Five-Year Incidence of Nd:YAG Capsulotomy After Cataract Surgery with Different Single-Piece Monofocal Intraocular Lenses: A Follow-Up Study of 3955 Eyes.

Purpose: To estimate the incidence of neodymium-doped yttrium aluminum garnet laser (Nd:YAG) capsulotomy up to five years after cataract surgery with different single-piece acrylic monofocal IOLs in a Spanish cohort. Patients and Methods: Data were extracted from electronic medical records. Eligible participants were aged ≥65, had cataract surgery with one of five different acrylic monofocal IOLs (Alcon AcrySof, AJL LLASY60, Medicontur Bi-flex, IOL Tech Stabibag and Zeiss Asphina), and more than six months baseline data. Participants were followed up to five years from surgery and up to six months from Nd:YAG. The incidence of Nd:YAG was compared between the IOLs and multivariate analyses were conducted to identify predictors of Nd:YAG incidence at five-years after cataract surgery. Results: The initial cohort included 9545 patients with 14,519 eyes (53% female, average age 75 years). Of those, 3955 eyes were available for analysis five years after cataract surgery. Throughout the five years post-surgery, Nd:YAG incidence was consistently lower with Alcon Acrysof IOLs than the other IOLs. At five years the Nd:YAG incidence rate for Alcon Acrysof was 8.8%. In comparison, the incidence was 47.4% for AJL LLASY60 (OR = 9.54, 95% CI [6.57, 13.84]), 44.3% for Zeiss Asphina (OR = 8.35, 95% CI [5.85, 11.94]) and 44.0% for IOL Tech Stabibag (OR = 8.02, 95% CI [4.60, 13.84]). Conclusion: Alcon AcrySof IOLs have a consistently lower risk of Nd:YAG incidence over a long follow-up period after cataract surgery, highlighting the importance of IOL choice for patients' long-term outcomes.

Costs and Healthcare Resource Utilization Associated with Posterior Capsule Opacification After Cataract Surgery with Five Different Intraocular Lenses: An Economic Analysis for Spain.

Purpose: To estimate the economic impact of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy and its related complications for five different intraocular lenses (IOLs) from the payer and hospital perspectives in Spain. Materials and Methods: The three-year incidence rates of Nd:YAG laser capsulotomy after cataract surgery with five different single-piece acrylic monofocal IOLs (AcrySof IOLs, AJL LLASY60, IOL Tech Stabibag, Medicontur Bi-flex, Zeiss Asphina) for 8293 patients were derived from odds ratios of multivariate analysis adjusted for age, gender, and diabetic retinopathy. A cost-consequence model for a hypothetical cohort of 2000 eyes was then developed to quantify the potential impact of Nd:YAG capsulotomy in terms of costs and time for each of the included IOLs, from the payer and hospital perspectives. Results: The adjusted three-year Nd:YAG laser capsulotomy incidence was 5.0% (95% CI 3.9 to 6.1) for AcrySof and ranged from 26.0% to 44.0% for the other four IOLs. The average costs of Nd:YAG treatment and related complications were €261.90 for payers and €19.99 for hospitals. The average time needed for Nd:YAG treatment and related complications was 32.82 minutes. Model estimates based on 2000 hypothetical cataract surgeries showed that AcrySof IOLs could lead to cost savings between €110,259.90 and €205,591.50 for payers. For hospitals, time, and cost savings with AcrySof ranged from 230.29 hours and €8415.79 compared to Zeiss Asphina to 429.40 hours and €15,692.15 compared to AJL LLASY60 IOLs. Conclusion: Post cataract surgery, AcrySof IOLs were associated with a significantly lower incidence of Nd:YAG treatment and its subsequent complications compared to other IOLs. Our analysis shows that IOL choice is an important factor that can reduce the burden for patients, payers, and hospitals.

Nd:YAG capsulotomy incidence associated with five different single-piece monofocal intraocular lenses: a 3-year Spanish real-world evidence study of 8293 eyes.

