Refractive Outcomes Following Trifocal Intraocular Lens Implantation in Post-Myopic LASIK and PRK Eyes.

Purpose: To assess refractive outcomes of a trifocal intraocular lens (IOL) in post-myopic laser refractive surgery eyes. Methods: This was a retrospective chart review of 35 eyes (21 patients), with history of laser refractive surgery, who were implanted with a trifocal IOL. Surgeon's standard procedure included femtosecond laser (FLACS), digital registration, and intraoperative aberrometry (IA). The primary outcome measure was absolute prediction error. Secondary measures were refractive outcomes, postoperative residual astigmatism (PRA), monocular uncorrected visual acuity at distance (UDVA; 4m), intermediate (UIVA; 60cm), and near (UNVA; 40cm), and monocular best-corrected visual acuity at distance (BCVA; 4m). Results: At 3 months postoperatively, 71% and 68% of eyes had absolute prediction error 0.5 D or less with IA and preoperative planning respectively, which was not statistically significant (p > 0.05). The PRA was 0.5 D or less in 91% of eyes with IA and 56% of eyes with preoperative planning. The PRA differences between IA and preoperative planning were statistically significant (p < 0.002). The percentage of eyes 20/20 or better for monocular UCVA, BCVA, UIVA, and UNVA was 29%, 77%, 78%, and 66%, respectively. Absolute prediction error 0.5 D or less was significantly higher in post-LASIK eyes versus post-PRK eyes (p < 0.003), at 85% and 56% of eyes, respectively. Conclusion: Implantation with a trifocal IOL can provide acceptable refractive and visual outcomes with minimal residual astigmatism in post-myopic LASIK and PRK eyes.

Clinical outcomes of a diffractive trifocal intraocular lens with femtosecond laser, digital tracking, and intraoperative aberrometry.

OBJECTIVE: To evaluate clinical outcomes of a trifocal intraocular lens using femtosecond laser-assisted cataract surgery (FLACS), digital tracking (DT), and intraoperative aberrometry (IA). SETTING: One site (Abbotsford, B.C., Canada) DESIGN: Retrospective, single-surgeon study. METHODS: This was a retrospective, single-surgeon study examining 200 eyes of 100 bilaterally implanted patients. Eligible participants were those presenting with visually significant cataracts or as a candidate for clear lens extraction who were interested in implantation of a diffractive toric or non-toric intraocular lens. Preoperative and postoperative data were collected for manifest refraction spherical equivalent (MRSE), refractive astigmatism (RA), and monocular uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA). RESULTS: Mean postoperative manifest refraction spherical equivalent (MRSE) was 0.006 ± 0.27 D. The absolute prediction error was 0.50 D or less in 88.0% (176/200) of eyes. Postoperative RA was 0.50 D or less in 98.5% (197/200) of eyes. Postoperative UDVA was 0.10 logMAR or better in 86% (172/200) of eyes, and 66.0% (132/200) of eyes were 0.00 logMAR or better. Postoperative UIVA was 0.10 logMAR or better in 99.5% (199/200) of eyes, and 95.0% (190/200) of eyes were 0.00 logMAR or better. Postoperative UNVA was 0.10 logMAR or better in 91.5% (183/200) of eyes, and 73.5% (147/200) of eyes were 0.00 logMAR or better. CONCLUSION: The results demonstrate that trifocal implantation with FLACS, DT, and IA can provide excellent refractive and visual outcomes.

Clinical Outcomes of Monofocal Toric IOLs Using Digital Tracking and Intraoperative Aberrometry.

