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We conducted a one-year prospective, multicenter study to assess clinical outcomes after implantation of segmented, rotationally asymmetric multifocal intraocular lenses (IOLs) with +1.5 diopters (D) near addition. In this phase III clinical trial, 120 eyes of 65 patients undergoing phacoemulsification and implantation of Lentis Comfort LS-313 MF15 (Oculentis GmbH) were included. The ophthalmological examinations were performed before and 1 day, 1 week, 1, 3, 6, 9, and 12 months after surgery. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuity at 70 cm, and uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity at 30 cm were measured. A defocus curve was obtained and patients were asked about the severity of photic phenomena. Postoperative distance and intermediate visual acuity was excellent, with UDVA, CDVA, UIVA, and DCIVA of approximately 20/20, 20/16, 20/25, 20/25 were attained, respectively. The level of near visual acuity was lower; UNVA and DCNVA remained at around 20/60 and 20/70, respectively. The defocus curve indicated that postoperative uncorrected visual acuity of 20/25 and 20/40 was obtained at as close as 67 cm and 50 cm, respectively. Contrast sensitivity was within the normal range, with a minimal level of subjective symptoms and high patient satisfaction. The rotationally asymmetric multifocal IOLs with +1.5 D near addition provided excellent distance and intermediate vision, but near vision was not enough for reading small prints. Contrast sensitivity was high, with very low incidences of photic phenomena and a high level of patient satisfaction.

PurposeMultifocal intraocular lenses (IOLs) offer the possibility of spectacle-free vision following cataract surgery compared to standard IOLs. Existing systematic reviews have generally concluded that multifocal IOLs result in better uncorrected near vision and greater spectacle independence, but more unwanted visual phenomena such as glare and halos, compared to monofocal IOLs. However, the certainty of evidence has been low for most outcomes, and pooled analyses have grouped together technologically obsolete lenses with newer lenses, potentially obscuring differences in performance across different lens types.MethodsWe performed a systematic review searching for RCTs of a multifocal IOL to a standard IOL or monovision that reported spectacle independence, visual acuity, or quality of life. Databases were searched from 1/1/2006–4/30/2017. Existing reviews were used to identify older studies. Title/abstract screening and data extraction were done in duplicate. Where possible, random effects meta-analysis was performed to synthesize results. In addition to comparing multifocal IOLs as a group to monofocal IOLs, we also compared newer diffractive lenses to obsolete or refractive lenses.ResultsTwenty-five eligible studies were identified. There was no difference in pooled estimates of corrected or uncorrected distance vision between multifocal and standard IOLs. Compared to monofocal IOLs, multifocal IOLs had statistically significantly better pooled results for the outcome of near vision (10 studies, 1025 patients, mean difference in logMAR of ‐0.26 (95% CI ‐0.37, ‐0.15)); spectacle dependence (12 studies, 1237 patients, relative risk of 0.27 (95% CI 0.20, 0.38)) and borderline significantly better quality of vision (6 studies, 596 patients, standardized mean difference of ‐0.54, (95% CI ‐1.12, 0.04)). Compared to monofocal IOLs, multifocal IOLs had statistically significantly worse pooled results for the outcomes of glare (9 studies, 847 patients, risk ratio of 1.36 (95% CI 1.15, 1.61) and halos (7 studies, 754 patients, risk ratio of 3.14 (95% CI 1.63, 6.08). Newer multifocal lenses had statistically significantly better outcomes than older diffractive lenses or refractive lenses, when compared to monofocal IOLs, in near vision, quality of vision, and risk of halos.ConclusionsMultifocal IOLs compared to standard IOLs or monovision result in better uncorrected near vision and a higher proportion of patients who achieve spectacle independence, but greater risk of unwanted visual phenomena. Newer diffractive lenses may be better than refractive lenses in near vision and quality of vision outcomes, with less risk of halos than older diffractive lenses and refractive lenses.(PROSPERO registration CRD42017069949)

