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PurposeTo evaluate the visual performance of an extended depth of focus (EDOF) intraocular lens (IOL) for patient selection.MethodsThis prospective non-comparative case series evaluated fifty-two eyes (26 patients) after bilateral implantation of the Tecnis Symfony IOL. Exclusion criteria were previous ocular surgeries, corneal astigmatism of >1.5 diopter, and ocular pathologies or corneal abnormalities. Uncorrected (UCVA) and distance-corrected (DCVA) visual acuity (VA) in 4 m, 80 cm, 60 cm and 40 cm (logMAR), defocus curve, contrast sensitivity (CS) and a questionnaire on subjective quality of vision (QoV) were assessed after 3 months.ResultsUCVA was −0.02 ± 0.071 logMAR at 4 m, 0.01 ± 0.077 logMAR at 80 cm, 0.08 ± 0.187 logMAR at 60 cm and 0.22 ± 0.153 logMAR at 40 cm. Defocus curve testing showed a flat VA range from 0.00 to −1.50 D (−0.05–0.02 logMAR). At near distance from −2.0 to −2.5 D a dip of DCVA was observed (0.14–0.28 logMAR). CS under photopic and mesopic conditions without and with glare was 1.56 logCS, 0.86 logCS, 0.78 logCS, respectively. Spectacle independence was achieved in 100% for distance and intermediate vision and 71% of patients at near distance.ConclusionThis EDOF IOL provides excellent intermediate and far (<0.1 logMAR) and acceptable near UCVA (<0.3 logMAR). Defocus curve testing confirmed an EDOF between far and intermediate distance and showed a dip at near distance. It provides good QoV, CS, high spectacle independence, perception of few optical phenomena, and particularly good night-driving capabilities.

Purpose To evaluate the relationship between pupil size and subjective visual quality after implantation of a simultaneous vision intraocular lens (IOL). Methods Patients after bilateral implantation of a trifocal, diffractive IOL were prospectively included. Three months postoperatively, subjective refraction, UDVA, and axis deviation were measured. Pupil size was obtained with an infrared-based pupillometer (PupilX; Albomed) in scotopic, mesopic, and photopic conditions. Subjective impairment with optical phenomena was surveyed in different lighting conditions. Results Fifty-two patients (mean age: 68 years) were included; 54 eyes received non-toric IOLs and 50 eyes received toric IOLs. Preoperative spherical equivalent (SE) was −0.914 diopters (D) (range: −10.00 to +5.92 D) and SE and lens torus were 20.3 D (range: 9.00 to 32.00 D) and 1.65 D (range: 1.00 to 3.75 D), respectively. Three months postoperatively pupil size was 5.42 mm (range: 2.60 to 7.50 mm) in scotopic, 4.24 mm (range: 2.60 to 6.10 mm) in mesopic, and 3.38 mm (range: 1.20 to 5.60 mm) in photopic conditions, spherical manifest refractive error 0.14 D (range: −0.75 to 1.25 D), SE 0.034 D (range: −1.13 to +1.13 D), and UDVA 20/22.4 (range: 20/63 to 20/12.5). In low light conditions, halos correlated weakly with scotopic (r = 0.268, P = .006) and mesopic (r = 0.298, P = .002) pupil size and double-contour with scotopic pupil size (r = 0.234, P = .018). Glare, starbursts, and blurred vision were not influenced in any condition. Further significant influential factors were postoperative spherical manifest refractive error (P = .014), SE (P = .007) and lens torus (P = .029) for halos and preoperative SE (P = .019), postoperative UDVA (P = .035), and lens SE (P = .023) for double-contour. In multiple regression analysis, lens torus, mesopic pupil size, preoperative SE, and postoperative UDVA remained significant. Conclusions Pupil size did not play a major role in disturbance with optical phenomena after implantation of a trifocal diffractive IOL. [J Refract Surg. 2025;41(7):e645–e654.]