PURPOSE: To evaluate clinical outcomes of a toric IOL using digital tracking (DT) and intraoperative aberrometry (IA). METHODS: This was a retrospective, single surgeon study examining 151 eyes of 106 patients. Inclusion criteria were subjects who presented with visually significant cataracts (or as a candidate for clear lens extraction) and were implanted with a toric intraocular lens. Spherical equivalent prediction errors for IA and preoperative planning were calculated and compared. Preoperative and postoperative refractive data and monocular uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were also collected at 3 months postoperatively. RESULTS: Postoperative actual residual refractive astigmatism with IA was 0.50 D or less in 140 eyes (92.8%) and was 0.50 D or less in 88 eyes (58.3%) with back-calculations based on preoperative planning. The absolute spherical equivalent prediction error was 0.50 D or less in 135 eyes (89.4%) for IA compared to 123 eyes (85.4%) for preoperative planning. Postoperative monocular UDVA was 0.10 logMAR or better in 124 eyes (82.1%) and 0.00 logMAR or better in 90 eyes (59.6%). Postoperative CDVA was 0.10 logMAR or better in 147 eyes (97.4%) and 134 eyes (88.7%) were 0.00 logMAR or better. CONCLUSION: The results demonstrate that toric implantation with DT and IA can provide excellent refractive and visual outcomes.

Astigmatic Results of a Diffractive Trifocal Toric IOL Following Intraoperative Aberrometry Guidance.

PURPOSE: To determine if intraoperative aberrometry (IA) improves astigmatic outcomes for trifocal toric IOL (TTI) cases. PATIENTS AND METHODS: This was a retrospective study examining 137 eyes that underwent cataract extraction and TTI implantation using femtosecond laser, digital registration, and IA. Final cylinder power and axis of placement were determined by IA. Monocular uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), and refractive data were collected at 3 months. Postoperative residual astigmatism (PRA) determined by manifest refraction was compared to back-calculated residual astigmatism (BRA) using the cylinder power calculated preoperatively. RESULTS: Postoperatively, 97.8% of eyes had IA PRA ≤ 0.50D and 80.3% had BRA ≤ 0.50 D, a difference of 17.5%. Mean PRA for IA was 0.07 D ± 0.19 (range 0.00-1.00 D) compared to BRA 0.31 D ± 0.33 (range 0.00-1.34 D) (P < 0.001). Cylinder power was changed in 50.4% of cases based upon IA. Postoperative mean UDVA (LogMAR) was 0.04 ± 0.09 (range -0.12-0.30 logMAR), and 65% of eyes were ≤ 0.0, 85% ≤ 0.1, and 99% ≤ 0.18. CONCLUSION: The proportion of eyes with PRA ≤ 0.50 D and mean PRA was significantly lower using IA versus the preoperative planned cylinder power.

Intermediate optimization of vision with bilateral nonaspheric multifocal intraocular lens implantation.

PURPOSE: To evaluate binocular visual function, refraction, and subjective outcomes of intermediate optimization of vision after simultaneous bilateral implantation of the nonaspheric AcrySof SA60D3 ReSTOR multifocal intraocular lens (IOL). SETTING: Private clinic, Abbotsford, British Columbia, Canada. METHODS: Intermediate optimization was performed by overcorrection of 1.00 diopter (D) to induce mild myopia in the nondominant eye in patients having bilateral implantation of the multifocal IOL. Distance manifest refraction and visual acuity at several distances were determined; contrast sensitivity function (CSF), near-point stereo acuity, and subjective outcomes were assessed postoperatively at 2 weeks and 1, 3, 6, and 12 months. RESULTS: Thirty-two patients with intended intermediate optimization and 5 patients with unintended intermediate optimization were prospectively evaluated. The mean manifest refraction spherical equivalent was stable from 2 weeks (-0.94 D+/-0.22 [SD]) to 12 months (-0.93+/-0.23 D) in the intermediate optimization eyes. Overall, postoperative mean binocular uncorrected near, intermediate, and distance visual acuities were 20/23, 20/23, and 20/22, respectively. No significant differences were found between best distance-corrected and uncorrected stereo acuity or between best distance-corrected and uncorrected binocular CSF under most conditions (P> .05). On questioning, 97% of patients had little or no difficulty seeing and were bothered occasionally or never by the visual fluctuation between the near range and intermediate range. CONCLUSION: Intermediate optimization with slight myopia in 1 eye after bilateral implantation of the multifocal IOL offered consistent good vision at all ranges, indicating it a safe option for patients who require good vision at intermediate ranges.

