Search Results (29)

Background/Objective: Whereas conventional flanged intrascleral fixation is limited to 3-piece intraocular lenses (IOLs), we developed and evaluated a novel haptic-extended flange technique for single-piece acrylic IOLs, including presbyopia-correcting and toric lenses. Methods: In this technique, a 6-0 polypropylene suture is secured along the lateral aspect of the single-piece IOL haptic to extend its length, followed by intrascleral flange fixation. Uncorrected visual acuity (UCVA) from far to near, corrected distance visual acuity (CDVA), and refraction were evaluated at 1 month postoperatively. IOL tilt and decentration were assessed using anterior segment optical coherence tomography. Results: This study included a consecutive series of 10 eyes of 10 patients (mean age: 58.3 ± 16.2 years), comprising 5 eyes with multifocal IOL, 2 eyes with multifocal toric IOL, 2 eyes with enhanced monofocal IOL, and 1 eye with monofocal IOL. All IOLs were securely fixed; the mean IOL tilt was 5.74 ± 2.93° and the mean decentration was 0.35 ± 0.19 mm. All eyes achieved CDVA of 20/20 or better, and all eyes with multifocal IOLs achieved UCVA at 40 cm of 20/25 or better. No early postoperative complications attributable to the surgical procedure were observed. In a case associated with atopic dermatitis, retinal detachment occurred 4 months after surgery. Conclusions: In this preliminary case series, haptic-extended flange fixation enabled early stabilization of selected single-piece acrylic IOLs with favorable short-term visual and anatomic outcomes. Larger studies with longer follow-up are needed to confirm long-term safety, durability and comparative effectiveness. Full article

Background/Objectives: Diffractive multifocal intraocular lenses (IOLs) are widely used following cataract surgery, but their impact on peripheral retinal image quality in ultra-widefield (UWF) fundus imaging has not been objectively characterized. This study aimed to quantify peripheral image sharpness in UWF fundus photographs and assess wavelength-specific differences between diffractive multifocal and enhanced monofocal IOLs. Methods: In this retrospective cohort study, 65 eyes from 51 patients implanted with enhanced monofocal (Tecnis Eyhance; n = 32) or diffractive multifocal IOLs (Tecnis Synergy, n = 19; Clareon PanOptix, n = 14) were analyzed. Non-mydriatic UWF fundus photographs (Optos; ~200°) were acquired within 1 month postoperatively. Red (R), green (G), and composite channel images were analyzed using three sharpness metrics—Laplacian variance, Brenner gradient, and Tenengrad gradient—within a predefined peripheral annular region (1.5–3.0 times the fovea–optic disc distance). Generalized estimating equations (GEE) with age as a covariate were applied as the primary analysis to account for inter-eye correlation and age differences between groups. Results: Brenner and Tenengrad gradient scores were significantly lower in the multifocal group in the R channel (p = 0.037 and p = 0.041, respectively), but not in the G or composite channels. The Laplacian metric revealed no significant intergroup differences in any channel. Subgroup analysis revealed no significant difference between hybrid multifocal and quadrifocal subtypes (p > 0.05). Group-level mean heatmaps confirmed a spatially distributed reduction in gradient magnitude across the annular zone in multifocal eyes. Conclusions: Diffractive multifocal IOL implantation was associated with a localized reduction in peripheral R channel sharpness, hypothesized to reflect transverse chromatic aberration. Composite channel quality remained comparable between groups, suggesting limited impact on routine clinical imaging. These findings may inform IOL selection and interpretation of peripheral retinal findings in multifocal IOL patients. Full article

