Ana B. Plaza-Puche

Visual outcomes and optical performance of a monofocal intraocular lens and a new-generation multifocal intraocular lens

PURPOSE: To compare visual acuity outcomes and ocular and intraocular optical quality in patients with a monofocal intraocular lens (IOL) or a multifocal IOL with rotational asymmetry. SETTING: Vissum Corporation, Alicante, Spain. DESIGN: Comparative case series. METHODS: Consecutive eyes of cataract patients were divided into 2 groups. One group received a Lentis Mplus LS‐312 multifocal IOL and the other, an Acri.Smart 48S monofocal IOL. Distance and near visual acuities, contrast sensitivity, intraocular aberrations (global minus corneal aberrations), and defocus curves were evaluated preoperatively and postoperatively during a 3‐month follow‐up. RESULTS: The study evaluated 52 eyes of 29 patients (age range 36 to 87 years); 24 eyes were in multifocal IOL group and 28 eyes, in the monofocal IOL group. Both groups had a significant improvement in uncorrected and corrected distance visual acuities and in distance‐corrected near visual acuity (DCNVA) postoperatively (P≤.04). The multifocal IOL group had significantly better uncorrected near acuity and DCNVA (Jaeger [J] 5 versus J2) (both P<.01). The defocus curves showed significantly better visual acuities in the multifocal group at several levels of defocus. The multifocal group had significantly higher amounts of postoperative intraocular primary coma (P<.01), especially in eyes with significant IOL tilt, although there were no significant differences in contrast sensitivity between the 2 IOL groups (P≥.25). CONCLUSIONS: The new‐generation multifocal IOL restored distance, intermediate, and near visual function after cataract surgery. The optical quality with this type of IOL was particularly affected by IOL tilt and decentration. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes.

Comparison of a New Refractive Multifocal Intraocular Lens with an Inferior Segmental Near Add and a Diffractive Multifocal Intraocular Lens

PURPOSE To compare the visual acuity outcomes and ocular optical performance of eyes implanted with a multifocal refractive intraocular lens (IOL) with an inferior segmental near add or a diffractive multifocal IOL. DESIGN Prospective, comparative, nonrandomized, consecutive case series. PARTICIPANTS Eighty-three consecutive eyes of 45 patients (age range, 36-82 years) with cataract were divided into 2 groups: group A, 45 eyes implanted with Lentis Mplus LS-312 (Oculentis GmbH, Berlin, Germany); group B, 38 eyes implanted with diffractive IOL Acri.Lisa 366D (Zeiss, Oberkochen, Germany). METHODS All patients underwent phacoemulsification followed by IOL implantation in the capsular bag. Distance corrected, intermediate, and near with the distance correction visual acuity outcomes and contrast sensitivity, intraocular aberrations, and defocus curve were evaluated postoperatively during a 3-month follow-up. MAIN OUTCOME MEASURES Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), corrected distance near and intermediate visual acuity (CDNVA), contrast sensitivity, intraocular aberrations, and defocus curve. RESULTS A significant improvement in UDVA, CDVA, and UNVA was observed in both groups after surgery (P ≤ 0.04). Significantly better values of UNVA (P<0.01) and CDNVA (P<0.04) were found in group B. In the defocus curve, significantly better visual acuities were present in eyes in group A for intermediate vision levels of defocus (P ≤ 0.04). Significantly higher amounts of postoperative intraocular primary coma and spherical aberrations were found in group A (P<0.01). In addition, significantly better values were observed in photopic contrast sensitivity for high spatial frequencies in group A (P ≤ 0.04). CONCLUSIONS The Lentis Mplus LS-312 and Acri.Lisa 366D IOLs are able to successfully restore visual function after cataract surgery. The Lentis Mplus LS-312 provided better intermediate vision and contrast sensitivity outcomes than the Acri.Lisa 366D. However, the Acri.Lisa design provided better distance and near visual outcomes and intraocular optical performance parameters.

Optical analysis, reading performance, and quality-of-life evaluation after implantation of a diffractive multifocal intraocular lens.

