Original article
Visual Performance of a Quadrifocal (Trifocal) Intraocular Lens Following Removal of the Crystalline Lens

https://doi.org/10.1016/j.ajo.2017.09.016Get rights and content

Purpose

To evaluate visual performance after implantation of a quadrifocal intraocular lens (IOL).

Methods

Setting: Department of Ophthalmology, Goethe University, Frankfurt, Germany. Study Population: Twenty-seven patients (54 eyes) received bilateral implantation of the PanOptix IOL (AcrySof IQ PanOptixTM; Alcon Research, Fort Worth, Texas, USA) pre-enrollment. Exclusion criteria were previous ocular surgeries, corneal astigmatism of >1.5 diopter (D), ocular pathologies, or corneal abnormalities. Intervention or Observational Procedure(s): Postoperative examination at 3 months including manifest refraction; uncorrected visual acuity (UCVA) and distance-corrected visual acuity (DCVA) in 4 m, 80 cm, 60 cm, and 40 cm slit-lamp examination; defocus testing; contrast sensitivity (CS) under photopic and mesopic conditions; and a questionnaire on subjective quality of vision, optical phenomena, and spectacle independence was performed. Main Outcome Measure(s): At 3 months postoperatively, UCVA and DCVA in 4 m, 80 cm, 60 cm, and 40 cm (logMAR), defocus curves, CS, and quality-of-vision questionnaire results.

Results

Mean spherical equivalent was −0.04 ± 0.321 D 3 months postoperatively. Binocular UCVA at distance, intermediate (80 cm, 60 cm), and near was 0.00 ± 0.094 logMAR, 0.09 ± 0.107 logMAR, 0.00 ± 0.111 logMAR, and 0.01 ± 0.087 logMAR, respectively. Binocular defocus curve showed peaks with best visual acuity (VA) at 0.00 D (−0.07 logMAR) and −2.00 D (−0.02 logMAR).

Conclusion

Visual performance of the PanOptix IOL showed good VA at all distances; particularly good intermediate VA (logMAR > 0.1), with best VA at 60 cm; and high patient satisfaction and spectacle independence 3 months postoperatively.

Section snippets

Study Design

This prospective, single-arm study included patients after bilateral phacoemulsification and implantation of a panfocal IOL (AcrySof IQ PanOptix, TNFT00; Alcon Laboratories Inc, Fort Worth, Texas, USA) 3 months postoperatively.

Enrollment of Participants

The study was conducted from January 5, 2016, to January 18, 2017, consistent with the tenets of the Declaration of Helsinki, and in compliance with Good Clinical Practices, including International Harmonization Guidelines. The study was registered at ClinicalTrials.gov

Results

The mean ± standard deviation (range) patient age was 63 ± 8.8 years (39–77 years) and 52% (14 of 27 patients) were female. Cataract surgery was performed in 21 patients; in 6 patients a refractive lens exchange was performed. The mean lens power was +21.75 ± 3.108 D (14-28.5 D) and the target refraction was −0.06 ± 0.122 D.

Spherical equivalent changed from −0.10 ± 2.582 D (−7.25 to 5.875 D) preoperatively to −0.04 ± 0.321 D (−1.00 to 1.125 D) 3 months postoperatively. Ninety-three percent (50

Discussion

This study analyzed the outcomes after binocular implantation of the PanOptix IOL with regard to monocular and binocular visual performance at various distances (40 cm, 60 cm, 80 cm, 4 m), defocus curves, subjective quality of vision at daily life activities, and spectacle independence. The aim of multifocal IOL implantation is to provide patients with good uncorrected visual acuity for near, intermediate, and distance visual tasks and spectacle independence. Prior studies analyzing visual

References (59)

  • J.F. Alfonso et al.

    Intermediate visual function with different multifocal intraocular lens models

    J Cataract Refract Surg

    (2010)
  • T. Kohnen et al.

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

    J Cataract Refract Surg

    (2009)
  • J.F. Alfonso et al.

    Clinical outcomes after bilateral implantation of an apodized +3.0 D toric diffractive multifocal intraocular lens

    J Cataract Refract Surg

    (2014)
  • M.S. Attia et al.

    Near and intermediate reading performance of a diffractive trifocal intraocular lens using a reading desk

    J Cataract Refract Surg

    (2015)
  • T. Kohnen et al.

    Trifocal intraocular lens implantation to treat visual demands in various distances following lens removal

    Am J Ophthalmol

    (2016)
  • E.F. Marques et al.

    Comparison of visual outcomes of 2 diffractive trifocal intraocular lenses

    J Cataract Refract Surg

    (2015)
  • J. Mendicute et al.

    Evaluation of visual outcomes and patient satisfaction after implantation of a diffractive trifocal intraocular lens

    J Cataract Refract Surg

    (2016)
  • T. Kohnen

    First implantation of a diffractive quadrafocal (trifocal) intraocular lens

    J Cataract Refract Surg

    (2015)
  • F.L. Ferris et al.

    Standardizing the measurement of visual acuity for clinical research studies: guidelines from the Eye Care Technology Forum

    Ophthalmology

    (1996)
  • J.C. Javitt et al.

    Outcomes of cataract extraction with multifocal intraocular lens implantation: functional status and quality of life

    Ophthalmology

    (1997)
  • S. Cillino et al.

    One-year outcomes with new-generation multifocal intraocular lenses

    Ophthalmology

    (2008)
  • D.F. Chang

    Prospective functional and clinical comparison of bilateral ReZoom and ReSTOR intraocular lenses in patients 70 years or younger

    J Cataract Refract Surg

    (2008)
  • N.E. de Vries et al.

    Long-term follow-up of a multifocal apodized diffractive intraocular lens after cataract surgery

    J Cataract Refract Surg

    (2008)
  • G. Monaco et al.

    Visual performance after bilateral implantation of 2 new presbyopia-correcting intraocular lenses: trifocal versus extended range of vision

    J Cataract Refract Surg

    (2017)
  • R.M. Nuijts et al.

    Bilateral implantation of +2.5 D multifocal intraocular lens and contralateral implantation of +2.5 D and +3.0 D multifocal intraocular lenses: clinical outcomes

    J Cataract Refract Surg

    (2016)
  • J. McCambridge et al.

    Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects

    J Clin Epidemiol

    (2014)
  • D. Calladine et al.

    Multifocal versus monofocal intraocular lenses after cataract extraction

    Cochrane Database Syst Rev

    (2012)
  • N. Tan et al.

    Comparison of visual performance after implantation of 3 types of intraocular lenses: accommodative, multifocal, and monofocal

    Eur J Ophthalmol

    (2014)
  • T. Kohnen et al.

    Use of multifocal intraocular lenses and criteria for patient selection

    Ophthalmologe

    (2008)
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