To assess visual outcomes and patient satisfaction for trifocal and extended depth of focus (EDOF) intraocular lenses (IOLs) compared to monofocal IOLs with and without monovision. Consecutive patients underwent bilateral cataract extraction surgery and implantation of either monofocal IOLs, monofocal IOLs using monovision, EDOF IOLs, or trifocal IOLs. Patients with preoperative biometric data, postoperative refraction, and visual acuity who completed a questionnaire regarding satisfaction and side effects were included. Visual outcome, spectacle independence, patient satisfaction, and subjective photic phenomena were assessed. Each group comprised 50 patients (100 eyes). The mean postoperative uncorrected distance, intermediate, and near visual acuities (logMAR) were: 0.17 ± 0.14 (Snellen 20/30), not applicable, and not applicable for monofocal; 0.08 ± 0.12 (Snellen 20/24), not applicable, and 0.07 ± 0.12 (Snellen 20/23) for monovision; 0.03 ± 0.08 (Snellen 20/21), 0.08 ± 0.12 (Snellen 20/24), and 0.23 ± 0.17 (Snellen 20/34) for EDOF; 0.07 ± 0.09 (Snellen 20/23), 0.08 ± 0.11 (Snellen 20/24), and 0.02 ± 0.06 (Snellen 20/21) for trifocal. Spectacle independence was reported by 36%, 70%, 74%, and 92% of patients, respectively. Postoperative halos and/or glare were experienced by 2%, 6%, 14%, and 38%, respectively, of which 2%, 0%, 6%, and 10%, respectively, were functionally disturbing. A total of 64%, 72%, 78%, and 76%, respectively, would choose the same IOL again. Patient satisfaction rates were high in all groups. Trifocal IOLs were more effective in improving unaided whole range of vision, but were associated with a higher rate of photic phenomena. The EDOF IOL and monovision provided partial spectacle independence with less photic phenomena. [J Refract Surg. 2019;35(7):434-440.].

Purpose With the aging population, the prevalence of presbyopia and the popularity of multifocal intraocular lenses is also growing worldwide. Unfortunately, in some cases, they are still associated with postoperative visual disturbances. Recent literature started to evaluate angle kappa- and angle alpha-derived metrics of chord mu and chord alpha as possible predictive values for visual outcomes after multifocal intraocular lens implantation but the published results are inconsistent between studies. Thus, this article aims to review the role of chord mu and chord alpha as postoperative predictors after multifocal intraocular lens implantation and lay the foundation for further research. Methods Relevant articles were identified using the following keywords: “presbyopia,” “multifocal intraocular lens,” “angle kappa,” “angle alpha,” “Chord mu,” and “Chord alpha” up to June 2022. An attempt was made to present the majority of publications that addressed the topic. Conclusions Chord mu and chord alpha have a predictive role on the outcomes after multifocal intraocular lens implantation but to a different extent. Cataract surgeons should take them into consideration and avoid implanting a multifocal intraocular lens for patients with speculated critical values of chord mu and alpha above 0.5–0.6 mm, depending on the device used for measurement and the multifocal intraocular lens implanted. Currently, chord alpha seems to be a more stable, more widely applicable, and reliable determinant in predicting postoperative outcomes and in patient selection prior to multifocal intraocular lens implantation when compared to chord mu. To draw conclusions on the topic, a controlled study is needed.

PurposeTo compare clinical outcomes of bilateral implantation of hybrid multifocal intraocular lenses (IOLs) versus mix-and-match implantation of hybrid multifocal and extended-depth-of-focus (EDOF) versus mix-and-match implantation of hybrid multifocal and enhanced monofocal IOLs.MethodsPatients with bilateral age-related cataract were randomised in one of three groups: group 1, bilateral hybrid multifocal IOL; group 2, EDOF in the dominant eye, hybrid multifocal in the non-dominant eye; group 3, enhanced monofocal in the dominant eye, hybrid multifocal in the non-dominant eye. Assessments at 6 months postoperatively included monocular and binocular uncorrected distance visual acuity (UDVA), intermediate (UIVA) and near distance (UNVA) at 40 and 33 cm, defocus curves, contrast sensitivity (CS), reading speed and questionnaires on quality of vision and dysphotopsia.Results75 patients (25 per group) were enrolled. There were no statistically significant differences in binocular UDVA and UNVA between groups (p>0.05); binocular UIVA was better for group 1 and 2 versus group 3 (p=0.030). Binocular uncorrected defocus curve showed better performance for group 1 compared with group 3 from −2.00 to −3.50 D. Significantly higher reading speed was measured for Jaeger 1 font in group 1. There were no differences in CS between groups, but higher incidence of starbursts in group 1 and higher need for near spectacles in group 3.ConclusionBilateral hybrid multifocal IOL implantation resulted in better near vision, but higher rates of photic phenomena compared with the mix-and-match groups. Combinations of IOLs may allow surgeons to fine-tune for individual patient’s needs.

