Effect of Refractive Astigmatism on All-Distance Visual Acuity in Eyes With a Trifocal Intraocular Lens.

PURPOSE: To investigate the effect of refractive astigmatism on all-distance visual acuity (VA) in eyes implanted with a diffractive trifocal or bifocal intraocular lens (IOL). DESIGN: Cross-sectional study. METHODS: Fifty eyes with trifocal IOLs (PanOptix; Alcon) and 50 eyes with bifocal IOLs (ReSTOR +3D) were enrolled. After simulating astigmatism by adding cylindrical lenses of 0, 0.5, 0.75, 1.0, and 1.5 diopters (D), the corrected logarithm of minimal angle of resolution (logMAR) VA was measured using an all-distance vision tester. RESULTS: Mean VAs at most distances significantly worsened in proportion to the added astigmatism (P ≤ .0111) with no significant differences in near VA at 0.3 m in the trifocal group or in intermediate VA at 0.7 m in the bifocal group. Mean intermediate VA at 0.5 m was significantly better in the trifocal group than in the bifocal group when the astigmatism was 0.75 D or less (P ≤ .0472), but VA at distances of ∞ and 5.0 m were significantly worse in the trifocal group when the astigmatism was 0.5 D or more (P ≤ .0457). Useful mean logMAR VA of 0.20 was achieved at all distances when the astigmatism was 0.75 D or less in the trifocal group and 1.0 D or less in the bifocal group. CONCLUSIONS: All-distance VA, particularly distance VA, worsened more in proportion to astigmatism with a trifocal IOL than with a bifocal IOL. Useful VA was achieved when the astigmatism was 0.75 D or less with a trifocal IOL, suggesting that astigmatism correction is necessary when astigmatism is more than 0.75 D.

Results of a clinical evaluation of a trifocal intraocular lens in Japan.

PURPOSE: To evaluate the effectiveness and safety of a new trifocal intraocular lens (IOL) after cataract removal in patients living in Japan. STUDY DESIGN: Prospective multicenter clinical study. METHODS: One hundred and thirty-five eyes of 68 patients (19 men, 49 women; mean age, 66.3 ± 7.4 years) were followed for 6 months. Trifocal IOLs with focal points at near, intermediate, and distance were implanted bilaterally in eyes with less than 1 diopter of corneal astigmatism. The visual acuity (VA) at distance, 60 and 40 centimeters (cm), and contrast sensitivities were measured. Patients completed quality-of-life questionnaires preoperatively and postoperatively. RESULTS: The mean bilateral logarithm of the minimum angle of resolution VA at 5 meters (m), 60 cm, and 40 cm were, respectively: uncorrected, - 0.104 ± 0.095, - 0.065 ± 0.111, and - 0.042 ± 0.105; and distance-corrected, - 0.197 ± 0.076, - 0.112 ± 0.111, and - 0.073 ± 0.111. The contrast sensitivities at distance and near were within the normal range at all spatial frequencies under photopic conditions. Patients reported complete spectacle independence in 75.0% of cases. Total use of spectacles was reported by 1.5% and partial by 20.6%; the purpose of spectacle use was primarily for near visual tasks. Mild-to-moderate glare was reported by 65.7% of patients and halos by 70.1%; only 1.5% of subjects reported severe glare and halos. CONCLUSIONS: This new trifocal IOL provides equally good uncorrected VAs at distance, intermediate, and near, and decreases spectacle dependence in daily life. Patients frequently report mild-to-moderate glare and halos, and patients should be informed about these before implantation.

Comparison of visual outcomes between bilateral trifocal intraocular lenses and combined bifocal intraocular lenses with different near addition.

