Evaluating Rotational Stability of an Extended Depth of Focus Toric Intraocular Lens Using a Slit Lamp and Image-Based Analysis.

PURPOSE: To evaluate the rotational stability of a toric extended depth of focus (EDOF) intraocular lens (IOL), using either slit lamp evaluation or image-processing software. SETTING: Three clinical practices in the USA. DESIGN: Prospective unmasked randomized clinical trial. METHODS: Subjects presenting for routine cataract surgery that were interested in improved near vision received toric EDOF lenses (TECNIS Symfony® Toric) in both eyes. The measures of interest in the current analysis were the change in orientation of the IOL between 1 day, 1 month and 3 months postoperative. Orientation was measured at the microscope on the day of surgery, and with the slit lamp at all other visits. Day 1, 1-month and 3-month images of the lens orientation were captured with a slit lamp camera. Differences in orientation were recorded and analyzed. RESULTS: A total of 150 eyes had IOL orientation data available. Image analysis showed mean absolute lens orientation changes from 1 day to 1 month and 3 months of less than 2 degrees. The percentage of lenses exhibiting rotation of ≤5 degrees between any measured time points was 97% or higher. Results were similar, but significantly more variable, when IOL orientation was measured at the slit lamp. CONCLUSION: The toric EDOF lens evaluated here demonstrated rotational stability that exceeded the prior ANSI standard. The best method to determine IOL orientation changes was through image analysis. .

Refractive predictability and visual outcomes of an extended range of vision intraocular lens in eyes with previous myopic laser in situ keratomileusis.

PURPOSE: To evaluate the refractive predictability obtained with an extended range of vision intraocular lens in eyes with previous myopic laser in situ keratomileusis, confirming which intraocular lens power formula provides the most accurate calculation. METHODS: The study enrolled 71 eyes with previous successful myopic laser in situ keratomileusis surgery of 43 patients undergoing cataract surgery with implantation of the extended range of vision intraocular lens TECNIS Symfony (Johnson and Johnson Vision). Intraocular lens power was calculated using all American Society of Cataract and Refractive Surgeons formulas, and their average value was selected for implantation. Refractive outcomes were evaluated at 3 months postoperatively. RESULTS: Postoperative spherical equivalent within ±0.50 and ±1.00 D was found in 61.6% and 86.3% of eyes, respectively. In eyes with pre-laser in situ keratomileusis data available, no significant correlation was found between pre-laser in situ keratomileusis spherical equivalent and post-cataract surgery spherical equivalent (r = 0.237, p = 0.114). A postoperative spherical equivalent within ±0.50 D was found in 65.2% and 55.6% of eyes in the subgroups with and without pre-laser in situ keratomileusis data available, respectively (p = 0.480). Statistically significantly higher differences between the intraocular lens power implanted and the calculation provided by the Potvin-Hill (p = 0.028) and Barrett True K No History formulas (p = 0.022) were found in those eyes with postoperative spherical equivalent > 0.50 D. CONCLUSION: The extended range of vision intraocular lens evaluated can provide a predictable refractive correction in eyes with previous laser in situ keratomileusis surgery. The Potvin-Hill and Barrett True K No History are the most adequate formulas to perform intraocular lens power calculations in these cases.

Influences of different reserved diopters during cataract extraction combined with TECNIS Symfony intraocular lens implantation on visual quality of presbyopia correction / 中华实验眼科杂志

