Purpose: To examine the rotational stability of a new toric intraocular lens (IOL), the TECNIS Eyhance Toric II, over a course of 3 months. Setting: Vienna Institute for Research in Ocular Surgery, Hanusch Hospital, Vienna, Austria. Design: Prospective unmasked single-center study. Methods: 50 eyes of 50 patients with cataract and regular corneal astigmatism ≥0.75 diopters (D) were included. The TECNIS Eyhance Toric II IOL was implanted in 1 eye of each study patient. Images of the alignment axis of the IOL were taken intraoperatively, as well as at 1 hour, 1 week, and 3 months postoperatively. For the measurement of toric IOL rotation, images were superimposed on the basis of ocular landmarks. Uncorrected and corrected distance (4 m) and intermediate (66 cm) visual acuities were assessed at the 3-month visit. Results: There was no significant difference in the rotational position between the intraoperative and 3 month timepoints, with a mean rotation of 1.34 ± 1.46 degrees, in 27 examined eyes. (P = 0.313). No patients had to undergo repositioning of the toric IOL. A significant reduction of refractive cylinder occurred from preoperatively 1.8 ± 1.1 to 0.40 ± 0.42 D at the 3-month visit (P = .001; n = 43). The corrected distance visual acuity improved significantly from 0.28 ± 0.16 logMAR preoperatively to −0.01 ± 0.13 logMAR at 3 months postoperatively (P = .001; n = 43). Conclusions: The TECNIS Eyhance Toric II showed a good visual performance with no significant rotation over a course of 3 months and, therefore, an excellent rotational stability. The intraocular lens showed a good safety profile with no adverse events.

This study aimed to explore the concept of total keratometry (TK) by analyzing extensive international datasets representing diverse ethnic backgrounds. The primary objective was to quantify the disparities between traditional keratometry (K) and TK values in normal eyes and assess their impact on intraocular lens (IOL) power calculations using various formulas. Retrospective multicenter intra-instrument reliability analysis. The study involved the analysis of biometry data collected from ten international centers across Europe, the United States, and Asia. Corneal power was expressed as equivalent power and astigmatic vector components for both K and TK values. The study assessed the influence of these differences on IOL power calculations using different formulas. The results were analyzed and plotted using Bland-Altman and double angle plots. The study encompassed a total of 116,982 measurements from 57,862 right eyes and 59,120 left eyes. The analysis revealed a high level of agreement between K and TK values, with 93.98% of eyes exhibiting an absolute difference of 0.25 D or less. Astigmatism vector differences exceeding 0.25 D and 0.50 D were observed in 39.43% and 1.08% of eyes, respectively. This large-scale study underscores the similarity between mean K and TK values in healthy eyes, with rare clinical implications for IOL power calculation. Noteworthy differences were observed in astigmatism values between K and TK. Future investigations should delve into the practicality of TK values for astigmatism correction and their implications for surgical outcomes.

Purpose: To evaluate the astigmatism-reducing effect of toric intraocular lenses (IOLs) for low amounts of corneal astigmatism. Setting: Hanusch Hospital, Vienna, Austria. Design: Randomized, masked, controlled trial with bilateral comparison. Methods: Patients scheduled for bilateral cataract surgery and a corneal astigmatism in both eyes between 0.75 diopters (D) and 1.5 D were included in this study. The first eye was randomized to receive either a toric IOL or a nontoric IOL, and the contralateral eye received the other type of IOL. At the follow-up visits, optical biometry, corneal measurements with tomography and topography, autorefraction, subjective refraction, corrected and uncorrected distance visual acuity (CDVA/UDVA) with ETDRS charts and a questionnaire were performed. Results: 58 eyes were included in the study. Postoperative median UDVA was 0.00 (logMAR) in the toric eyes and 0.10 in the nontoric eyes (P = .03). The median CDVA was 0.00 in both groups (P = .60). Median residual astigmatism determined by subjective refraction and autorefraction in the toric eyes was 0.25 D and 0.50 D, respectively (P = .04), and 0.50 D and 1.00 D in the nontoric eyes, respectively (P < .001). Conclusions: The use of a toric IOL appears to be appropriate from a threshold value of approximately 0.75 D preoperative corneal astigmatism. Further studies in a larger patient population are needed to confirm these results.