Background/Objectives: Contrast sensitivity (CS) is an important measure of visual function, particularly in patients with glaucoma. While minimally invasive glaucoma surgery (MIGS) combined with cataract surgery is increasingly performed, postoperative CS outcomes—especially comparing enhanced monofocal intraocular lenses (emIOLs) and monofocal intraocular lenses (mIOLs)—remain unclear. This study aimed to compare postoperative CS between emIOL and mIOL in eyes undergoing combined MIGS and cataract surgery. Methods: This retrospective observational study included eyes that underwent combined MIGS and cataract surgery at a single center. CS was measured preoperatively and at 2–3 months postoperatively using the imo vifa system and quantified as the area under the log contrast sensitivity function (AULCSF). Clinical parameters were compared between IOL types using univariate and multivariate analyses, including a generalized linear mixed model (GLMM). Propensity score matching was performed to adjust for baseline differences. Results: A total of 140 eyes (71 emIOL, 69 mIOL) were analyzed. CS significantly improved postoperatively in both groups (p < 0.001). In multivariate analysis, IOL type was not significantly associated with CS (p = 0.10), whereas postoperative status was associated with improved CS (p = 0.01). CS measurement pattern significantly affected results, but no interaction between IOL type and measurement pattern was observed. After propensity score matching, postoperative CS was higher in the emIOL group (p = 0.01); however, multivariate analysis still showed no significant association between IOL type and CS (p = 0.20). Conclusions: CS improved after combined MIGS and cataract surgery regardless of IOL type. No independent difference in CS was observed between emIOL and mIOL, suggesting that emIOL may provide comparable visual quality in terms of CS, even in glaucoma patients. Full article

Background/Objectives: Intermediate vision has become increasingly important after cataract surgery because many daily activities require functional visual performance beyond distance vision alone. Enhanced monofocal intraocular lenses may improve intermediate visual function while maintaining good distance visual acuity. The aim of this study was to compare binocular distance and intermediate visual outcomes after bilateral implantation of Clareon and TECNIS Eyhance intraocular lenses. Methods: This was a single-center, non-randomized comparative observational study with assessment of postoperative visual outcomes. Eighty-six patients who had previously undergone uncomplicated bilateral age-related cataract surgery with implantation of the same IOL model in both eyes were included. Forty-two patients received Clareon IOLs and forty-four patients received TECNIS Eyhance IOLs. Postoperative assessment was performed at least 12 weeks after surgery of the second eye. Binocular corrected distance visual acuity (CDVA) and distance-corrected intermediate visual acuity (DCIVA) were measured using ETDRS charts at 4 m and 66 cm. Results: Baseline biometric and clinical parameters were comparable between groups. Mean postoperative DCIVA was 0.23 ± 0.09 logMAR in the Clareon group and 0.21 ± 0.08 logMAR in the Eyhance group. The mean between-group difference, calculated as Clareon minus Eyhance, was 0.02 logMAR, with a 95% confidence interval from −0.02 to 0.06 logMAR. Mean binocular CDVA was 0.02 ± 0.02 logMAR in the Clareon group and 0.02 ± 0.03 logMAR in the Eyhance group, with a 95% confidence interval for the between-group difference from −0.01 to 0.01 logMAR. Mean postoperative manifest refraction spherical equivalent was −0.27 ± 0.42 D in the Clareon group and −0.29 ± 0.37 D in the Eyhance group. Conclusions: Both Clareon and TECNIS Eyhance IOLs provided good binocular distance and intermediate visual acuity after bilateral implantation. Intermediate visual performance after Clareon implantation was comparable to that achieved with TECNIS Eyhance, while distance visual acuity remained similarly high in both groups. These findings suggest that both IOL models may represent useful options for patients undergoing cataract surgery who expect good distance vision and functional intermediate visual performance. Full article

Background/Objectives: Enhanced monofocal intraocular lenses (IOLs) aim to extend functional vision into the intermediate range while preserving the distance visual quality of standard monofocal aspheric lenses. This study compared the clinical and patient-reported outcomes of two enhanced monofocal IOLs, TECNIS Eyhance™ and Evolux™, and characterised the anterior surface profile of the Evolux™ optic. Methods: This single-centre, retrospective comparative case series included consecutive patients who received bilateral implantation of either Evolux™ or TECNIS Eyhance™ between February and July 2023. Primary outcomes were monocular uncorrected and distance-corrected intermediate visual acuity (UIVA, DCIVA). Secondary outcomes included monocular and binocular distance and near visual acuity, binocular intermediate visual acuity, spherical equivalent and patient-reported outcomes assessed using the Revised Heidelberg Daily Task Evaluation (DATE) questionnaire. Equivalence testing, Welch’s t-test, and covariate-adjusted ANCOVA were performed. Anterior surface profilometry of the Evolux™ IOL was conducted using an optical profilometer. Results: A total of 44 patients were included, 14 in the Evolux™ group and 30 in the TECNIS Eyhance™ group. Monocular and binocular UIVA and DCIVA were statistically equivalent between groups (TOST p = 0.028, 0.016, 0.008, and 0.005, respectively). Monocular and binocular distance outcomes were likewise equivalent. Binocular distance-corrected near visual acuity was significantly better in the Evolux™ group (0.164 ± 0.084 vs. 0.233 ± 0.112 logMAR; p = 0.030; Cohen’s d = 0.661), without a corresponding monocular difference. This isolated finding should be interpreted cautiously given the exploratory, multiple-outcome analysis and because it did not retain statistical significance after covariate adjustment for baseline biometric imbalances. Conclusions: In this exploratory study, both IOLs showed no statistically significant differences in intermediate and distance visual outcomes at one month after second eye surgery. The unadjusted binocular near vision finding for Evolux™, which did not retain significance after covariate adjustment, warrants further investigation in prospective, adequately powered, biometrically balanced studies. Full article

