José F. Alfonso

Prospective visual evaluation of apodized diffractive intraocular lenses.

PURPOSE: To evaluate distance, intermediate, and near visual performance in patients who had multifocal apodized diffractive intraocular lens (IOL) implantation. SETTING: Fernández‐Vega Ophthalmological Institute, Oviedo, Spain. METHODS: The best corrected distance visual acuity, best distance‐corrected near visual acuity, intermediate visual acuity, distance contrast sensitivity under photopic and mesopic conditions, and patient satisfaction were measured in 325 patients and 335 patients who had bilateral implantation of the model SA60D3 IOL (AcrySof ReSTOR, Alcon) and model SN60D3 IOL (AcrySof Natural ReSTOR), respectively. RESULTS: At the 6‐month postoperative visit, binocular best corrected distance acuity with the ReSTOR IOL and the Natural ReSTOR IOL was 0.034 logMAR ± 0.004 (SD) and 0.019 ± 0.020 logMAR, respectively (∼20/20). Binocular best distance‐corrected near acuity was 0.011 ± 0.012 logMAR and 0.035 ± 0.013 logMAR, respectively (∼20/20). Intermediate visual acuity with both IOL models worsened significantly as a function of the distance of the test (P<.01). Photopic contrast sensitivity was within the standard normal range with both IOLs. Under mesopic conditions, contrast sensitivity with both IOLs was comparable to that with monofocal IOLs and lower, particularly at higher spatial frequencies, than under photopic conditions. No statistically significant differences in visual acuity or photopic and mesopic contrast sensitivity were found between the 2 IOL models (P>.1). A patient satisfaction questionnaire showed that both IOLs performed well and were comparable in satisfaction regarding distance, intermediate, and near activities under different lighting conditions. CONCLUSIONS: The AcrySof ReSTOR IOL and AcrySof Natural ReSTOR IOL provided good visual performance at distance and near under photopic and mesopic conditions. Intermediate vision with both models was reduced compared with distance and near vision.

Prospective study of the Acri.LISA bifocal intraocular lens

PURPOSE: To assess the visual results after bilateral implantation of the bifocal Acri.LISA 366D intraocular lens (IOL) (Acri.Tec AG). SETTING: Fernández‐Vega Ophthalmological Institute, Oviedo, Spain. METHODS: Eighty‐one patients had bilateral implantation of the distance‐dominant bifocal Acri.LISA 366D IOL in a prospective study. Monocular and binocular best corrected distance visual acuity and best distance‐corrected near visual acuity, binocular best distance‐corrected intermediate visual acuity, and distance contrast sensitivity under photopic (85 cd/m2) and mesopic (5 cd/m2) conditions were determined. RESULTS: At the 3‐month postoperative visit, the mean binocular best corrected distance acuity was 0.048 ± 0.111 logMAR and the mean binocular best distance‐corrected near acuity, 0.012 ± 0.0084 logMAR (both approximately 20/20). The mean binocular best distance‐corrected intermediate acuity changed significantly as a function of the distance of the test, from 0.012 ± 0.084 logMAR (approximately 20/20) at 33 cm to 0.265 ± 0.099 logMAR (approximately 20/40) at 70 cm (P<.01). Contrast sensitivity was within normal limits under photopic and mesopic conditions. Binocular contrast sensitivity was statistically significantly better than monocular contrast sensitivity at all spatial frequencies under both illumination levels (P<.01). CONCLUSION: The Acri.LISA 366D IOL provided a satisfactory full range of vision; a high level of uncorrected and corrected distance, intermediate, and near acuity; and improved contrast sensitivity under photopic and mesopic conditions.

Visual function after bilateral implantation of apodized diffractive aspheric multifocal intraocular lenses with a +3.0 D addition