To compare interindividual differences in visual performance of an advanced monofocal with a nondiffractive extended depth of focus intraocular lens (IOL) using a mini-monovision approach. Single-center, randomized, controlled, double-masked study. In total, 48 patients (96 eyes) with bilateral age-related cataract were enrolled. One group received an advanced monofocal IOL RAO200E (RayOne EMV; Rayner) and the other group a non-diffractive extended depth of focus IOL DFT015 (Acrysof IQ Vivity; Alcon) in both eyes. Target refraction for both groups was mini-monovision. After 3 months, monocular and binocular distance corrected and uncorrected distance (CDVA/UDVA), intermediate (DCIVA/UIVA), and near visual acuity (DCNVA/UNVA); contrast sensitivity; binocular defocus curves; halometry; and Quality of Vision questionnaire scores were compared. Binocular mean CDVA, DCIVA at 66 cm, and DCNVA at 40 cm were -0.10±0.10, 0.15±0.11, and 0.32±0.16 logMAR for the RAO200E and -0.10±0.10, 0.12±0.10, and 0.27±0.16 logMAR for the DFT015, respectively, with no significant difference. A significant difference could be shown for the dominant eye in monocular DCIVA and DCNVA and for the dominant and nondominant eye in monocular UNVA, with 0.28±0.14, 0.48±0.22, 0.46±0.21, and 0.41±0.20 logMAR for the RAO200E and 0.14±0.10 (P = .023), 0.35±0.16 (P = .008), 0.30±0.14 (P = .001), and 0.21±0.10 (P = .003) logMAR for the DFT015, respectively. Significantly smaller halo size in the RAO200E group and significantly better distance-corrected defocus curve at -2.5 (P = .031), -2.0 (P = .03), and -1 diopters (P = .03) of defocus in the DFT015 group could be shown. Distance corrected or uncorrected binocular visual acuity for far, intermediate, and near distance between the advanced monofocal IOL RAO200E and the non-diffractive extended depth of focus IOL DFT015, when compared in a mini-monovision setting, showed no significant differences.

Purpose: To quantify intraoperative stress levels in cataract surgeons and investigate the relationship between intraoperative stress and surgeon experience. Setting: Department of Ophthalmology, Hanusch Krankenhaus, Vienna, Austria. Design: Prospective, observational case series. Methods: 5 ophthalmologists with surgery experiences of 70 to 15 000 previous surgeries volunteered for this study. Surgeons' heart rate (HR) and heart rate variability (HRV) were measured during a total of 45 cataract surgeries. HR and HRV values were normalized to the minimal HR and maximal HRV of an overnight baseline measurement. The resulting normalized HR measure and HRV stress index are stress dependent and comparable between subjects. No case selection was performed. Results: Less experienced surgeons showed higher HRV stress indices; differences between the surgeons with less than 180 and 500 surgeries and the 2 with 600 and 1500 surgeries, respectively, were statistically significant (α = 0.05). No statistically significant difference in stress indices was found between surgeons with 1500 and 15 000 surgeries, suggesting that there may be a plateau effect after 1500 surgeries. HRV stress indices and case times were negatively correlated with the logarithm of experience in the number of previously performed surgeries (r ² = 0.67 and 0.52). No significant stress buildup over multiple successive surgeries was found (α = 0.05). Conclusions: The new HRV stress index is a simple but powerful tool for quantifying intraoperative stress in cataract surgeons. Decreases in stress with increasing experience are congruent with previous works on general surgeons' stress and follow a similar timeline as previously published, proficiency-based learning curves for cataract surgery.