Background/Objectives: Enhanced monofocal and non-diffractive extended depth-of-focus (EDoF) intraocular lenses (IOLs) aim to improve intermediate vision while maintaining contrast sensitivity. However, direct comparative evidence under both photopic and mesopic conditions remains limited. This study prospectively compared the visual performance of two enhanced monofocal IOLs (Tecnis^® Eyhance^™ and ISOPure^®) and one non-diffractive EDoF IOL (AcrySof^® IQ Vivity^™). Methods: Sixty patients undergoing bilateral cataract surgery were implanted with one of three IOL groups (n = 20 each). Patients were assigned to one of three IOL groups based on preoperative consultation and clinical indications. One month postoperatively, monocular corrected distance (CDVA), distance-corrected intermediate (DCIVA), and near visual acuity (DCNVA) were measured under photopic and mesopic conditions. Photopic defocus curves, contrast sensitivity under photopic and mesopic conditions and correlation between pupil diameter and visual acuities were also assessed. Results: Baseline characteristics were comparable among groups. Under photopic conditions, Vivity^™ achieved significantly better UDVA, DCIVA and DCNVA than both Eyhance^™ and ISOPure^®. Under mesopic conditions, distance acuity did not differ significantly, but Vivity™ showed superior DCIVA and DCNVA. Defocus curves demonstrated a broader functional range of vision with Vivity™, while Eyhance^™ and ISOPure^® showed nearly overlapping profiles. Contrast sensitivity was similar among all IOLs under both lighting conditions, with no statistically significant differences. Conclusions: The non-diffractive EDoF AcrySof^® IQ Vivity^™ provided a wider and more functional depth-of-focus than the enhanced monofocal lenses evaluated, without compromising contrast sensitivity. Eyhance^™ and ISOPure^® offered comparable performance, with good distance vision and modest depth-of-focus extension. All three IOLs maintained CS levels comparable to those typically reported for standard monofocal IOLs under both photopic and mesopic illumination, indicating no clinically relevant contrast penalty. Full article

The objective of this study was to compare subjective manifest refraction with wavefront-based automated refraction using iTrace (ray tracing) and LadarWave (Hartmann–Shack) in eyes implanted with two enhanced monofocal intraocular lenses (IOLs) and a standard aspheric monofocal IOL, emphasizing agreement and refractive variability across optical designs. This retrospective cohort included 84 eyes from 42 patients implanted with Tecnis Eyhance (DIB00), RayOne EMV (RAO200E), or Tecnis ZCB00 IOLs. Postoperative evaluation (1–3 months) included uncorrected and corrected distance visual acuity and subjective manifest refraction, followed by automated refraction with iTrace and LadarWave. Outcomes were sphere, cylinder, and spherical equivalent (SE). Agreement was assessed using mean signed difference, mean absolute error, root mean square error, Bland–Altman limits of agreement, proportions within clinically relevant thresholds, and vector astigmatism (J0, J45). Linear mixed-effect modeling evaluated SE differences across methods and IOL types while accounting for within-subject correlation. Subjective SE differed among IOLs (p = 0.027), with RAO200E more myopic than ZCB00 (−0.20 ± 0.32 D vs. −0.08 ± 0.44 D, p = 0.035). Automated refraction showed greater variability and poorer agreement in enhanced monofocal IOLs, particularly for cylinder and SE, with wider limits of agreement and fewer eyes within ±0.50 D compared with ZCB00. In mixed-effect contrasts (three-method repeated-measures model), iTrace and LadarWave showed a consistent myopic bias versus manifest refraction in DIB00 and RAO200E, whereas in ZCB00 the iTrace–manifest difference was not significant and LadarWave retained a significant myopic bias. Enhanced monofocal IOLs exhibit reduced agreement between wavefront-based automated and subjective manifest refraction compared with a standard aspheric monofocal IOL. Manifest refraction remains essential for postoperative assessment, and automated measurements should be interpreted as complementary, particularly in IOL designs that modify aberrations. Full article

