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To assess the spectacle independence and satisfaction of subjects after bilateral implantation of the PanOptix trifocal intraocular lens (IOL) at the time of cataract surgery. Single site, prospective, single-arm study. Eligible subjects interested in a trifocal IOL to potentially reduce dependence on spectacles for near, intermediate and distance vision were enrolled and followed for 3 months after the second eye surgery. Visual acuity and refractive data were collected 1 month and 3 months postoperative, including the uncorrected and best distance-corrected binocular visual acuities at distance (4m), intermediate (60 cm) and near (40cm). A patient satisfaction and spectacle independence questionnaire were administered at the 3-month visit. A total of 30 subjects successfully completed the study. Eighty-five percent of eyes (51/60) had a refraction within 0.50 D of plano with ≤ 0.50 D of refractive cylinder. One subject (3%) reported needing glasses for distance work, 3 (10%) for intermediate work and 4 (13%) for near work. Ninety percent or more of all subjects reported never wearing glasses or wearing them only a little at all working distances. Ninety percent or more were able to function without glasses at all 3 working distances all or most of the time. More than ninety percent of subjects reported being \"com.pletely\" or \"mostly\" satisfied with their vision without glasses or contact lenses at all three distances and overall. A high percentage of patients are likely to achieve spectacle independence for distance, intermediate and near vision with this trifocal IOL.

To review refractive, visual acuity, defocus curve and contrast sensitivity results after bilateral implantation of a trifocal intraocular lens (IOL) in a large population. One site in Santiago, Chile. Single arm, non-randomized retrospective chart review. This was a single-arm retrospective chart review of clinical outcomes after bilateral implantation of a trifocal IOL (Panoptix ), both toric and non-toric versions. Binocular visual acuity at 4 m, 60 cm and 40 cm was tested. Other tests included refraction, mesopic and photopic contrast sensitivity, and defocus curve measurement. The review included 500 eyes of 250 patients implanted with the trifocal IOL and 200 eyes of 100 patients implanted with the trifocal toric IOL, with no clinically significant differences between groups. Ninety-six percent of all eyes were within 0.50D of the intended spherical equivalent correction. In the toric group, 94% of eyes (187/200) had a residual refractive cylinder ≤0.50D, compared to 81% of eyes (406/500) in the non-toric group. Four out of five patients (80.6%, 282/350) had a binocular uncorrected VA of 0.1 logMAR (20/25) at all test distances. Mean defocus was 0.1 logMAR or better from vergences from 0.00 to -3.00 D (corresponding to vision from distance to about 33 cm). With a cutoff of 0.2 logMAR, 96% of patients had a range of vision 2.5 D or greater. Contrast sensitivity was similar between the toric and non-toric lenses, and similar to age-matched normal results. The non-toric and toric trifocal IOLs provided good distance, intermediate and near vision to patients, with a wide range of vision and good contrast sensitivity.

Background: To compare clinical outcomes and subjective experience after bilateral implantation of two diffractive trifocal and one monofocal intraocular lenses (IOLs). Methods: Fourty-eight patients received bilateral implantation of the RayOne Trifocal IOL (Rayner), the AcrySof IQ PanOptix IOL (Alcon), or the AcrySof IQ SN60WF IOL (Alcon). At 1-month, 3-month, and 12-month follow-up visits, the tested outcomes were monocular and binocular uncorrected and corrected distance, intermediate at 70 cm, and near at 30 cm visual acuities, subjective refractive outcomes, defocus curves, contrast sensitivity and ocular aberrometry. Subjective patient satisfaction in terms of visual disturbance and spectacle independence was also evaluated. Results: Each group comprised 32 eyes (16 patients). Refractive outcomes of RayOne and PanOptix IOLs were comparable. Both trifocal IOLs demonstrated superior visual acuity to the AcrySof monofocal IOL at near and intermediate ranges and along the defocus curves at all points other than at 0.0 D. The patient satisfaction results were comparable between the RayOne and PanOptix trifocal IOL groups. Conclusions: Both trifocals performed similarly providing good visual outcomes at all distances, demonstrating superior visual acuity compared to the monofocal IOL. Patients implanted with these trifocal IOLs reported similar levels of quality of vision and satisfaction. The RayOne trifocal and PanOptix IOLs are a valuable alternative for patients wishing to seek spectacle independence and low visual disturbances when undergoing cataract surgery.

