

PURPOSE: To evaluate the visual outcome and patient satisfaction at three months after implantation of ReSTOR(R) Aspheric multifocal IOL D1 (+3.0 D) and D3 (+4.0 D) in unilateral and bilateral cataract surgery groups. METHODS: Among 73 patients who received cataract surgery and implantation of D1 or D3, visual outcome and satisfaction score of 34 patients in the unilateral surgery group and 39 patients in the bilateral surgery group were analyzed respectively. The unilateral surgery group was divided into 2 sub-groups (D1, D3), and the bilateral surgery group was sub-divided into 3 groups (D1/D1, D1/D3, D3/D3) according to the combination of implanted IOL. Uncorrected near visual acuity (UNVA, 30 cm), uncorrected intermediate visual acuity (UIVA, 40 cm, 50 cm), uncorrected distant visual acuity (UDVA) and best corrected visual acuity (BDVA) were measured at three months postoperatively. Also, all patients answered questionnaires to assess satisfaction. RESULTS: In the unilateral surgery sub-groups, visual acuity of the D1 group was higher than that of the D3 group at 50 cm (p < 0.001), although the D3 group showed better visual outcome at 30 cm (p < 0.001). In satisfaction analysis, the D1 group reported significantly higher scores in three categories (general satisfaction with surgery; p = 0.027, intermediate vision; p < 0.001, recommendation to others; p = 0.026). Among the bilateral surgery groups, the D1/D1 group showed the best intermediate visual acuity at 50 cm (p = 0.011), and the D3/D3 group achieved the highest postoperative near visual acuity (p = 0.004). In satisfaction analysis, the scores of the three categories (general satisfaction with surgery; p = 0.008, intermediate vision; p < 0.001, recommendation to others; p = 0.006) showed significant differences among the three groups, with the D1/D1 group reporting the highest scores in all three categories. CONCLUSIONS: In bilateral ReSTOR(R) lens implantation, insertion of D1 in both eyes is expected to achieve the most favorable visual outcome and patient satisfaction. In unilateral ReSTOR(R) lens implantation, implantation of D1 rather than D3 would be more advantageous in general.

Comparison of Higher-Order Aberration and Contrast Sensitivity in Monofocal and Multifocal Intraocular Lenses

PURPOSE: The visual performance of pseudophakic eyes depends on the type of intraocular lenses (IOLs) that are implanted. Aspherical and multifocal IOLs have recently been developed to improve visual quality after cataract surgery, but multifocal IOLs can be associated with decreased contrast sensitivity (CS), halos, and glare. This study compares the visual performance of monofocal and multifocal IOLs by measurement of higher-order aberrations (HOAs) and CS values. MATERIALS AND METHODS: HOAs and CS values of 42 eyes with implanted monofocal IOLs and 40 eyes with implanted multifocal IOLs were measured preoperatively and more than 6 months after surgery. In the multifocal IOL group, HOAs and CS values were also measured with addition of a trial lens of -0.5 diopter (D) to evaluate the compensatory effect on spherical aberration. RESULTS: CS values of the multifocal IOL group were significantly lower than those of the monofocal IOL group for all spatial frequencies tested (p<0.01), and the spherical aberration was significantly higher in the multifocal IOL group than in the monofocal IOL group (p<0.001). Addition of a -0.5 D lens to the multifocal IOL group decreased the difference in CS between the two groups (p=0.003). CONCLUSION: Increased spherical aberration may contribute to lower CS in the multifocal IOL group. In such cases, CS can be improved by addition of a -0.5 D lens to compensate for the spherical aberration.

The Analysis of Refractive Errors of AMO Array(R) Multifocal Intraocular Lens with SRK II Formula

PURPOSE: To evaluate the accuracy of the SRK II formula for the AMO Array(R) multifocal intraocular lens (Array lens) power calculation according to axial length. In case of refractive error more than +/- 1.0 diopter (D), we compared the accuracy of the SRK II with that of other formulas. METHODS: Participants were 178 eyes (142 patients) received the Array lens. These were divided into 3 subgroups based on axial length. Group I had 21 eyes of short axial length (less than 22.0 mm). Group II had 133 eyes of average axial length (more than 22.0mm below 24.5mm). Group III had 24 eyes of long axial length (more than 24.5mm). The difference between preoperative predicted refractive value and postoperative manifest refractive value were calculated. We compared the accuracy of the SRK II and that of SRK/T, Holladay formulas in case of refractive error more than +/- 1.0D. RESULTS: Three eyes (14.2%) in Group I, 14 eyes (10.5%) in group II and 15 eyes (62.5%) in Group III showed refractive errors more than +/- 1.0D. Fifteen eyes (62.5%) in Group III were significantly reduced to 7 eyes (29.1%) with using SRK/T, Holladay formulas. CONCLUSIONS: SRK II formula had better predictive accuracy in axial length less than 24.5mm with Array lens. But it is better to apply SRK/T or Holladay formulas when axial length is more than 24.5mm.