PURPOSE: To compare outcomes in patients implanted bilaterally with a trifocal intraocular lens (IOL) with patients implanted with bifocal IOLs having different near addition in each eye. STUDY DESIGN: Nonrandomized comparative study. METHODS: Seventy-eight patients scheduled for multifocal IOL implantation were divided into a trifocal group (n=32) implanted bilaterally with trifocal IOLs (Alcon TFNT00), and a combined bifocal group (n=46) implanted with a bifocal IOL with +3.0 diopter (D) addition in the dominant eye and +4.0D addition in the nondominant eye. At 3 months postoperatively, binocular all-distance visual acuity (VA), binocular contrast VA alone and with glare (glare VA), near stereoacuity, and incidence of patients reporting halo symptoms were assessed. RESULTS: Both mean binocular uncorrected and corrected VAs at far to intermediate distances were significantly better in the trifocal group than in the combined bifocal group (P≤0.0325), while binocular near VA did not differ significantly between groups. Mean photopic and mesopic contrast VA and glare VA at most contrasts, and stereoacuity were significantly better in the trifocal group than in the combined bifocal group (P≤0.0426). The incidence of patients reporting moderate halo symptoms was significantly greater in the trifocal group (P=0.0482). CONCLUSIONS: Bilateral implantation of a trifocal IOL provided significantly better binocular VA at far to intermediate distances and comparable near VA compared with combined implantation of bifocal IOLs with +3.0D and +4.0D addition. Contrast VA and stereoacuity were significantly better, but the incidence of halo symptoms tended to be worse in patients with trifocal IOLs.

Effect of Spherical Equivalent Error on Visual Acuity at Various Distances in Eyes With a Trifocal Intraocular Lens.

PURPOSE: To examine the effect of manifest refraction spherical equivalent error on visual acuity at various distances in eyes that received a trifocal intraocular lens (IOL). METHODS: Sixty eyes of 30 patients who underwent bilateral implantation of a trifocal IOL (Alcon PanOptix TFNT00; Alcon Laboratories, Inc., Fort Worth, TX) were enrolled. Corrected visual acuity from far to near distances was measured using an all-distance vision tester after simulating the spherical equivalent error by adding spherical lenses with refractive powers of +1.00, +0.50, 0.00, -0.50, and -1.00 diopters (D); addition of a plus lens simulates myopia, whereas addition of a minus lens simulates hyperopia. RESULTS: Mean visual acuity at all distances differed significantly among the spherical lens added groups (P ≤ .0374). Mean distance visual acuity at infinity, 5, and 3 m was significantly worse in all lens added groups (+1.00, +0.50, -0.50, and -1.00 D) than in the no lens group (P < .0001). Mean intermediate visual acuity at 1 and 0.7 m did not differ significantly between each of the lens added groups and the no lens group. Mean near visual acuity at 0.3 m was significantly better in the +1.00 and +0.50 D groups and significantly worse in the -0.50 and -1.00 D groups than in the no lens group (P ≤ .0044). CONCLUSIONS: A manifest spherical equivalent error of slight myopia significantly improved near visual acuity but worsened distance visual acuity, whereas that of slight hyperopia worsened both distance and near visual acuity in eyes with trifocal IOLs, suggesting that slight myopia is a better target refraction than slight hyperopia, although emmetropia is the optimum target. [J Refract Surg. 2019;35(5):274-279.].

Phacoemulsification after retinal detachment surgery.

PURPOSE: To evaluate the outcomes of phacoemulsification in eyes that had previous retinal detachment (RD) surgery. SETTING: Hayashi Eye Hospital, Fukuoka, Japan. METHODS: Ninety-six eyes of 90 consecutive patients who had phacoemulsification after previous RD surgery (RD group) were included. Fifty-one fellow eyes that had not had RD surgery but did have phacoemulsification served as controls (control group). Recurrence of RD, visual acuity, complications, and the neodymium:YAG (Nd:YAG) laser capsulotomy rate were examined. RESULTS: Recurrent RD after phacoemulsification occurred in 2 eyes (2.1%) in the RD group. Three eyes (5.9%) in the control group developed RD postoperatively. The incidence of RD was not significantly different between the 2 groups (P =.3416). The mean final visual acuity in the RD group was 20/30, significantly worse than in the control group (P =.0099). Posterior capsule opacification developed in 29 eyes (30.2%) in the RD group and 11 eyes (21.6%) in the control group; the difference between the groups was not significant. Eighteen eyes (43.9%) that had implantation of a poly(methyl methacrylate) (PMMA) intraocular lens (IOL) and 7 eyes (6.6%) that received an acrylic IOL had an Nd:YAG capsulotomy; the capsulotomy rate was significantly higher in eyes with a PMMA IOL than in eyes with an acrylic IOL (P<.0001). CONCLUSIONS: The rate of recurrent RD after phacoemulsification in eyes that had previous RD surgery was similar to that of new occurrence of RD in fellow eyes without RD before phacoemulsification. Because the Nd:YAG capsulotomy rate was lower in eyes with acrylic IOLs than in eyes with PMMA IOLs, acrylic IOLs are recommended for eyes at high risk for RD.