PurposeMultifocal intraocular lenses (MIOLs) are often discouraged in patients with or at risk of retinal disorders (including diabetic retinopathy, age-related macular degeneration, and epiretinal membranes), as MIOLs are believed to reduce contrast sensitivity (CS). Concerns with MIOLs have also been raised in individuals with visual field defects, fixation instability or eccentric preferred retinal locations. The aim of this study is to review the influence of MIOL on quality of vision in patients with retinal diseases.MethodsWe reviewed the PubMed and Web of Science databases to identify relevant studies using the following keywords: multifocal intraocular lens, cataract surgery, cataract extraction, lens exchange, diabetic retinopathy, age-related macular degeneration, and contrast sensitivity.ResultsStudies evaluating CS in MIOLs present conflicting results: MIOLs either did not influence CS or resulted in worse performance under low-illuminance conditions and higher spatial frequencies when compared to monofocal IOLs. Nevertheless, MIOLs preserved CS levels within the age-matched normal range. Two studies reported that patients with concurrent retinal diseases receiving a MIOL, both unilaterally and bilaterally, reported a significant improvement in visual-related outcomes. Individuals with a monofocal IOL in one eye and a MIOL in the fellow eye reported greater subjective satisfaction with the MIOL.ConclusionWe were unable to find evidence suggesting that patients with retinal diseases should be advised against MIOLs. Nevertheless, more research is needed to address the aforementioned concerns and to optimize the use of MIOLs in eyes with retinal disease.

To evaluate the correlation between preoperative, postoperative, and change in angle kappa and alpha to visual outcomes following implantation of three multifocal intraocular lenses. This is a retrospective study which included 122 eyes of 61 patients. There were 38 eyes in the Synergy (Johnson & Johnson, USA) group and 42 eyes each from both the Panoptix (Alcon Laboratories, USA) and FineVision (Physiol BVI, Belgium) groups. Visual outcome parameters (uncorrected distance, intermediate, near vision, halo and starburst) and angle kappa and alpha were recorded preoperatively and at three months postoperatively. The preoperative, postoperative and the amount of change in angle kappa and alpha were correlated to visual outcomes and photic phenomena among the three different diffractive trifocal IOLs. There were no significant differences in the preoperative and postoperative magnitude of angle kappa and alpha among the Synergy, Panoptix, and FineVision groups. There was no significant correlation between the preoperative and postoperative magnitude, and change in angle kappa and alpha with the postoperative uncorrected distance, intermediate and near visual acuity, and halo and starburst scores of the three different diffractive IOLs. The frequency of eyes with greater than 0.5 mm angle kappa and alpha values were low. Visual outcomes can be good even in eyes in which the angle kappa and alpha were greater than 0.5 mm. The newer diffractive multifocal IOLs were observed to be more tolerant to low and intermediate levels of angle kappa and alpha.

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 assess differences in intraocular lens (IOL) power calculation prediction error (PE) considering the manufacturing tolerance or exact power (EP) versus labeled power (LP), and to compare accuracy using the Barrett formula with optimized constant versus a thick-lens formula. Methods The PE and absolute PE were calculated for a random eye of patients implanted with the multifocal Liberty Q-Flex 640PM IOL (Medicontur Ltd) considering the LP and the EP provided by the manufacturer. The outcomes for the Barrett with optimized constant formula and a thick-lens formula personalized for the surgeon, biometer, and IOL were compared. Results A total of 155 eyes were included in the analysis. The mean absolute tolerance was 0.12 diopters (D) (range: 15.00 to 25.00 D) and 0.19 D (range: 25.00 to 30.00 D). These mean values corresponded to 0.07 and 0.11 D at the corneal plane, respectively (P = .002). Differences in mean PE considering the LP versus EP were 0.05 D or less (P > .05) for both formulas. No differences were found for absolute PE with a magnitude of 0.01 D or less (P < .05). The percentage of eyes within ±0.375 D ranged between 74.2% and 75.5% (P > .05). Conclusions The percentage of eyes within ±0.375 D did not increase using EP in comparison to LP in patients implanted with a multifocal IOL with powers ranging from 18.00 to 27.00 D. If the constant is properly optimized, a thick-lens formula also results in no clinically relevant differences versus the Barrett formula.

This study evaluated the accuracy of newer formulas (Barrett Universal II, EVO 2.0, Kane, Hoffer QST, and PEARL-DGS) and the Haigis formula in Korean patients with the Alcon TFNT multifocal intraocular lens. In total, 3100 randomly selected eyes of 3100 patients were retrospectively reviewed. After constant optimization, the standard deviation (SD) of the prediction error was assessed for the entire group, and the root mean square error was compared for short and long axial length (AL) subgroup analysis. The Cooke-modified AL (CMAL) was experimentally applied to the Haigis formula. All the newer formulas performed well, but they did not significantly outperform the Haigis formula. In addition, all the newer formulas exhibited significant myopic outcomes (− 0.23 to − 0.29 diopters) in long eyes. Application of the CMAL to the Haigis formula with single constant optimization produced similar behavior and higher correlation with the newer formulas. The CMAL-applied triple-optimized Haigis formula yielded a substantially smaller SD, even superior to the Barrett and Hoffer QST formulas. The AL modification algorithms such as the CMAL used in newer formulas to cope with optical biometry’s overestimation of the AL in long eyes seemed to overcompensate, particularly in the long eyes of the East Asian population.