PURPOSE: To evaluate the reading performance, changes in quality of life, and optical performance after cataract surgery with multifocal diffractive intraocular lens (IOL) implantation. SETTING: Vissum Corporation, Alicante, Spain. DESIGN: Prospective case series. METHODS: Patients with bilateral cataract had implantation of Acri.LISA 366D multifocal IOLs. Visual acuity and contrast sensitivity outcomes were evaluated during a 6‐month follow‐up. Other parameters evaluated included reading performance (Salzburg Reading Desk), a 25‐item quality‐of‐life questionnaire (National Eye Institute Visual Functioning Questionnaire‐25 [NEI VFQ‐25] and appendix NEI VFQ‐39), and ocular optical performance (ocular aberrometry and modulation transfer function). RESULTS: The study included 48 eyes (24 patients) ranging in age from 47 to 77 years. The mean uncorrected distance visual acuity (logMAR) improved significantly 1 month postoperatively (P<.01), with no significant changes afterward (6 months, P≥.06). The mean reading acuity without correction improved significantly from 0.68 logRAD ± 0.20 (SD) to 0.16 ± 0.08 logRAD 1 month after surgery (P < .01). However, it was worse by the end of the follow‐up (6 months, P = .04). During the follow‐up, no significant changes were found in the mean reading speed without near correction (6 months, P = .50). Contrast sensitivity improved significantly at all spatial frequencies under photopic and scotopic conditions after surgery (6 months, P≤.02). The quality‐of‐life index related to reading ability also improved significantly (3 months, P = .03). CONCLUSION: Implantation of the multifocal diffractive IOL significantly improved reading performance, which had a positive effect on the patient’s quality of life postoperatively. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Comparison of the visual and intraocular optical performance of a refractive multifocal IOL with rotational asymmetry and an apodized diffractive multifocal IOL.

PURPOSE To compare the visual outcomes and intraocular optical quality observed postoperatively in patients implanted with a rotationally asymmetric multifocal intraocular lens (IOL) and an apodized diffractive multifocal IOL. METHODS Seventy-four consecutive eyes of 40 cataract patients (age range: 36 to 79 years) were divided into two groups: zonal refractive group, 39 eyes implanted with a rotationally asymmetric multifocal IOL (Lentis Mplus LS-312 IOL, Oculentis GmbH); and diffractive group, 35 eyes implanted with an apodized diffractive multifocal IOL (ReSTOR SN6AD3, Alcon Laboratories Inc). Distance and near visual acuity outcomes, contrast sensitivity, intraocular optical quality, and defocus curves were evaluated during 3-month follow-up. Calculation of the intraocular aberrations was performed by subtracting corneal aberrations from total ocular aberrations. RESULTS Uncorrected near visual acuity and distance-corrected near visual acuity were better in the diffractive group than in the zonal refractive group (P=.01), whereas intermediate visual acuity (defocus +1.00 and +1.50 diopters) was better in the zonal refractive group. Photopic contrast sensitivity was significantly better in the zonal refractive group (P=.04). Wavefront aberrations (total, higher order, tilt, primary coma) were significantly higher in the zonal refractive group than in the diffractive group (P=.02). CONCLUSIONS Both multifocal IOLs are able to successfully restore visual function after cataract surgery. The zonal refractive multifocal IOL provides better results in contrast sensitivity and intermediate vision, whereas the diffractive multifocal IOL provides better near vision at a closer distance.

Visual and Optical Performance With Two Different Diffractive Multifocal Intraocular Lenses Compared to a Monofocal Lens

PURPOSE To compare the visual acuity outcomes as well as the ocular optical performance of eyes implanted with either a monofocal or one of two diffractive multifocal intraocular lenses (IOLs). METHODS One hundred two consecutive eyes of 51 bilateral cataract patients (age 49 to 80 years) were divided into three groups: 22 eyes were implanted with a monofocal IOL (monofocal group), 40 eyes with the Acrysof ReSTOR SN6AD3 IOL (ReSTOR group), and 40 eyes with the Acri.Lisa 366D IOL (Acri.Lisa group). Visual acuity and contrast sensitivity were evaluated pre- and postoperatively. Additionally, ocular optical quality and intraocular aberrations were evaluated postoperatively. RESULTS Significant improvement after surgery in uncorrected and corrected distance and near visual acuity was observed in all three groups (P≤.05). Uncorrected near visual acuity was significantly better in eyes from the ReSTOR and Acri.Lisa groups compared to the monofocal group (P≤.01). Photopic contrast sensitivity was significantly better for the spatial frequency of 3 cycles/degree in the monofocal group (P<.01). Significantly higher values of the ocular Strehl ratio and cutoff modulation transfer function spatial frequency were also found in the Acri.Lisa group (P=.01). An acceptable range of vision between near and distance peaks was observed in the defocus curves of the ReSTOR and Acri.Lisa groups. CONCLUSIONS The AcrySof ReSTOR and Acri.Lisa 366D IOLs are able to successfully restore near and intermediate visual function after cataract surgery; however, the Acri.Lisa design seems to provide better optical performance. These results need to be confirmed in a randomized, prospective trial.