Objective To compare the efficacy and visual quality of biocular cataract surgery combined with TECNIS Symfony intraocular lens( IOL) implantation in the correction of presbyopia with three different methods of reserved diopters. Methods A prospective cohort design was adopted. From October in 2016 to December in 2018,120 patients 240 eyes with binocular cataract surgery implanted TECNIS Symfony IOL were divided into regular group,micro-near-vision group and micro-monovision group according to different reserved diopters,40 patients 80 eyes in each group. The binocular IOL reserved diopter is +0. 10--0. 20 D in regular group. The binocular IOL reserved diopter is -0. 20--0. 50 D in micro-near-vision group, meanwhile, the dominant eye reserved diopter is +0. 10--0. 20 D, and the non-dominant eye reserved the myopia of -0. 50--0. 75 D in micro-monovision group. Defocus curves of single eye and binocular were measured and full distance visual acuity were analyzed 3 months after surgery. MTF values were detected by iTrace and compared between different groups. Visual function questionnaire of multifocal intraocular lenes ( MIOLs ) were analyzed and spectacle independence rate of presbyopia correction and disturbing photic phenomena were compared 3 months after surgery. This study protocol was approved by the ethics committee of Chongqing Aier Mega Eye Hospital, and this study followed the Declaration of Helsinki. Results Compared with regular group, the whole defocus curve of micro-near-vision group actually shifted to the right by 0. 35 D,with almost no change in shape. The shape of the binocular defocus curve of micro-monovision group changed significantly compared with that of regular group,that is the wave peak became significantly wider,and the downward trend was more gentle. Spectacle independence rate of the three groups were all 100. 00％, spectacle independence rate of intermediate distance in Micro-monovision group was 100. 00％, which was higher than that of regular group (80. 00％) and micro-near-vision group(90. 00％),and the differences were statistically significant (χ2=37. 04;P<0. 01). The MTF value of the dominant eye was higher than that of the non-dominant eye in the Micro-monovision group,and the difference was statistically significant(t=3. 74,P=0. 001). There was no statistically significant difference in the occurrence rate of disturbing photic phenomena among the three groups(P>0. 05). Conclusions Different reserved diopter design during cataract extraction combined with TECNIS Symfony IOL implantation suits different patients. Among the three different reserved diopters methods, the effect of micro-monovision method can obtain the highest spectacle independence rate, and provide satisfactory binocular far to near full-distance visual acuity.

Influences of different reserved diopters during cataract extraction combined with TECNIS Symfony intraocular lens implantation on visual quality of presbyopia correction / 中华实验眼科杂志

Objective@#To compare the efficacy and visual quality of biocular cataract surgery combined with TECNIS Symfony intraocular lens(IOL) implantation in the correction of presbyopia with three different methods of reserved diopters.@*Methods@#A prospective cohort design was adopted.From October in 2016 to December in 2018, 120 patients 240 eyes with binocular cataract surgery implanted TECNIS Symfony IOL were divided into regular group, micro-near-vision group and micro-monovision group according to different reserved diopters, 40 patients 80 eyes in each group.The binocular IOL reserved diopter is + 0.10--0.20 D in regular group.The binocular IOL reserved diopter is -0.20--0.50 D in micro-near-vision group, meanwhile, the dominant eye reserved diopter is + 0.10--0.20 D, and the non-dominant eye reserved the myopia of -0.50--0.75 D in micro-monovision group.Defocus curves of single eye and binocular were measured and full distance visual acuity were analyzed 3 months after surgery.MTF values were detected by iTrace and compared between different groups.Visual function questionnaire of multifocal intraocular lenes (MIOLs)were analyzed and spectacle independence rate of presbyopia correction and disturbing photic phenomena were compared 3 months after surgery.This study protocol was approved by the ethics committee of Chongqing Aier Mega Eye Hospital, and this study followed the Declaration of Helsinki.@*Results@#Compared with regular group, the whole defocus curve of micro-near-vision group actually shifted to the right by 0.35 D, with almost no change in shape.The shape of the binocular defocus curve of micro-monovision group changed significantly compared with that of regular group, that is the wave peak became significantly wider, and the downward trend was more gentle.Spectacle independence rate of the three groups were all 100.00%, spectacle independence rate of intermediate distance in Micro-monovision group was 100.00%, which was higher than that of regular group(80.00%) and micro-near-vision group(90.00%), and the differences were statistically significant (χ2=37.04; P<0.01). The MTF value of the dominant eye was higher than that of the non-dominant eye in the Micro-monovision group, and the difference was statistically significant(t=3.74, P=0.001). There was no statistically significant difference in the occurrence rate of disturbing photic phenomena among the three groups(P>0.05).@*Conclusions@#Different reserved diopter design during cataract extraction combined with TECNIS Symfony IOL implantation suits different patients.Among the three different reserved diopters methods, the effect of micro-monovision method can obtain the highest spectacle independence rate, and provide satisfactory binocular far to near full-distance visual acuity.

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.

Influence of the level of monovision on visual outcome with an extended range of vision intraocular lens.