Background/Objectives: The purpose of the study is to assess visual and refractive outcomes and patient satisfaction after bilateral implantation of an enhanced monofocal intraocular lens (IOL) in a monovision configuration. Methods: Prospective, monocentric, non-comparative study including adults 21 years or older, with astigmatism less than 1.50 D, who were suitable for bilateral cataract surgery targeted with −1.00 D monovision. Participants were implanted with the RayOne EMV and followed up for three months. Outcome measures included refraction, monocular and binocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected and distance-corrected intermediate visual acuity (UIVA and DCIVA) at 66 cm and 80 cm, binocular defocus curve, and CatQuest-9SF questionnaire. Results: Sixty eyes of thirty patients were included. Postoperative spherical equivalent (SEQ) was −0.16 ± 0.29 D in the dominant eyes and −1.24 ± 0.43 D in the non-dominant eyes. Binocularly, mean UDVA at 4 m was −0.01 ± 0.07 and 0.1 logMAR or better in all patients. Mean binocular UIVA at 66 cm was 0.08 ± 0.08 and 0.2 logMAR or better in 92.9% of patients. Binocular UDVA was statistically significantly improved compared to monocular UDVA of the dominant eye targeted for distance (p < 0.001). Similarly, binocular UIVA was statistically significantly improved compared to monocular UIVA of the non-dominant eye targeted for −1.00 D (p < 0.001). A total of 96.6% of patients were satisfied with their sight. Conclusions: Bilateral implantation of an enhanced monofocal IOL in a monovision configuration provided excellent binocular uncorrected vision at distance and intermediate ranges, demonstrating effective binocular summation and a high level of patient satisfaction. Full article

Background/Objectives: To compare the clinical outcomes following cataract surgery with implantation of a new partial depth of field (DOFi) intraocular lens (IOL) versus a monofocal IOL of identical material, platform, and haptic design. Methods: Single-center, non-randomized trial including 55 patients randomly assigned to be implanted either with the partial-DOFi IOL Tecnis PureSee (partial-DOFi group, 29 patients) or the Tecnis monofocal IOL DCB00/ZCU (both Johnson & Johnson Surgical Vision) (monofocal group, 26 patients). Monocular visual acuity (VA), refractive, binocular defocus curve, and patient-reported outcomes (QoV and Catquest 9SF questionnaires) were evaluated during a 3-month follow-up. Results: No significant differences between monofocal and partial-DOFi groups were found in monocular postoperative uncorrected- (0.03 ± 0.08 vs. 0.05 ± 0.10, p = 0.419) and corrected-distance VA (−0.03 ± 0.04 vs. −0.03 ± 0.05, p = 0.642). Significantly better distance-corrected intermediate VA was found in the partial-DOFi group (0.29 ± 0.08 vs. 0.10 ± 0.06, p < 0.001). Similarly, postoperative monocular distance-corrected near VA was better in the partial-DOFi group (0.51 ± 0.10 vs. 0.31 ± 0.09, p < 0.001). In the defocus curve, significantly better distance-corrected VAs compared to monofocal were found for all defocus levels from −1.50 to −4.00 D. Minor reports of starbursts were found in both IOL groups. With the Catquest questionnaire, some significant differences were found between groups including reduced difficulty reading newspapers (p < 0.001), improved visibility of prices while shopping (p < 0.001) and enhanced performance of hobbies (p = 0.030) and needlework (p < 0.001). Conclusions: The partial-DOFi IOL evaluated demonstrates superior intermediate and near visual performance compared to a monofocal IOL, while maintaining equivalent distance vision and visual quality. Full article

