Purpose: To evaluate the ARTIS Symbiose complementary intraocular lens (IOL) system, consisting of the MID and PLUS models, in comparison with a conventional trifocal IOL (AcrySof IQ PanOptix). Setting: The David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. Design: Laboratory investigation. Methods: Modulation and phase transfer functions were obtained in polychromatic light using an optical bench setup. Simulated visual acuity (VA) values were derived from optical quality metrics weighted by neural contrast sensitivity. United States Air Force (USAF) chart images were acquired and processed. Furthermore, the light distribution beyond the center of a polychromatic point spread function was assessed. Results: The peak simulated VA values of ARTIS Symbiose MID were at 0 diopters (D) of defocus (−0.02 logMAR) and at −1.5 D (0.00 logMAR); of ARTIS Symbiose PLUS, they were at 0 D of defocus (−0.01 logMAR) and at −2.5 D (0.01 logMAR). AcrySof IQ PanOptix demonstrated 3 peaks: at 0 D of defocus (−0.02 logMAR), at −1.75 D (0.03 logMAR), and at −2.5 D (0.02 logMAR). The summation of USAF chart images in the simulated binocular IOL system produced a slightly better image quality at −1.0 D and −1.5 D than AcrySof IQ PanOptix. The IOLs yielded comparable light spread across the studied range except for a localized intensity spike of the ARTIS Symbiose IOLs. Conclusions: The complementary IOL system may yield better monocular intermediate VA compared with the conventional trifocal IOL. However, the effect of binocular summation in terms of VA and the perception of photic phenomena still needs to be investigated.

To evaluate visual outcomes and patient-reported results after bilateral femtosecond-laser-assisted refractive lens exchange (RLE) with the implantation of a diffractive trifocal intraocular lens. Prospective interventional case series. A study of 27 patients (54 eyes) implanted with the Clareon PanOptix (Alcon) multifocal intraocular lens during femtosecond-laser-assisted RLE in a university hospital setting. The uncorrected (UDVA) and corrected (CDVA) distance visual acuity, uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuity at 60 cm, uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity at 40 and 33 cm were evaluated at 3 months postoperatively and compared with the preoperative values. In addition, we assessed the postoperative defocus curve, mesopic and photopic contrast sensitivity, and patient-reported spectacle independence. The mean postoperative binocular UDVA was -0.02 ± 0.06 logMAR and CDVA was -0.11 ± 0.05 logMAR. The UIVA was -0.07 ± 0.05 logMAR and DCIVA was -0.07 ± 0.07 logMAR. The UNVA at 40 cm was 0.03 ± 0.09 logMAR and DCNVA was -0.02 ± 0.06 logMAR; and, at 33 cm UNVA was 0.14 ± 0.10 logMAR and DCNVA was 0.11 ± 0.08 logMAR. In comparison to the preoperative binocular CDVA (-0.12 ± 0.08 logMAR), no statistically significant change was observed (P = 1.0), while all the other binocular visual acuities improved (P < .01). In the mean binocular defocus curve, the visual acuity was better than 0.10 logMAR in the range between +0.5 D and -3.0 D. The mean contrast sensitivity was within the normal range, and most patients reported complete spectacle independence. The RLE surgery improved uncorrected visual acuity at far, intermediate, and near distances without negatively affecting the CDVA. Patients achieved a high level of spectacle independence.

Purpose: To objectively quantify glare of intraocular lenses (IOLs) using a diffractive principle to extend the visual range and to identify models with increased susceptibility to inducing glare. Setting: David J Apple Laboratory, Heidelberg, Germany. Design: Laboratory investigation. Methods: Glare was assessed by means of a straylight parameter with a standard C-Quant intended for 7 degrees. In addition, 2 C-Quant modifications were used to test lower angles (ie, 2.5 degrees and 3.5 degrees). The following IOL models were assessed: PanOptix, AT Lisa Tri, Synergy, and Triumf, the latter 2 with chromatic aberration correction at distance. Straylight from trifocal IOLs was compared against a monofocal W-60R lens. The C-Quant test was performed through the studied IOLs by using additional optical components attached to their ocular. Results: Straylight (deg²sr⁻¹) of the control was <1 at all tested angles, with the trifocal models showing comparable straylight at 7 degrees. At 3.5 degrees, Triumf's straylight increased to 15.5 ± 0.6, followed by Synergy (6.2 ± 1.1), PanOptix (4.1 ± 0.3), and AT Lisa Tri (2.0 ± 0.8). The chromatic aberration–correcting models demonstrated correspondingly higher straylight (Synergy: 18.8 ± 1.3; Triumf: 17.3 ± 0.5) at 2.5 degrees compared with PanOptix (4.3 ± 0.4), AT Lisa Tri (2.1 ± 0.1), and monofocal IOLs yielding minimal or no increase. Conclusions: Trifocal IOLs induced increased straylight, but it was limited to lower angles, which may cause difficulties detecting these effects using a standard clinical approach. The latest IOL designs featuring chromatic aberration correction at far focus seem more susceptible than the established trifocal IOLs to inducing a glare phenomenon.