Quality of life evaluation after implantation of 2 multifocal intraocular lens models and a monofocal model

PURPOSE: To compare vision‐related quality of life using the National Eye Institute Visual Function Questionnaire (NEI VFQ‐25) in patients with 1 of 3 types of intraocular lenses (IOLs) and to correlate it with postoperative visual outcomes. SETTING: Vissum Corporation–Instituto Oftalmológico de Alicante, Alicante, Spain. DESIGN: Comparative case series. METHODS: This study comprised eyes having cataract surgery with bilateral implantation of a monofocal IOL (Group A), apodized multifocal IOL (Group B), or full diffractive multifocal IOL (Group C). Distance and near visual acuities, contrast sensitivity, and quality of life were evaluated preoperatively and postoperatively. RESULTS: The study enrolled 106 eyes (53 patients; age range 49 to 80 years). All groups had significant improvement in uncorrected and corrected distance visual acuities postoperatively (P≤.05). Near vision outcomes were significantly better in Groups B and C (P≤.01). Groups B and C had significantly less difficulty in some near tasks, such as reading the newspaper (A–B, P=.02; A–C, P=.02) or reading bills (A–B, P=.04; A–C, P=.004). Group C also had significantly less difficulty driving at night than Group B (P<.01). Near visual acuity and contrast sensitivity were significantly correlated with difficulty in near visual tasks in Groups B and C. Night‐driving difficulty correlated significantly with contrast sensitivity in Group B. CONCLUSIONS: Patients with multifocal IOLs could perform several daily tasks at near and intermediate distances, with less night‐driving limitation with the full diffractive IOL than with apodized multifocal and monofocal IOLs. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Comparative analysis of the clinical outcomes with 2 multifocal intraocular lens models with rotational asymmetry.

PURPOSE: To compare the clinical outcomes after cataract surgery with implantation of 2 models of a new rotationally asymmetric multifocal IOL to ascertain which provides better visual performance and patient satisfaction. SETTING: Vissum Instituto Oftalmologico de Alicante, Alicante, Spain. DESIGN: Comparative case series. METHODS: Consecutive eyes of cataract patients were divided into 2 groups. Group A received a Lentis Mplus LS‐312 MF15 IOL (with a near addition [add] power of +1.50 diopters [D]) and Group B, a Lentis Mplus LS‐312 MF30 IOL (with a near add power of +3.00 D). Distance, near, and intermediate visual acuity outcomes were evaluated preoperatively and postoperatively during a 6‐month follow‐up. Postoperative contrast sensitivity, patient satisfaction, ocular aberrations, ocular optical quality, and defocus curves were analyzed. RESULTS: Patients ranged in age from 55 to 83 years. Group A comprised 22 eyes and Group B, 21 eyes. Both groups had a statistically significant improvement in uncorrected and corrected distance and corrected near visual acuities postoperatively (P≤.01). Group B had statistically significantly better uncorrected and distance‐corrected near visual acuity (P≤.01) and Group A, significantly better uncorrected intermediate visual acuity (P=.01) at 3 months. There were statistically significant differences between‐group differences in several levels of defocus based on defocus curves. There were no significant differences in postoperative contrast sensitivity, patient satisfaction, optical quality, and ocular aberrometry between groups (P≥.07). CONCLUSIONS: Both IOL models restored distance visual function and improved intermediate vision. Near visual rehabilitation was complete with the +3.00 D add IOL. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Postoperative bilateral reading performance with 4 intraocular lens models: Six-month results