Presbyopia-correcting IOLs have revolutionized cataract surgery by enabling functional vision across multiple focal distances, thereby reducing dependence on spectacles. These lenses—ranging from multifocal to extended depth-of-focus (EDOF) and hybrid designs—incorporate advanced optical technologies to address the limitations of traditional monofocal IOLs. Despite their clinical promise, patient satisfaction remains variable, with a substantial subset experiencing postoperative visual discomfort. This review provides a comprehensive overview of presbyopia-correcting IOL technologies, detailing their optical principles, design evolution, and clinical performance. It further analyzes the multifactorial causes of postoperative dissatisfaction, which include optical phenomena such as glare, halos, and reduced contrast sensitivity; ocular comorbidities like dry eye disease, corneal irregular astigmatism, glaucoma, and macular pathology; and surgical variables including IOL centration, pupil size, and biometry accuracy. Additionally, non-physiological factors—such as patient expectations, lifestyle demands, and psychological disposition—play a critical role in perceived outcomes. To address these challenges, the review explores evidence-based strategies for improving satisfaction. These include rigorous preoperative screening for ocular surface disease and aberrations, personalized lens selection based on anatomical and functional criteria, and thorough patient counseling to align expectations with achievable results. Emerging IOL designs that blend multifocal and EDOF features offer promising avenues for minimizing visual disturbances while preserving range of vision. By integrating optical innovation with individualized clinical care, ophthalmologists can enhance postoperative outcomes and optimize real-world satisfaction with presbyopia-correcting IOLs. Full article

Background/Objectives: Cataract is the most common cause of blindness in the world. Enhanced monovision intraocular lenses (EMV IOLs) have been recently made available on the market. In this study, we aimed to further the understanding of EMV IOLs and their potential benefits in cataract surgery, while also identifying areas for future research. Methods: In this review, we discuss the findings of a few previously published comparative studies concerning different types of EMV IOLs. We conducted a systematic review of comparative studies (randomized controlled trials, prospective and retrospective observational studies) describing binocular uncorrected intermediate vision acuity (UIVA) in patients after cataract surgery and implantation of monofocal plus IOLs based on emmetropia and monovision. Results: The secondary outcomes measured were uncorrected distance visual acuity, uncorrected near visual acuity (UNVA; described in eight studies), spectacle independence and patients’ satisfaction. A total of 199 patients (average age 68.11 years) were analyzed in the included studies; of these patients, 169 achieved UNVA reaching an average of 0.188 logMAR. Conclusions: The monovision approach may provide enhanced intermediate and near vision without significantly compromising distance vision or patient satisfaction, though results varied across studies. Future randomized trials with standardized outcome measures and conducted over a longer follow-up period are warranted to confirm these findings. Full article

As surgeries using multifocal intraocular lenses (IOLs) to correct both cataracts and presbyopia have become common, it has become essential for clinicians to understand their basic optical characteristics to select the optimal lens for their patients. However, there are relatively few review articles on optics that are directly useful to clinicians who perform surgery on patients. In this paper, we systematically review fundamental concepts, from the basic properties of light, geometric optics, and Gaussian approximation to lens performance metrics like the point spread function and modulation transfer function (MTF), and the clinical implications of spherical and chromatic aberrations. Based on these principles, the mechanisms of major multifocal technologies are explained. We also explore the refractive extended depth of focus lenses, which expand the range of focus by precisely controlling higher-order spherical aberrations. In contrast, diffractive lenses use diffractive kinoforms to split light into multiple foci, and they may also leverage higher diffraction orders to correct chromatic aberration. However, this multifocality involves an optical compromise, often resulting in a reduced overall MTF compared to monofocal IOLs and photic phenomena such as glare and halo. In conclusion, while multifocal IOLs are groundbreaking technology that significantly enhances quality of life by reducing spectacle dependence, this comes at the cost of sacrificing optimal image quality. Therefore, a thorough understanding of these optical principles by ophthalmologists is crucial for selecting the optimal lens according to each patient’s ocular condition and for managing postoperative outcomes. Full article