PURPOSE: To evaluate visual function after bilateral implantation of apodized diffractive aspheric multifocal intraocular lenses (IOLs) with a +3.0 diopter addition (add) power. SETTING: Multicenter study at 5 European sites. METHODS: Five surgeons prospectively enrolled patients to receive bilateral implantation of AcrySof IQ ReSTOR SN6AD1 IOLs. Assessments included defocus testing, uncorrected and corrected distance visual acuities at various distances, and patient questionnaires. RESULTS: Ninety‐three patients were enrolled. The mean distance‐corrected visual acuities at far, intermediate, and near distances were significantly better postoperatively. At 6 months, uncorrected visual acuity (logMAR) was −0.03 ± 0.13 (SD) at 4 m, 0.20 ± 0.14 at 70 cm, 0.13 ± 0.15 at 60 cm, 0.05 ± 0.18 at 50 cm, and 0.04 ± 0.11 at 40 cm. The mean patient‐preferred near distance was 41 ± 4 cm, at which distance the mean visual acuity was −0.01 ± 0.11 logMAR. The defocus curve had a plateau of optimum near vision from 40 to 50 cm. Postoperatively, patients reported having minimal to no difficulty with 22 of 27 visual disturbances or visual activities; the other 5 items were ranked minimally to moderately difficult. The mean patient satisfaction with vision was 8.3 ± 1.6 (out of 10); 88% of patients were spectacle independent. CONCLUSIONS: Bilateral apodized diffractive aspheric multifocal IOLs with a +3.0 D add provided a broad range of optimum near vision, good intermediate visual acuity, and low rates of visual disturbances. Patients were highly satisfied with their vision, and 88% were spectacle independent.

Intermediate visual function with different multifocal intraocular lens models

PURPOSE: To compare visual acuity at different distances after bilateral implantation of 1 of 4 multifocal intraocular lenses (IOLs). SETTING: Fernández‐Vega Ophthalmological Institute, Oviedo, Spain. METHODS: This study evaluated consecutive patients who had bilateral implantation of a spherical multifocal IOL with a +4.00 diopter (D) addition (add) (AcrySof ReSTOR SN60D3) or an aspheric multifocal IOL with a +4.00 D add (AcrySof ReSTOR SN6AD3), +3.75 D add (Acri.LISA 366D), or +3.00 D add (AcrySof ReSTOR SN6AD1). Six months postoperatively, binocular measurement of corrected distance visual acuity (CDVA) at 4 m, corrected near visual acuity (CNVA) at 40 cm, and corrected intermediate visual acuity (CIVA) at 50, 60, 70, and 80 cm were performed; the defocus curve was also measured. RESULTS: Each IOL model was implanted in 20 eyes (10 patients). All IOL models resulted in good distance vision, with no statistically significant differences between models. Patients with the +3.00 aspheric IOL had statistically better binocular CIVA at 50, 60, and 70 cm (P<.0001) and binocular CNVA at 40 cm (P = 3 × 10−3) than patients with the other IOL models. CONCLUSION: Patients with bilateral multifocal aspheric IOLs with a lower add had better intermediate and distance near visual acuity than patients with bilateral multifocal spherical IOLs or bilateral aspheric IOLs with a higher add. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Posterior chamber collagen copolymer phakic intraocular lenses to correct myopia : five-year follow-up

PURPOSE: To evaluate the long‐term safety and efficacy of posterior chamber collagen copolymer phakic intraocular lens (pIOL) implantation to correct myopia. SETTING: Fernández‐Vega Ophthalmological Institute, Oviedo, Spain. DESIGN: Cohort study. METHODS: Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, pIOL vault, endothelial cell loss, and adverse events were evaluated for 5 years after implantation of the Visian Implantable Collamer Lens pIOL for moderate to high myopia. RESULTS: The mean spherical equivalent (188 eyes) decreased from −11.17 diopters (D) ± 3.40 (SD) preoperatively to −0.88 ± 0.72 D 5 years postoperatively. The mean change in refraction from 1 month to 5 years was −0.65 ± 0.65 D. The mean UDVA and CDVA (Snellen decimal) were 0.69 ± 0.26 and 0.83 ± 0.15, respectively. The mean safety and efficacy indices were 1.27 ± 0.33 and 0.89 ± 0.35, respectively. No eye lost more than 2 lines of visual acuity; 70% achieved 0.80 or better CDVA. Three eyes (1.6%) developed late anterior subcapsular cataract that was clinically significant in 1 case, leading to pIOL removal and phacoemulsification. Of the 3 eyes (1.6%) with a mild transient increase in intraocular pressure (up to 27 mm Hg), none required a second surgical procedure or prolonged topical medication. The total endothelial cell loss (considered cumulatively at consecutive intervals through 5 years) was 7.7%. There was a tendency toward decreased pIOL vault decrease over time. No vision‐threatening complications occurred. CONCLUSION: Implantation of the collagen copolymer pIOL for moderate to high myopia was safe and effective and provided long‐term predictable, stable refractive results. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Clear lens extraction for the correction of high myopia