PURPOSE: To compare bilateral reading performance within the first 6 months after implantation of 4 intraocular lens (IOL) models. SETTING: Vissum‐Instituto de Oftalmológico de Alicante, Alicante, Spain, and University Eye Clinic, Paracelsus Medical University, Salzburg, Austria. DESIGN: Comparative case series. METHODS: Patients had bilateral phacoemulsification and implantation of Acri.Smart 48S monofocal, Acrysof Restor SN6AD3 apodized multifocal, Acri.LISA 366D diffractive multifocal, or Rezoom refractive multifocal IOLs. Bilateral reading performance with and without near correction was evaluated preoperatively and postoperatively using the Salzburg Reading Desk. RESULTS: The study comprised 304 eyes of 152 patients 51 to 90 years old. All groups had a significant improvement in uncorrected and corrected distance visual acuities postoperatively (P≤.01). The apodized multifocal and diffractive multifocal groups had significantly better uncorrected reading acuity than the monofocal and refractive multifocal groups 1 month and 6 months postoperatively (P<.01). Uncorrected reading speed was significantly worse in the refractive multifocal group than in the monofocal group at 1 month (P<.01). The monofocal group had the greatest uncorrected reading distance at 1 month and 6 months (P<.01). CONCLUSION: Multifocal IOLs with a diffractive component provided a comparable reading performance that was significantly better than the one obtained with refractive multifocal and monofocal IOLs. Financial Disclosure: Drs. Alió, Plaza‐Puche, Rasp, Piñero, Seyeddain, Rodríguez‐Prats, Ayala, Moreu, Hohensinn, and Riha have no financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Design of short Spanish sentences for measuring reading performance: Radner-Vissum test

PURPOSE: To develop 24 short Spanish optotype sentences for the construction of a test based on the Radner reading test to simultaneously measure near visual acuity and reading speed. SETTING: Department of Refractive Surgery, Vissum‐Instituto de Oftalmológico de Alicante, Alicante, Spain. METHODS: Thirty‐one sentences were constructed in Spanish following the procedure defined by Radner to obtain sentence optotypes with comparable structure and the same lexical and grammatical difficulty. Sentences were statistically selected and standardized in 60 patients divided into 2 groups by educational level. Group A (30 patients) had a university education and Group B (30 patients), a primary school education. The interval of reading time was defined as the overall mean ±1.1 × SD. All sentences with a mean between 3.59 seconds and 4.04 seconds were selected for the reading charts. RESULTS: The mean age was 30.8 years ± 6.2 (SD) in Group A and 37.3 ± 10.7 years in Group B. The mean reading time was 3.8 ± 0.9 seconds in all patients, 3.5 ± 0.6 seconds in Group A, and 4.1 ± 1.0 seconds in Group B. CONCLUSION: The 24 short single Spanish sentences were highly comparable in syntactical structure; number, position, and length of words; lexical difficulty; and reading length.

Visual outcomes and optical performance with a monofocal intraocular lens and a new-generation single-optic accommodating intraocular lens

PURPOSE: To compare the visual acuity outcomes and the ocular and intraocular optical quality in patients with a monofocal intraocular lens (IOL) or a new‐generation single‐optic accommodating IOL. SETTING: Vissum Corporation, Alicante, Spain. DESIGN: Comparative case series. METHODS: Consecutive eyes of bilateral cataract patients were divided into 2 groups. One group had implantation of a monofocal IOL (Acri.Smart 48S) and the other group, of a single‐optic accommodating IOL (Crystalens HD). Distance and near visual acuities were evaluated preoperatively and postoperatively. In addition, postoperative ocular optical quality, intraocular aberrations, and defocus curves were evaluated. RESULTS: The 20 patients included in the study ranged in age from 50 to 87 years. The monofocal IOL group comprised 24 eyes and the accommodating IOL group, 16 eyes. In both groups, the uncorrected and corrected distance visual acuities improved significantly from preoperatively to postoperatively (P≤.03). The distance‐corrected near visual acuity also improved significantly in both groups (P≤.03); the difference between groups was at the limit of statistical significance (P = .05). The uncorrected near visual acuity was significantly better in the accommodating IOL group (J5 versus J3; P = .01). The defocus curves showed significantly better visual acuity in the accommodating IOL group at several levels of defocus. There were no statistically significant differences between the 2 groups in any intraocular aberrometric coefficient (P≥.06). CONCLUSIONS: The new‐generation single‐optic accommodating IOL restored distance visual function after cataract surgery and improved near vision. The optical quality with the accommodating IOL was similar to that with the conventional monofocal IOL. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.