Background/Objectives: The Tecnis Eyhance is an enhanced monofocal intraocular lens (IOL) designed to improve intermediate vision without compromising distance clarity or increasing the incidence of photic phenomena. Although short-term results have been encouraging, long-term data remain limited. This study presents the 5-year follow-up of a previously published 6-month clinical evaluation, aiming to assess the stability of visual, optical, and patient-reported outcomes over time. Methods: A single-center retrospective study of 18 patients (36 eyes) undergoing bilateral Tecnis Eyhance IOL implantation was conducted. The same cohort from the original 6-month study was re-evaluated after a mean follow-up of 5 years. Visual acuity (distance, intermediate, near), defocus curves, contrast sensitivity, optical quality, effective lens position (ELP), halo size, and patient-reported measures were assessed. Results: Visual acuity remained stable across all distances, with binocular uncorrected intermediate visual acuity (UIVA) ≤ 0.2 logMAR in all patients. No significant changes were observed in optical quality parameters or contrast sensitivity. ELP remained consistent over time (p = 0.298), and posterior capsule opacification (PCO) requiring Nd:YAG capsulotomy developed in 5% of the eyes. Halo size was mild, and subjective glare perception did not increase. Spectacle independence remained high for distance (100%) and intermediate (more than 75%) tasks. Conclusions: This 5-year follow-up study confirms the long-term stability and effectiveness of the Tecnis Eyhance IOL. These findings support its long-term use as a stable monofocal IOL with enhanced intermediate function. Full article

Background/Objectives: A new, purely refractive extended depth-of-focus (EDOF) intraocular lens (IOL) was designed with a continuous change in power to bridge the gap between monofocal and multifocal IOLs. This study aimed to evaluate the real-world clinical outcomes of the new EDOF IOL compared with those of the enhanced monofocal IOL. Methods: A retrospective analysis was conducted on 100 eyes from 50 patients undergoing bilateral cataract surgery with either the PureSee™ EDOF (ZEN00V) or Eyhance™ (ICB00) monofocal IOL at a single institution. Visual acuity, defocus curves, contrast sensitivity, and patient-reported outcomes were evaluated three months postoperatively. Results: The ZEN00V group demonstrated superior uncorrected intermediate (0.11 ± 0.08 vs. 0.17 ± 0.11 logMAR, p = 0.006) and near visual acuity (0.25 ± 0.08 vs. 0.31 ± 0.13 logMAR, p = 0.023) compared to the ICB00 group, with comparable distance visual acuity. Both groups exhibited comparable defocus curves and contrast sensitivity. While photic phenomena were more frequent in the ZEN00V group, spectacle dependence was significantly lower for near vision (36% vs. 80%, p = 0.002) and comparable for intermediate and far vision. Conclusions: The PureSee™ EDOF IOL demonstrated enhanced intermediate and near vision with minimal compromise to distance vision while maintaining high contrast sensitivity. It also offered significant spectacle independence and patient satisfaction, making it a promising option for presbyopia correction. Full article

Objectives: This study compared the clinical outcomes of Vivinex Impress (XY1-EM) enhanced monofocal and standard Vivinex (XY1) intraocular lenses (IOLs) in mini-monovision cataract surgery. In this retrospective study, patients underwent bilateral implantation with either XY1-EM (33 patients, 66 eyes) or XY1 (24 patients, 48 eyes) in a −1D mini-monovision configuration. Methods: Visual acuity was evaluated from 5 m to 30 cm, along with spectacle dependence, contrast sensitivity, and patient-reported outcomes. Results: The XY1-EM group demonstrated significantly better intermediate and near visual acuity at distances of 30−50 cm (p < 0.05) and reduced spectacle dependence for intermediate distances (p = 0.02). Visual function questionnaire (VFQ-25) scores were significantly higher in the XY1-EM group for general vision, role difficulty, mental health, dependency, and near activity domains (p < 0.05). No significant differences were found in glare, contrast sensitivity, or quality of vision scores. Conclusions: The XY1-EM lens in mini-monovision configuration provides enhanced intermediate and near visual acuity with reduced spectacle dependence compared to standard monofocal IOLs, offering a valuable option for patients seeking improved quality of vision with reduced spectacle use. Full article