OBJECTIVE To evaluate the postoperative outcomes and intraoperative and postoperative complications of clear lens extraction (CLE) with posterior chamber intraocular lens (IOL) implantation in highly myopic eyes. DESIGN Retrospective case series. PARTICIPANTS One hundred seven patients (190 eyes) who had undergone CLE with posterior chamber IOL implantation and who had been observed for at least 3 years after surgery. METHODS Medical records of patients who had undergone CLE with posterior chamber IOL implantation to treat high myopia (axial length >26.00 mm) over 7 years (January 1990 to December 1996) were reviewed. Visual acuity and refractive error were assessed before and after surgery, and perioperative, intraoperative, and postoperative complications were recorded. MAIN OUTCOME MEASURES Axial length, preoperative and final best spectacle-corrected visual acuity (BSCVA), preoperative and postoperative spherical equivalent (SE), argon laser treatments, surgical complications, neodymium:yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy, retinal detachment (RD), time from surgery or Nd:YAG capsulotomy to RD, subfoveal choroidal neovascularization (CNV), and follow-up period. RESULTS The mean postoperative follow-up period was 4.78 years (range, 3.10-8.03 years). Final BSCVA was better than preoperative BSCVA in 159 eyes (83.68%), equal in 24 eyes (12.63%), and worse in 7 eyes (3.68%). Postoperative BSCVA was 20/40 or better in 136 eyes (71.60%) vs. 52 eyes (27.36%) before surgery (P<0.001). The mean final postoperative SE was -1.22 diopters. The risk of Nd:YAG laser capsulotomy was 77.89%. The incidence of RD was 2.10%; retinal reattachment was achieved in all cases, and none of these eyes had worse final BSCVA than before surgery. Subfoveal CNV developed in 4 eyes (2.10%) of 3 patients; all of these eyes presented with a macular lacquer crack. CONCLUSIONS Clear lens extraction with posterior chamber IOL implantation has good outcomes with acceptable predictability and improvement in best-corrected visual acuity. During follow-up, patients tended to remain stable, and the risk of retinal detachment was low. We attribute our favorable results to careful patient selection and follow-up.

Correlation of pupil size with visual acuity and contrast sensitivity after implantation of an apodized diffractive intraocular lens

PURPOSE: To determine whether pupil size is correlated with visual acuity and contrast sensitivity at all distances in eyes with an apodized diffractive intraocular lens (IOL). SETTING: Private Clinic, Oviedo, Spain. METHODS: Six months after surgery, the best corrected distance visual acuity, best distance‐corrected near visual acuity, intermediate visual acuity, and distance contrast sensitivity under photopic (85 cd/m2) and mesopic (5 cd/m2) conditions were measured in 670 eyes of 335 consecutive patients who had implantation of the AcrySof ReSTOR Natural IOL (SN60D3, Alcon). Pupil diameters in distance vision were measured using a pupillometer. RESULTS: The logMAR best corrected distance acuity was significantly better with larger pupils (r = 0.297; P = 1.36 × 10−8), whereas logMAR best distance‐corrected near acuity was significantly worse with larger pupils (r = 0.276, P = 1.02 × 10−7). For all pupil diameters, intermediate visual acuity worsened significantly as the distance of the test increased (P<.01). Statistically significant differences in photopic and mesopic contrast sensitivity at all spatial frequencies were found between the small‐pupil and large‐pupil groups (P<.01). Distance photopic contrast sensitivity and mesopic contrast sensitivity were better in patients with large pupils than in patients with small pupils. CONCLUSIONS: A larger pupil was correlated significantly with better distance visual acuity and with worse near visual acuity. For all pupil diameters, intermediate visual acuity worsened significantly as the distance of the test increased. Distance contrast sensitivity was better with larger pupils at all spatial frequencies in bright‐light and dim‐light conditions.

