The main objective was to evaluate distance, intermediate, and near vision in patients who have undergone cataract extraction with bilateral implantation of a new trifocal diffractive intraocular lens (IOL), along with patient-reported outcomes (PRO). A total of 50 eyes from 25 patients after Asqelio^TM Trifocal IOL (AST Products, Inc., Billerica MA, USA) implantation were assessed in this study. At 3 months after surgery, the photopic visual acuity (VA) at distance, intermediate, and near distances was measured. Binocular photopic defocus curves were also obtained. Three questionnaires to assess patients’ visual satisfaction and spectacle dependence, among other items, were completed: the Catquest-9SF, the patient-reported spectacle independence questionnaire (PRSIQ), and the patient-reported visual symptoms questionnaire (PRVSQ). The average spherical equivalent was 0.21 ± 0.37 D at 3 months post-operation, and the average absolute tolerance to defocus was 3.64 ± 0.70 D. The mean binocular uncorrected VAs for distance, intermediate, and near vision were −0.02 ± 0.09, 0.06 ± 0.08, and 0.11 ± 0.07 logMAR, respectively. The best-corrected VA was better than 0.1 logMAR for the whole range from distance to near. PROs revealed spectacle independence and general satisfaction with vision, and the incidence of photic phenomena were low. This study shows that the new bi-aspheric diffractive trifocal IOL provides a good visual performance at different distances under photopic conditions, accompanied by patient satisfaction and spectacle independence.

Purpose: To develop a prediction model based on machine learning to calculate the postoperative vault and the ideal implantable collamer lens (ICL) size, considering for the first time the implantation orientation in a White population. Setting: Arruzafa Ophthalmological Hospital (Cordoba, Spain) and Barraquer Ophthalmology Center (Barcelona, Spain). Design: Multicenter, randomized, retrospective study. Methods: Anterior segment biometric data from 235 eyes of patients who underwent ICL lens implantation surgery were collected using the anterior segment optical coherence tomography CASIA II to train and validate 5 types of multiple regression models based on advanced machine learning techniques. To perform an external validation, a dataset of 45 observations was used. Results: The Pearson correlation coefficient between observed and predicted values was similar in the 5 models in the external validation, with least absolute shrinkage and selection operator regression being the highest (r = 0.62, P < .001), followed by random forest regression model (r = 0.60, P < .001) and backward stepwise regression (r = 0.58, ρ < 0.001). In addition, the predictions generated by the different models showed closer agreement with the actual vault compared with the Nakamura formulas. Using the new methods, about 70% of the observations had a prediction error below 150 μm. Conclusions: Advanced forms of regressions models based on machine learning allow satisfactory calculation of the ideal lens size, offering greater precision to surgeons customizing surgery according to implant orientation.

Objective: We aimed to study acquired esotropia in adults and its risk factors, compile treatments performed and describe surgical technique used, with a novel indication. Methods: We conducted a retrospective study of patients with insidious distant esotropia along with distant horizontal diplopia (angles 2–30 PD with wide fusion amplitude): Refractively emmetropic, moderately myopic and mildly hyperopic. No systemic alterations. Results: 30 cases were included, average age: 38.13 ± 14.95. Mean time elapsed from the onset of symptoms to surgical treatment was 22.52. Mean spherical equivalent is −3.19 ± 2.83. Mean preoperative horizontal deviation was 18.58 ± 5.45 PD in distant vision and 5.48 ± 8.35 PD in close vision (p < 0.001). 100% of cases reported diplopia in distance vision. 20% required prismatic treatment (10 PD) by lateral rectus resection, with an average of 4.82 ± 1.23 mm. Sensory result was successful in 100% of the cases and motor in 75%. Conclusions: We are facing a new type of acquired esotropia in adults that can be individualized by its clinical and therapeutic characteristics. Our prismatic and surgical treatment has been successful.