Trifocal intraocular lenses: a comparison of the visual performance and quality of vision provided by two different lens designs Kjell G Gundersen,1 Rick Potvin2 1IFocus Øyeklinikk AS, Haugesund, Norway; 2Science in Vision, Akron, NY, USA Purpose: To compare two different diffractive trifocal intraocular lens (IOL) designs, evaluating longer-term refractive outcomes, visual acuity (VA) at various distances, low contrast VA and quality of vision.Patients and methods: Patients with binocularly implanted trifocal IOLs of two different designs (FineVision [FV] and Panoptix [PX]) were evaluated 6 months to 2 years after surgery. Best distance-corrected and uncorrected VA were tested at distance (4 m), intermediate (80 and 60 cm) and near (40 cm). A binocular defocus curve was collected with the subject’s best distance correction in place. The preferred reading distance was determined along with the VA at that distance. Low contrast VA at distance was also measured. Quality of vision was measured with the National Eye Institute Visual Function Questionnaire near subset and the Quality of Vision questionnaire.Results: Thirty subjects in each group were successfully recruited. The binocular defocus curves differed only at vergences of −1.0 D (FV better, P=0.02), −1.5 and −2.00 D (PX better, P<0.01 for both). Best distance-corrected and uncorrected binocular vision were significantly better for the PX lens at 60 cm (P0.3).Conclusion: Both trifocal lenses provided excellent distance, intermediate and near vision, but several measures indicated that the PX lens provided better intermediate vision at 60 cm. This may be important to users of tablets and other handheld devices. Quality of vision appeared similar between the two lens designs. Keywords: FineVision, Panoptix, multifocal, defocus curve, contrast sensitivity

Purpose: To prospectively evaluate postoperative clinical outcomes with implantation of toric intraocular lenses (IOLs) using preoperative keratometry from an optical low coherence reflectometry (OLCR) ocular biometer (Lenstar^® LS900) and the built-in Barrett toric calculator. Patients and methods: A prospective observational study recruited one or both eyes of subjects who underwent uncomplicated cataract surgery with toric IOL implantation using OLCR biometery data and the Barrett toric IOL calculator for toric IOL planning. Data were collected at the preoperative, operative, 1-day and 2-month postoperative visits. The primary outcome measure was the manifest refractive astigmatism magnitude at 2 months. The secondary outcome measures included the manifest refraction, corneal keratometry, and distance visual acuity (corrected and uncorrected). The results obtained with the Barrett toric calculator were compared with simulated results based on the toric calculators designed for the IOLs being used. Results: Data from 98 eyes of 54 subjects were available for analysis. In the 74 eyes with postoperative lens orientation as planned, and sufficient IOL cylinder power to correct subjects’ measured astigmatism, 77% of eyes (57/74) had 0.5 diopter (D) or less refractive cylinder 2 months postoperatively, while 89% (66/74) had 0.75 D or less. Simulated results after adjusting actual IOL orientation to the planned orientation suggested that the Barrett calculator would result in postoperative residual astigmatism about 0.2 D lower than that expected with standard calculators. Conclusion: Use of the Barrett toric calculator with biometry data from the Lenstar LS900 biometer for toric IOL planning in a clinical setting resulted in significantly lower levels of residual refractive cylinder than might be expected with standard calculators. Postoperative lens orientation and variability in the measurement of corneal astigmatism pre- and postoperatively appear to be important limiting factors in toric IOL outcomes.