Visual acuity comparison of 2 models of bifocal aspheric intraocular lenses

PURPOSE: To compare visual acuity after bilateral implantation of 2 models of multifocal aspheric intraocular lenses (IOLs). SETTING: Fernández‐Vega Ophthalmological Institute, Oviedo, and University of Valencia, Valencia, Spain. METHODS: Prospective study of patients who had bilateral implantation of an AcrySof ReSTOR SN6AD3 IOL (Group 1) or an Acri.LISA 366D IOL (Group 2). Six months postoperatively, binocular uncorrected and best corrected distance visual acuity, uncorrected‐distance and best distance‐corrected near visual acuity, best corrected intermediate visual acuity, and the defocus curve were measured in both IOL groups. RESULTS: Group 1 comprised 36 eyes (18 patients) and Group 2, 40 eyes (20 patients). The mean binocular values in Group 1 and Group 2, respectively, were as follows: best corrected distance acuity, −0.05 ± 0.09 logMAR and −0.08 ± 0.08 logMAR (both approximately 20/20); best distance‐corrected near acuity, −0.01 ± 0.16 logMAR and −0.05 ± 0.07 logMAR; best corrected intermediate acuity at 80 cm, 0.20 ± 0.18 logMAR (approximately 20/32) and 0.16 ± 0.13 logMAR (approximately 20/25) and at 60 cm, 0.16 ± 0.16 logMAR (approximately 20/25) and 0.18 ± 0.13 logMAR (approximately 20/25). There were no statistically significant between‐group differences in visual acuity at any distance (P>.3). Defocus curves were similar between groups (2.00 to −5.00 diopters) (P>.26). CONCLUSIONS: The 2 multifocal aspheric IOL models gave similar and good high‐contrast visual acuity at distance and near. Intermediate visual acuity, also comparable between IOL models, was better than published results of a spherical IOL model.

Visual function after implantation of an aspheric bifocal intraocular lens.

PURPOSE: To evaluate distance, intermediate, and near vision after bifocal aspheric AcrySof ReSTOR SN6AD1 intraocular lens (IOL) implantation. SETTING: Fernández‐Vega Ophthalmological Institute, Oviedo, Spain. METHODS: Binocular distance best corrected visual acuity (BCVA) (4.0 m), best distance‐corrected near (40.0 cm) and intermediate (70.0, 60.0, 50.0 cm) acuities, and contrast sensitivity under photopic (85.0 candelas [cd]/m2) and mesopic (3.0 cd/m2) conditions with and without glare were measured postoperatively. A patient‐satisfaction and visual phenomena questionnaire was administered. RESULTS: Six months postoperatively, the mean acuities (logMAR) were binocular BCVA, −0.064 ± 0.049 (SD); best corrected near, −0.041 ± 0.061; best corrected intermediate, 0.147 ± 0.130 (70.0 cm), 0.036 ± 0.133 (60.0 cm), and −0.126 ± 0.077 (50.0 cm). The BCVA and best corrected near acuity were 20/25 or better in all patients. Through‐focus binocular logMAR acuities had 2 peaks at the expected far focus and near focus (0.00 diopter [D] and −2.40 D, respectively), with somewhat reduced acuity (20/32) at intermediate distances. Photopic contrast sensitivity was within the standard normal range. Mesopic contrast sensitivity was lower than under photopic conditions, particularly at higher spatial frequencies. Patients reported good performance for distance, near, and intermediate visual tasks with no or minimal difficulty with specific tasks. No patient reported severe visual phenomena; halos and glare were rated as none to moderate. CONCLUSIONS: The aspheric IOL provided good functional vision at far and near, with lower performance at intermediate distance; good photopic contrast sensitivity and lower mesopic performance; and a low incidence of visual disturbances.

Collagen copolymer toric posterior chamber phakic intraocular lens in eyes with keratoconus.

PURPOSE: To assess the safety, efficacy, stability, and predictability of collagen copolymer toric phakic intraocular lens (pIOL) implantation to correct myopia and astigmatism in eyes with keratoconus. SETTING: Fernández‐Vega Ophthalmological Institute, Oviedo, Spain. METHODS: This prospective study comprised keratoconic eyes that had implantation of a toric Intraocular Collamer Lens. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, and postoperative complications were evaluated 1, 3, 6, and 12 months postoperatively. RESULTS: Preoperatively, the mean spherical equivalent in the 30 eyes (21 patients) was −5.38 diopters (D) ± 3.26 (SD) (range −13.50 to −0.63 D) and the mean cylinder, −3.48 ± 1.24 D (range −1.75 to −6.00 D). At 12 months, 86.7% of the eyes were within ±0.50 D of the attempted refraction and all eyes were within ±1.00 D. For the astigmatic components J0 and J45, 83.3% of eyes and 86.7% of eyes, respectively, were within ±0.50 D. The mean Snellen UDVA was 0.81 ± 0.20 and the mean CDVA, 0.83 ± 0.18; CDVA was 20/40 or better in 29 eyes 96.7% of eyes and 20/25 or better in 22 eyes (73.3%). No eyes lost more than 2 lines of CDVA; 29 eyes (96.7%) maintained or gained 1 or more lines. The efficacy index was 1.07 and the safety index, 1.16. There were no complications or adverse events. CONCLUSIONS: The results confirm that toric ICL implantation is a predictable, effective procedure to correct ametropia in eyes with keratoconus. Predictability and stability were achieved early and remained fairly stable up to 12 months. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.