Hyperopia is a kind of refractive error in which incoming light is focused behind, instead of on, the retina wall due to insufficient accommodation by the lens. It is likely affected by ethnicity, geography, and a family history of hyperopia or accommodative esotropia and is categorized as low (≤ 2.00D), moderate (2.00-4.00 D), and high (> 4.00D). Beyond hyperopia refractive error, patients may have poor accommodative function or visual perceptual skills. This study aimed to present the latest approaches to planning trifocal intraocular lens (IOL) and toric trifocal IOL implantation for residual refractive errors in young adults with high astigmatism and hyperopia and increase the patients' best visual outcome and satisfaction using Small Incision Lenticule Extraction (SMILE) after implantation. Eighty eyes of 40 consecutive patients who underwent refractive lensectomy were included in this retrospective study. It included patients aged 20-45 years seeking spectacle independence with pre-operative high spherical hypermetropia of 4D or higher and astigmatism of 3D or higher. Patients' treatment status was categorized as trifocal IOL (n=40) and toric trifocal IOL (n=40).The mean patient follow-up time was six months after IOL implantation. First, we assessed visual acuity and satisfaction for both groups and then examined laser vision correction results of patients who were dissatisfied after IOL implantation (trifocal IOL group) and underwent SMILE surgery to increase satisfaction level. There were no statistically significant differences between trifocal IOL and toric trifocal IOL for near (UNVA), intermediate (UIVA), and distance (UDVA) uncorrected visual acuity. Comparisons related to patient satisfaction six months after IOL implantation were statistically significant for using a computer and night driving. In the trifocal IOL group, compared to pre-operative values, sphere and cylinder at six months were significantly improved. In young adults, toric trifocal and trifocal IOL provided sufficient results in visual acuity; however, patients were dissatisfied after implantation. This study reported patient satisfaction levels, including quality of life and life without glasses by using Small Incision Lenticule Extraction (SMILE) surgery.

To objectively determine if angle kappa materially influenced clinical outcomes or patient-reported satisfaction and visual quality of patients implanted with a trifocal intraocular lens (IOL). This was a non-interventional study of clinical outcomes. Subjects were patients choosing to be bilaterally implanted with a trifocal IOL (PanOptix ) who were then evaluated 3 months postoperative. Angle kappa (AK) was measured before surgery and at the 3-month visit. The 3-month visit included a manifest refraction, and measurement of uncorrected and distance corrected acuity at 4 m, 60 cm and 40 cm. Visual quality and satisfaction questionnaires were also administered. Data from 56 eyes of 28 subjects were analyzed; 26 eyes had an AK magnitude <0.3 mm, 14 had an AK from 0.3 mm to less than 4 mm and 16 had an AK ≥0.4 mm. Neither visual disturbances (eg, glare, halos, starbursts), satisfaction nor spectacle dependence were correlated to the magnitude of angle kappa. The magnitude of postoperative AK was significantly lower than preoperative (0.24 ± 0.12 mm vs 0.30 ± 0.16 mm, p < 0.01). The magnitude of preoperative Angle Kappa had no apparent effect on the refractive, visual acuity or subjective (visual disturbances, quality of vision, satisfaction) clinical outcomes with this trifocal IOL. The magnitude of angle kappa was significantly lower after surgery.

Purpose This study aimed to investigate the in vitro tolerance to decentration of biaspheric intraocular lens (IOLs) with refractive phase-ring extended depth-of-focus (EDOF) and diffractive trifocal designs. Methods This experimental study was carried out at the Department of Optics and Optometry and Vision Science, University of Valencia, Spain. The modulation transfer function (MTF) of the ETLIO130C EDOF and the TFLIO130C trifocal IOLs (AST Products Inc., Billerica, MA, USA) were determined at different levels of decentration for a given wavelength and pupil diameter using the PMTF optical bench (Lambda-X Ophthalmics, Nivelles, Belgium). The modulation transfer function (MTF) curves, the through-focus MTF curves, and the Strehl ratios were measured at 3-mm pupil aperture for 0.25-, 0.50- and 0.75-mm decentration. Results The optical design of the trifocal TFLIO130C IOL is robust to small decentrations, with virtually no change in MTF response for 0.25 mm decentration. For greater decentration levels, the MTF response is slightly reduced with increasing decentration. The ETLIO130C EDOF design is robust to decentration, as the MTF response is only minimally affected when increasing the decentration up to 0.75 mm. Conclusions MTF responses are slightly reduced with greater levels of decentration, but the range of focus provided by both trifocal and EDOF designs are preserved. The effects for average levels of decentration reported in the literature are minimum for both IOL designs.

This study aimed to estimate the net monetary benefit (NMB) of trifocal intraocular lenses (IOL) versus monofocal IOL in South Korea according to patient age. A hybrid model with a short-term decision tree, followed by a lifetime Markov model, was developed. The study considered patients aged 45–75 years old. Probabilities of visual disturbances and wearing glass were obtained from a clinical trial of trifocal IOL (NCT03280108). The analysis considered medical and glass costs. Utility values for each age were adopted from previous studies. The incremental QALY was mapped to the patient’s willingness to pay (WTP) thresholds of gross domestic product per capita (GDP; $32,310), $23,000, and $15,000 per QALY gain to estimate the NMB. Trifocal IOL incurred higher costs but resulted in increased QALYs in all age groups. Under the WTP of $15,000, the NMB ranged from $694 at 75 to $6,880 at 45. The NMB with GDP was from $6,731 at 75 to $19,590 at 45. Using trifocal IOL can enhance the quality of life compared to no presbyopia correction with monofocal IOL in patients who want to correct presbyopia. Younger patients have greater economic benefits. Thus, trifocal IOLs are a worthy treatment option considering age and WTP.