Purpose: To compare the visual acuity (VA) and quality of vision between bilateral implantation of a trifocal intraocular lens (IOL) and blended bifocal IOLs with an intermediate add in the dominant eye and a near add in the nondominant eye. Patients and methods: Patients with either trifocal or blended bifocal IOLs implanted were recruited after surgery. Subjects returned for a single diagnostic visit between 3 and 24 months after surgery. VA was tested at various distances, including low-contrast acuity and acuity at their preferred reading distance. A binocular defocus curve was obtained, and subjective visual function and quality of vision were evaluated. Results: Twenty-five trifocal subjects and 30 blended bifocal subjects were enrolled. There were no significant differences in low-contrast acuity, preferred reading distance, or acuity at that reading distance. Binocular vision at 4 m, 60 cm, and 40 cm was not statistically significantly different. The trifocal provided statistically significantly better visual acuity (P<0.05) at vergences from -0.5 to -1.5 D (from 2 m to 67 cm viewing distance, P<0.05). There was no statistically significant difference in the near vision subscale scores of the 39-question National Eye Institute Visual Function Questionnaire or the overall scores of the Quality of Vision questionnaire, though significantly more trifocal subjects reported that the observed visual disturbances were “bothersome” (P<0.05). Conclusion: Both lens modalities provided subjects with excellent binocular near and distance vision, with similar low rates of visual disturbances and good reported functional vision. The trifocal IOL provided significantly better intermediate VA in the viewing distance range of 2 m to 67 cm, corresponding to viewing things such as a car dashboard or grocery shelf. VA was similar between groups at viewing distances from 60 to 40 cm, corresponding to computer or reading distance.

Purpose: To determine the incidence and etiology of required retreatment after multifocal intraocular lens (IOL) implantation and to evaluate the methods and clinical outcomes of retreatment. Patients and methods: A retrospective chart review of 416 eyes of 209 patients from one site that underwent uncomplicated cataract surgery with multifocal IOL implantation. Biometry, the IOL, and refractive data were recorded after the original implantation, with the same data recorded after retreatment. Comments related to vision were obtained both before and after retreatment for retreated patients. Results: The multifocal retreatment rate was 10.8% (45/416 eyes). The eyes that required retreatment had significantly higher residual refractive astigmatism compared with those who did not require retreatment (1.21±0.51 D vs 0.51±0.39 D, P<0.01). The retreatment rate for the two most commonly implanted primary IOLs, blended bifocal (10.5%, 16/152) and bilateral trifocal (6.9%, 14/202) IOLs, was not statistically significantly different (P=0.12). In those requiring retreatment, refractive-related complaints were most common. Retreatment with refractive corneal surgery, in 11% of the eyes, and piggyback IOLs, in 89% of the eyes, was similarly successful, improving patient complaints 78% of the time. Conclusion: Complaints related to ametropia were the main reasons for retreatment. Residual astigmatism appears to be an important determinant of retreatment rate after multifocal IOL implantation. Retreatment can improve symptoms for a high percentage of patients; a piggyback IOL is a viable retreatment option.

Purpose: The purpose of this study was to provide clinical outcomes data related to secondary intraocular lens (IOL) implantation for the correction of residual refractive error after cataract surgery. Patients and methods: A chart review was conducted to identify all eyes implanted with the monofocal spherical or toric AddOn^® secondary IOL. Data were collated from charts where uncomplicated initial cataract surgery was completed. Measures of interest included the original IOL implanted, the postoperative refractive error (before secondary IOL implantation) and the associated corrected and uncorrected visual acuities (VAs). Postoperative data of interest included the residual refractive error, the best-corrected visual acuity (BCVA) and uncorrected visual acuity (UCVA). Results: Refractive and VA data from 1 week to 3 months post-surgery were available for 46 of 70 eyes implanted with a secondary IOL by one surgeon at one practice between 4/15 and 3/17. There was a statistically significant improvement in UCVA of about 2 lines after surgery (p<0.01), with no change in BCVA (p=0.94). No eyes lost a line of BCVA. There was a statistically significant reduction in the absolute magnitude of the residual spherical equivalent refractive error (p<0.01). In the 10 cases with a toric secondary IOL, there was a statistically significant reduction in refractive cylinder (p<0.01). Conclusion: The secondary IOL studied here appears to be a viable surgical option to correct residual refractive error after primary IOL implantation.