Preoperative and postoperative diagnostics play an important role in ensuring the safety of patients with phakic intraocular lenses (pIOLs). The risk of endothelial cell loss can be addressed by regularly measuring the endothelial cell density using specular microscopy and considering the endothelial cell loss rate and the endothelial reserve in accordance with the patient’s age when deciding whether to explant a pIOL. The anterior chamber morphometrics, including the anterior chamber depth and the distance between the pIOL and the endothelium, measured using Scheimpflug tomography and anterior segment optical coherence tomography (AS-OCT), can help to assess the risk of the endothelial cell loss. In patients undergoing posterior chamber pIOL implantation, accurate prediction of the vault and its postoperative measurements using AS-OCT or Scheimpflug tomography are important when assessing the risk of anterior subcapsular cataract and secondary glaucoma. Novel approaches based on ultrasound biomicroscopy and AS-OCT have been proposed to increase the vault prediction accuracy and to identify eyes in which prediction errors are more likely. Careful patient selection and regular postoperative follow-up visits can reduce the complication risk and enable early intervention if a complication occurs.

To present a case of a 62-year-old patient implanted with multifocal intraocular lenses (IOLs) who underwent a bilateral IOL exchange due to positive dysphotopsia. In an attempt to reduce the symptoms and compensate for the loss of multifocality, we implanted an aspheric monofocal IOL with enhanced intermediate function in one eye and a spherical monofocal IOL in the other eye. The patient presented with complaints of halo and glare, measured with a simulator, following the implantation of segmented multifocal IOLs two years earlier. The uncorrected distance visual acuity (UDVA) was 20/20 in both eyes. Before presentation at our clinic, a laser capsulotomy had been performed on the right eye. We proceeded with a bilateral IOL exchange. Because of capsular insufficiency in the right eye, we implanted a spherical monofocal three-piece IOL in the ciliary sulcus with optic capture. In the left eye, we used a monofocal IOL with an enhanced intermediate function. Two weeks postoperatively, UDVA (monocularly) was 20/20 in OD and OS, the uncorrected intermediate visual acuity (UIVA) was 20/32, and the uncorrected near visual acuity (UNVA) was 20/50. Binocularly, UDVA was 20/20, UIVA was 20/25 and UNVA was 20/25. The patient reported a marked decrease in halos and glare. When planning IOL exchange surgery, in cases of intolerance to multifocal IOLs, the clinician should consider the dilemma of loss of multifocality. Recent developments in monofocal IOL technology present new options to improve visual function in cases of multifocal IOL explantation.

To compare automated customized ray-tracing-guided laser in situ keratomileusis (LASIK) with wavefront-optimized LASIK by assessing intraindividual refractive and visual acuity outcomes. Prospective, interventional, randomized, double-blinded, contralateral-eye comparison. Thirty patients (60 eyes) with myopia and myopic astigmatism. Ray-tracing-guided LASIK, termed wavelight plus (Alcon), was performed in one eye and wavefront-optimized LASIK in the fellow eye. For wavelight plus, the ablation profile was calculated automatically by ray-tracing, using only objective measurements obtained with a single diagnostic device. The manifest refraction was used for planning wavefront-optimized LASIK treatment. Manifest refraction spherical equivalent (MRSE), refractive cylinder, uncorrected (UDVA) and corrected (CDVA) distance visual acuity, safety and efficacy indices were analyzed. The primary endpoint was the percentage of eyes with a MRSE within ±0.50D at 3 months, tested for non-inferiority of wavelight plus. At 3 months after wavelight plus and wavefront-optimized LASIK, MRSE was within ±0.50D in 100% (95%CI: 88.6-100%) and 90.0% (95%CI: 74.4-96.5%) of eyes, and within ±0.25D in 83.3% (95%CI: 66.4-92.7%) and 76.7% (95%CI: 59.1-88.2%) of eyes, respectively (wavelight plus non-inferior for ±0.50D, p0.05). The mean monocular UDVA was -0.11±0.07 logMAR and -0.09±0.09 logMAR, while the monocular CDVA was -0.14± 0.05 logMAR and -0.13±0.06 logMAR after wavelight plus and wavefront-optimized treatments, respectively (p>0.05). UDVA was ≥20/20 in 100% (95%CI: 88.6-100%) and 93.3% (95%CI: 78.7-98.2%) of eyes, and ≥20/16 in 83.3% (95%CI: 66.4-92.7%) and 73.3% (95%CI: 55.6-85.8%) of eyes after wavelight plus and wavefront-optimized LASIK, respectively. The efficacy index was 1.01±0.14 and 0.98±0.16, while the safety index was 1.08±0.13 and 1.07±0.14 for wavelight plus and wavefront-optimized LASIK, respectively (p>0.05). The automated ray-tracing-guided LASIK treatment wavelight plus had a high safety and efficacy, with comparable visual acuity outcomes to those after wavefront-optimized LASIK. Without the need of manifest refraction, wavelight plus achieved non-inferior refractive outcomes and a slightly higher accuracy in MRSE.