Comparison of Optical Aberrations and Contrast Sensitivity between Monofocal and Multifocal Intraocular Lens

PURPOSE: The purpose of this study was to compare the postoperative contrast sensitivity and optical aberration between monofocal and multifocal IOL implanted patients. METHODS: Postoperative contrast sensitivity and optical aberration were measured for 7 cataract patients, 12 eyes that underwent monofocal IOL implantation and for 8 cataract patients, 9 eyes that underwent multifocal IOL implantation. Phacoemulsification was conducted on all patients prior to either multifocal or monofocal IOL implantation, and Multivison Contrast Tester (MCT 8000, Vistech, Dayton, U.S.A.) and WaveScan WavefrontT M system (VISX, Santa Clara, U.S.A.) were used to measure contrast sensitivity and optical aberration. RESULTS: Under the nighttime contrast sensitivity mode, the multifocal-group displayed a statistically significant decrease in contrast sensitivity compared to the monofocal-group (P< 0.01), while there was no statistical difference in the optical aberration index of the two groups. (the multi-group; 0.36, the monogroup; 0.31, p=0.64) CONCLUSIONS: After cataract extraction, there was no difference in the optical aberration between the multifocal IOL implantated patients and the monofocal IOL implanted patients. The decrease in postoperative contrast sensitivity was subjectively greater for multifocal IOL implantated patients than the monofocal IOL implanted patients.

Clinical Results of AMO ARRAY Multifocal Intraocular Lens

Various kinds of multifocal intraocular lenses(IOLs) have been developed for the improvement of near and far visual acuity after cataract operation. This prospective study was performed to compare a function of AMO ARRAY multifocal IOL(Array group) with conventional monofocal IOL(Mono group). Each type of IOL was implanted into 25 eyes and uncorrected visual acuity(UCVA) and best corrected visual acuity(BCVA) at near, intermediate and far distance were evaluated before and 2 months after operation in both groups. Contrast sensitivity, photophobia and glare were also evaluated as subjective symptoms in both groups. Mean UCVA at distant and near distance before operation was 0.23+/-0.15 and 0.25+/-0.20 in mono group, and 0.13+/-0.11 and 0.14+/-0.11 in Array group. Mean UCVA/BCVA at distant and near distance 2 month after operation was improved to 0.79+/-0.28/0.87+/-0.27 and 0.34+/-0.15/0.82+/-0.26 in mono group and 0.83+/-0.19/0.86+/-0.19 and 0.50+/-0.15/0.79+/-0.15 in Array group. The difference of UCVA at near distance was statistically significant(P<0.05), while that of BCVA at near and far distance was not statistically significant between two groups(P<0.05). Array group had less contrast sensitivity at all spatial frequencies(1.5, 3, 6, 12, 18 cycles/degree) and more glare than the mono group after operation. AMO ARRAY multifocal IOL induces a good result of visual rehabilitation in both near and far distance, but it may cause more glare and less contrast sensitivity than the monofocal IOL.

The change of visual acuity and visual field by diminished illumination in eyes with multifocal intraocular lens

To investigate the effect of illumination on visual acuity and visual field in eyes with multifocal intraocular lens (IOL), the near and far visual acuity of the eyes with multifocal implants were compared to those of the eyes with monofocal implants in the diminished illumination, and the visual fields of two groups were also compared by the different target size and intensity. The near and far visual acuity of the eyes with multifocal implants were significantly decreased as compared to those of the eyes with monofocal implants under diminished illumination, and the visual field of the multifocal implanted eyes also significantly decreased as compared to that of the monofocal implanted eyes by the reduction of spot size and intensity. From the above results, it is assumed that the bifocal separation of incident light to two simultaneous focal points in the multifocal implants causes more decreased visual acuity and narrower visual field in the diminished illumination as compared to that of the eyes with monofocal implants.