OBJECTIVES: To investigate the associations between different single-piece monofocal intraocular lenses (IOLs) and neodymium-doped yttrium aluminum garnet laser (Nd:YAG) capsulotomy incidence 3 years after cataract surgery in a Spanish cohort. METHODS: This is a longitudinal retrospective cohort study. Data were extracted from the electronic medical records of two large regional hospitals in Spain. Patients aged ≥65 years receiving cataract surgery with placement of five different IOLs and with ≥6 months of baseline data were included. We report the Nd:YAG capsulotomy incidence 3 years post cataract surgery, and the survival plot over the 3 years of follow-up time. The associated adjusted (age, gender, and diabetic retinopathy) multivariate analysis with odds ratios (ORs) and 95% CIs is also presented. RESULTS: The cohort (53% female, mean age 75 ± 5.9 years) included 14,519 eyes (Alcon AcrySof = 2968, AJL LLASY60 = 1776, Medicontur Bi-flex = 5176, Zeiss Asphina = 4478, and IOL Tech Stabibag = 121). Of these, 8293 were retained until 3-year follow-up. At 3 years after cataract surgery, the Nd:YAG capsulotomy incidence was 5% for Alcon AcrySof, while it ranged from 21.2% to 31.1% for the other IOLs (p < 0.0001 for each comparison). The odds for Nd:YAG capsulotomy were significantly higher (p < 0.0001) for other IOLs compared with those of Alcon AcrySof (ORs = 8.85, 5.86, 5.74, 5.21 for AJL LLASY60, Medicontur Bi-flex, IOL Tech Stabibag, and Zeiss Asphina, respectively). CONCLUSIONS: The lower Nd:YAG capsulotomy rates for Alcon AcrySof IOLs compared to the other IOLs support the importance of lens choice in reducing patient burden and treatment costs.

Distribution of preoperative and postoperative astigmatism in a large population of patients undergoing cataract surgery in the UK.

PURPOSE: To assess the prevalence and severity of preoperative and postoperative astigmatism in patients with cataract in the UK. SETTING: Data from 8 UK National Health Service ophthalmology clinics using MediSoft electronic medical records (EMRs). DESIGN: Retrospective cohort study. METHODS: Eyes from patients aged ≥65 years undergoing cataract surgery were analysed. For all eyes, preoperative (corneal) astigmatism was evaluated using the most recent keratometry measure within 2 years prior to surgery. For eyes receiving standard monofocal intraocular lens (IOLs), postoperative refractive astigmatism was evaluated using the most recent refraction measure within 2-12 months postsurgery. A power vector analysis compared changes in the astigmatic 2-dimensional vector (J0, J45) before and after surgery, for the subgroup of eyes with both preoperative and postoperative astigmatism measurements. Visual acuity was also assessed preoperatively and postoperatively. RESULTS: Eligible eyes included in the analysis were 110 468. Of these, 78% (n=85 650) had preoperative (corneal) astigmatism ≥0.5 dioptres (D), 42% (n=46 003) ≥1.0 D, 21% (n=22 899) ≥1.5 D and 11% (n=11 651) ≥2.0 D. After surgery, the refraction cylinder was available for 39 744 (36%) eyes receiving standard monofocal IOLs, of which 90% (n=35 907) had postoperative astigmatism ≥0.5 D and 58% (n=22 886) ≥1.0 D. Visual acuity tended to worsen postoperatively with increased astigmatism (ρ=-0.44, P<0.01). CONCLUSIONS: There is a significant burden of preoperative astigmatism in the UK cataract population. The available refraction data indicate that this burden is not reduced after surgery with implantation of standard monofocal IOLs. Measures should be taken to improve visual outcomes of patients with astigmatic cataract by simultaneously correcting astigmatism during cataract surgery.

Comparison of the Ultraviolet Light Filtering across Different Intraocular Lenses.