PURPOSE: The purpose of this study was to evaluate the influence of different levels of monovision on the clinical outcomes achieved with an extended range of vision (ERV) intraocular lens (IOL). PATIENTS AND METHODS: Subanalysis of 411 patients from the multicenter CONCERTO study aimed at evaluating the outcomes after bilateral implantation of the Tecnis Symfony IOL. Visual acuity, spectacle independence, photic phenomena incidence, and patient satisfaction outcomes were evaluated in six groups defined according to the level of monovision: 0.0 D (75 patients; group 1), 01.0 D (19 patients; group 6). RESULTS: Mean binocular uncorrected distance visual acuity (decimal) ranged from 0.90±0.17 in group 6 to 0.97±0.20 in group 2. Mean binocular uncorrected intermediate visual acuity (decimal) ranged from 0.77±0.25 in group 2 to 0.94±0.30 in group 4. Mean binocular uncorrected near visual acuity ranged from 0.64±0.23 in group 2 to 0.79±0.26 in group 6. The level of spectacle independence was high, with the highest value for near vision in group 6 (94.7%). Less patients reported halos (6.7%) in group 1, whereas only 3.8% of patients in group 4 reported disturbing glare symptoms. For near vision, the highest patient satisfaction was achieved in groups 4, 5, and 6. A total of 96.7% (group 3) and 96.2% (group 4) of patients would recommend the same procedure to their friends and family and would choose the same lens again. CONCLUSION: Mini-monovision of around 0.75 D after implantation of the Tecnis Symfony IOL provides a complete visual rehabilitation with minimal photic phenomena and high levels of patient satisfaction.

A clinical assessment of visual performance of combining the TECNIS® Symfony Extended Range of Vision IOL (ZXR00) with the +3.25 D TECNIS Multifocal 1-piece IOL (ZLB00) in subjects undergoing bilateral cataract extraction.

PURPOSE: To combine the increased depth of focus of the TECNIS® Symfony intraocular lens (IOL) with a TECNIS Multifocal (MF) low-add IOL (+3.25) to enable a patient to be less dependent on corrective lenses. SETTING: Clinic in Canada. DESIGN: Single-center, prospective, open-label. MATERIALS AND METHODS: Fifty patients were enrolled for bilateral surgery. Patients were implanted with TECNIS Symfony Extended Range of Focus lens in the dominant eye, and TECNIS low-add +3.25 MF IOL in the non-dominant eye. Patients were ≥18 years of age and had best-corrected visual acuity >20/30 in both eyes, pupil size >3.5 mm, and <1.5 D of corneal astigmatism. Patients were evaluated preoperatively, operatively, and postoperatively on Day 1, Day 7, Month 1, and Month 3. Postoperative evaluations at Month 3 were completed by 32 of 50 patients enrolled, and included distance, intermediate and near visual acuity (VA), and subjective outcomes. RESULTS: Three months postoperatively, binocular results without correction revealed 97% (29/30) of patients had distance VA of 20/20 or better, 97% (29/30) had intermediate VA of 20/25 or better, and 94% (28/30) had near VA of 20/25 or better. At Month 3, the majority of patients reported "none" for visual symptoms of glare (30/30, 100%), halo (29/30, 96.6%), starbursts (29/30), or other - blur (30/30, 100%). CONCLUSION: Three months postoperatively, the combination of the increased depth of focus of the TECNIS Symfony IOL with a TECNIS MF low-add (+3.25) IOL may provide excellent uncorrected VA at near, intermediate, and far distances with minimal ocular symptoms.

Successful Restoration of Visual Acuity with an Extended Range of Vision Intraocular Lens after Multifocal Laser Ablation.

As our baby boomer population is aging and developing cataracts, so are our post-LASIK patients. These patients underwent LASIK surgery as they wished to be spectacle-free and are hoping to remain so after intraocular lens (IOL) surgery. Unfortunately, very little information is available regarding the suitability of presbyopia correcting IOLs for post-LASIK patients. This case represents successful implantation of an extended range of vision IOL in a 59-year-old patient who underwent multifocal ablation excimer laser surgery 12 years before. Emmetropia was targeted for the dominant eye and -0.5 D for the fellow eye. The 13 month follow-up after bilateral implantation of the TECNIS Symfony IOL revealed an uncorrected visual acuity of 20/25 for distance, 20/20 for intermediate and 20/16 for near. The patient is very happy and did not report any visual symptoms when asked. This successful case should encourage surgeons to consider implanting an extended range of vision IOLs in post-LASIK patients.