Visual function and change in quality of life after bilateral refractive lens exchange with the ReSTOR multifocal intraocular lens.

PURPOSE: To evaluate vision and quality of life and explore the correlation between vision and change of quality of life after bilateral refractive lens exchange of the Acrysof SA60D3 ReSTOR multifocal intraocular lens (IOL) for correction of ametropia in presbyopic populations. METHODS: Pre- and postoperatively, the National Eye Institute Refractive Error Quality of Life Instrument (NEI-RQL) was self-administered by 30 consecutive refractive lens exchange patients, including 19 myopes and 11 hyperopes. The change of NEI-RQL scores was determined for each subscale covering a specific aspect of quality of life. Refraction, visual acuity, and contrast sensitivity function were evaluated 3 and 6 months postoperatively. RESULTS: Postoperatively, all patients achieved binocular uncorrected distance and near visual acuity of 20/30 or better. Photopic contrast sensitivity function decreased significantly at high spatial frequencies (P < .05). Overall scores of expectations, activity limitations, dependence on correction, appearance, and satisfaction were significantly higher postoperatively (P < .05). Greater improvement in near vision and dependence on correction was achieved in hyperopes. However, glare scores were significantly lower postoperatively (P < .001). Lower preoperative uncorrected near visual acuity was associated with higher scores for dependence on correction in myopes (r = 0.51, P = .027), and overall patient satisfaction correlated significantly with postoperative uncorrected distance visual acuity (r = -0.44, P = .015). CONCLUSIONS: Refractive lens exchange with the ReSTOR IOL in presbyopic patients provided good visual function and better patient satisfaction compared with preoperative corrections. Improvement in vision-related quality of life was most evident in hyperopes. A slight reduction in contrast sensitivity function appears to have no influence on quality of life.

Visual and refractive status at different focal distances after implantation of the ReSTOR multifocal intraocular lens.

PURPOSE: To evaluate the visual acuity and determine the refraction in emmetropic pseudophakic eyes at different focal distances after implantation of the AcrySof SA 60D3 ReSTOR multifocal intraocular lens (IOL) (Alcon Laboratories). SETTING: Private clinical practice. METHODS: Thirty-seven eyes of 20 patients received the ReSTOR IOL. Visual acuity was measured at several distances, and best distance corrected, best intermediate corrected (60 cm), and best near corrected (33 cm) visual acuities were determined 3 months after surgery. Subjective outcomes were assessed by a questionnaire. RESULTS: Postoperatively, 36 of 37 eyes (97.3%) were within +/-1.00 diopter (D) of the manifest refraction spherical equivalent and cylinder. Monocularly, the mean best distance corrected, best distance corrected intermediate, and best distance corrected near visual acuities were 20/20, 20/46, and 20/23, respectively. The best distance corrected acuities at 40, 50, 60, and 70 cm were significantly worse than the best distance corrected and best distance corrected near acuities (P<.05). On the questionnaire, all patients noted intermediate blur, but 75% had little or no difficulty seeing and were bothered by the blur occasionally or never. The mean additional add to best distance correction for best intermediate corrected visual acuity was +1.20 diopters (D) +/- 0.27 D or -1.68 +/- 0.24 D and for best near corrected visual acuity, -0.26 +/- 0.24 D. CONCLUSIONS: Implantation of the ReSTOR IOL offered excellent visual acuity at distance and near distance and functional visual acuity in the intermediate range. For patients who need excellent vision at intermediate range, leaving 1 eye with distance myopia or hyperopia to compensate for intermediate vision may provide consistent good binocular vision over the full range in cases of bilateral implantation.