Purpose: To determine the visual outcomes and safety 12 months after implantation of the Presbia Flexivue Microlens refractive corneal inlay. Methods: In this prospective, non-randomized trial, 22 patients with a mean age of 52.54 ± 2.86 years were implanted with the Flexivue Microlens refractive corneal inlay in the non-dominant eye at the Department of Ophthalmology, Goethe University, Frankfurt, Germany. Corrected near, intermediate, and distance (CNVA, CIVA, and CDVA) visual acuity and uncorrected near, intermediate, and distance (UNVA, UIVA, and UDVA) visual acuity, manifest refraction, subjective quality of vision, endothelial cell count, and contrast sensitivity were measured 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Results: For binocular CDVA, no patient lost two or more lines and 30% lost only one line at the 12-month visit. In the eye that had surgery, 85% of the patients lost two or more lines of UDVA, which was statistically significant. Sixty-five percent of the patients gained one or more lines in binocular UIVA, and 80% achieved 20/40 or better in DCIVA. UNVA showed a statistically significant improvement, with 90% of the patients achieving 20/40 or better 12 months after implantation. A total of 85% gained two or more lines in binocular UNVA. Conclusions: This refractive corneal inlay showed an improvement in binocular UNVA, UIVA, CNVA, and CIVA, whereas binocular CDVA and UDVA were not statistically affected. [J Refract Surg. 2024;40(1):e1–e9.]

To evaluate the visual performance after bilateral implantation of a toric diffractive aspheric multifocal intraocular lens (IOL) with a +2.17 diopters (D) (60 cm) intermediate and a +3.25 D (40 cm) addition (add) power. This prospective single-arm study was conducted at the Department of Ophthalmology, Goethe University, Frankfurt, Germany. Twenty-five patients (50 eyes) received bilateral implantation of the toric PanOptix IOL (AcrySof IQ PanOptix; Alcon Research LLC) before enrollment. Exclusion criteria were previous ocular surgeries excluding lens surgery and ocular pathologies or corneal abnormalities. Examination at 3 months postoperatively included manifest refraction; monocular and binocular uncorrected distance (UDVA) and distance-corrected (DCVA) visual acuity at 4 m and 80, 60, and 40 cm; and slit-lamp examination. At 3 months postoperatively, monocular and binocular defocus, binocular contrast sensitivity under photopic and mesopic conditions, and optical phenomena, and spectacle independence were evaluated. Mean refractive spherical equivalent was 0.12 ± 0.380 D and mean refractive cylinder was −0.21 ± 0.237 D at 3 months postoperatively. A significant decrease in refractive cylinder was observed postoperatively (P <.05), with 98% showing a postoperative astigmatism below 0.75 D. Monocular UDVA was better than 0.14 logMAR in all distances. Binocular defocus curve showed peaks at 0.00 D (−0.09 logMAR) and −1.50 and −2.00 D (−0.02 and 0.00 logMAR). The worst values between far (4 m) and near (40 cm) distance were 0.04 logMAR at −1.00 D. Despite some optical phenomena, 92% of patients would choose the same IOL again and recommend it to others. The visual performance of the toric PanOptix IOL showed good visual acuity at all distances; more than 90% achieved a decrease of refractive cylinder below 0.75 D, high patient satisfaction despite some optical phenomena, and high spectacle independence 3 months postoperatively.

To compare the effective lens position (ELP), anterior chamber depth (ACD) changes, and visual outcomes in patients with and without pseudoexfoliation syndrome (PEX) after cataract surgery. Prospective, randomized, fellow-eye controlled clinical case series. This prospective comparative case series enrolled 56 eyes of 56 consecutive patients with (n = 28) or without PEX (n = 28) and clinically significant cataract who underwent standard phacoemulsification and were implanted with single-piece acrylic posterior chamber intraocular lenses (IOLs). The primary outcome parameters were the ACD referring to the distance between the corneal anterior surface and the lens anterior surface, which is an indicator of the postoperative axial position of the IOL (the so-called ELP) and distance corrected visual acuity (DCVA). Before surgery, the ACD was 2.54 ± 0.42 mm in the PEX group and 2.53 ± 0.38 mm in the control group (p = 0.941). Postoperatively, the ACD was 4.29 ± 0.71 mm in the PEX group and 4.33 ± 0.72 mm in the normal group, respectively (p = 0.533). There was no significant difference in ACD changes between groups (PEX group: 1.75 ± 0.74 mm, control group: 1.81 ± 0.61 mm, p = 0.806) and DCVA pre- (p = 0.469) and postoperatively (PEX group: 0.11 ± 0.13 logMAR, control group: 0.09 ± 0.17 logMAR, p = 0.245) between groups. Preoperative and postoperative ACD, as an indicator of ELP, between PEX eyes and healthy eyes after cataract surgery showed no significant difference. Phacoemulsification induced similar changes in eyes with PEX compared to healthy eyes.