SIGNIFICANCE: We have analyzed the ultraviolet transmittance of some commercial intraocular lenses (IOLs). The results show differences of wavelength cutoff among them. PURPOSE: The purpose of this study was to measure and compare the ultraviolet light transmittance of different IOLs made out of acrylic hydrophobic, hydrophilic, and hydrophilic with hydrophobic surface materials from different manufacturers. METHODS: The spectral transmission curves of eight monofocal IOLs with the same dioptric power of +20.0 diopters were measured using a PerkinElmer Lambda 35 ultraviolet/visible spectrometer. Two IOLs of each type were tested three times. The ultraviolet cutoff wavelength at 10% transmission and the mean values were calculated. RESULTS: All lenses prevented transmission of ultraviolet C (200 to 280 nm) and B radiation (280 to 315 nm). However, not all IOLs provided the same filtering properties in ultraviolet A (315 to 380 nm). Within the ultraviolet A range, the ultraviolet radiation cutoff wavelength of 10% ranges from approximately 360 to 400 nm. HOYA iSert 250 provided a cutoff wavelength of 398.4 nm; AcrySof SA60AT, 396.2 nm; AcrySof SA60WF, 395.7 nm; CT Asphina 404, 378.34 nm; Tecnis ZCB00, 377.70 nm; CT Lucia 607P, 379 nm; C-Flex 570C, 377 nm; and enVista MX60, 360 nm. CONCLUSIONS: Intraocular lenses of different materials and manufacturers have different ultraviolet transmission characteristics. AcrySof (SA60AT and SA60WF) and HOYA iSert 250 provided the highest ultraviolet radiation transmission; the cutoff wavelength of 10% is close to 400 nm. In contrast, enVista IOL showed the lowest ultraviolet radiation cutoff.

Visual simulation through different intraocular lenses in patients with previous myopic corneal ablation using adaptive optics: effect of tilt and decentration.

PURPOSE: To evaluate visual quality differences between intraocular lenses (IOLs) in patients with previous myopic laser ablations and assess the impact of IOL decentration and tilt on visual quality. SETTING: University of Valencia, Burjassot, Spain. DESIGN: Cohort study. METHODS: An adaptive optics visual simulator was used to simulate the wavefront aberration pattern of 1 aberration-correcting IOL (Acrysof IQ SN60WF), 1 aberration-free IOL (Akreos Adapt AO), and 1 spherical IOL (Triplato) under 5 IOL situations: centered, 0.2 mm and 0.4 mm decentered, and 2 degrees and 4 degrees tilted in eyes with simulated low or high myopic laser corneal ablations. Monocular distance visual acuity at 100%, 50%, and 10% contrast were measured. RESULTS: Ten eyes of 10 patients were evaluated. When the IOLs were centered, the aberration-correcting IOL provided the best visual quality results in both groups. When the IOLs were misaligned, there was a decrease of visual quality with all simulated IOLs except the aberration-free IOL in the high myopia group. In the misaligned situations, all simulated IOLs obtained comparable visual quality results in both groups. CONCLUSIONS: The results suggest that in patients with previous myopic laser corneal ablation, aberration-correcting IOLs should be implanted. The decrease in visual quality when these IOLs are decentered or tilted demonstrates the importance of accurate implantation of these IOLs. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Effect of simulated IOL tilt and decentration on spherical aberration after hyperopic LASIK for different intraocular lenses.

PURPOSE: To evaluate visual quality differences among intraocular lenses (IOLs) in patients with previous hyperopic laser ablations and to assess the impact of decentration and tilt of IOLs on visual quality. METHODS: An adaptive optics visual simulator was used to simulate the wavefront aberration pattern of one aberration-correcting IOL (AcrySof IQ SN60WF, Alcon Laboratories Inc) and two spherical IOLs with different amounts of positive spherical aberration (Akreos Adapt [Bausch & Lomb] and Triplato [AJL Ophthalmic]) in five situations-centered, 0.2 mm and 0.4 mm of decentration, and 2° and 4° of tilt-in two groups: simulated low hyperopic laser corneal ablation (low hyperopia group) and high hyperopic laser corneal ablation (high hyperopia group). Monocular distance visual acuity at 100%, 50%, and 10% contrast were measured. RESULTS: Ten eyes were evaluated. When the IOLs were centered, all IOLs obtained comparable results for the low hyperopia group, whereas for the high hyperopia group, the Akreos Adapt and AcrySof IQ SN60WF showed better visual acuity than the Triplato. When the IOLs were misaligned, for the low hyperopia group, the best visual acuity results were obtained with the Akreos Adapt and the most critical situation was at 0.4 mm of decentration. For the high hyperopia group, misalignments decreased visual acuity in a higher amount than for the low hyperopia group. CONCLUSIONS: Our results suggest that the IOLs studied offer good visual quality when they are centered for both groups. However, tilt and decentration of monofocal IOLs have an impact on visual function in patients with hyperopic ablations. For these patients, the Akreos Adapt is the most robust to misalignments.