PurposeTo assess the visual outcomes and ocular safety when implanting diffractive trifocal intraocular lenses in a population of high myopic eyes.MethodsThis is a retrospective cumulative clinical study. Two hundred five myopic eyes consecutively operated in the hospitals of Clínica Baviera, Spain, were included. All eyes presented an axial length equal or greater than 26 mm and were treated and examined following the same methodology for at least 2 years. Refractive and visual outcomes and also intraoperative or postoperative complications were tabulated for later analysis. Furthermore, a subjective questionnaire was completed by all patients at the end of the follow-up period.ResultsThe percentage of eyes that lost two or more lines of corrected distance visual acuity (CDVA) was 5.9%, 11.5% and 10.7% 3, 12 and 48 months after surgeries respectively. However, 33% of eyes gained two or more lines of CDVA 2 years after implantation. Excimer laser correction of residual refractive error was performed after implants in 29.75% of eyes. Uncorrected distance visual acuities (UDVAs) were significantly better 1 year (0.10 ± 0.3 logMAR) and 2 years after the surgeries (0.10 ± 0.14 logMAR) compared with those estimated 3 months postoperatively (0.14 ± 0.15 logMAR; Kruskal–Wallis; p < 0.001). Mean near and intermediate uncorrected visual acuities remained stable from the first to the last postoperative visit (Kruskal–Wallis; p > 0.05 for all comparisons). Of the eyes, 27.31% were diagnosed and treated with yttrium aluminum garnet (YAG) laser after being diagnosed as having posterior capsular opacification. Retinal detachment (RD) was diagnosed in six eyes (2.92%).ConclusionsDiffractive trifocal IOLs have good efficacy and predictability in high myopic eyes. Retinal concerns should lead the surgeons to explore other alternatives for refractive surgery in young patients without cataracts.

Purpose: To compare four different types of intra ocular lenses (IOLs), namely, AT LISA, Eyecryl SERT trifocal, Eyhance, Eyecryl SERT extended depth of focus (EDOF) with respect to their clinical outcomes. Methods: This is a retrospective comparative study in which patients who underwent surgery and one of the four types of IOL were implanted. Postoperative evaluation was recorded at one month, postoperatively. The monocular uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) (6 m), uncorrected intermediate visual acuity (UIVA) (60 cm), distance-corrected intermediate visual acuity (CIVA), uncorrected near visual acuity (UNVA) (40 cm), and corrected near visual acuity (CNVA) were assessed postoperatively on post operative day 30, for all four IOL groups. Defocus curve and contrast sensitivity were also compared. Results: With regards to UDVA and CDVA, P value was not statistically significant. (P = 0.534 and 0.421, respectively). EDOF group of IOLs had statistically significant better UIVA and CIVA than trifocal IOL group. (P < 0.001, 0.012, <0.001) and EDOF group had statistically significant worse P value pertaining to UNVA and CNVA (P < 0.001, 0.070, <0.001, 0.190). Pertaining to contrast sensitivity, EDOF group had better contrast sensitivity than Trifocal IOL group (P < 0.001). Conclusion: All four IOLs compared in this study had good comparable distant visual acuity. Near visual acuity was better with AT LISA and Eyecryl SERT trifocal IOL while intermediate vision was better with Eyhance and Eyecryl SERT EDOF IOL. Contrast sensitivity was better in EDOF IOLs than in both trifocal IOLs.

To assess subjective satisfaction and visual and refractive outcomes after combining an enhanced monofocal intraocular lens (IOL) and trifocal IOL in patients with specific visual demands. Patients underwent refractive lens exchange and received an enhanced monofocal lens (Tecnis Eyhance) in the dominant eye and a trifocal lens (FineVision) in the nondominant eye. At least 3 months after surgery, we evaluated subjective satisfaction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), predictability, safety, and efficacy. Sixty eyes from 30 patients met the inclusion criteria. At completion, postoperative binocular logMAR UNVA, UIVA, and UDVA were 0.10, 0.30, and 0.00, respectively. The change in visual acuity (before and after surgery, binocular) was statistically significant for UNVA and UDVA (p<0.01 and 0.004, respectively). Safety was better for the enhanced monofocal lens than for the trifocal lens (p=0.032), with no statistically significant differences in efficacy between the eyes. No eyes lost lines of CDVA. Predictability for ±0.5 D and ±1 D was better in eyes with FineVision and Eyhance, respectively, although the differences were not statistically significant. Patient satisfaction was high, enabling most patients to meet their special visual needs. Combining an enhanced monofocal IOL in the dominant eye with a trifocal IOL in the nondominant eye provides considerable satisfaction and spectacle independence and is safe and efficacious in patients with special visual requirements.