Clinical Outcomes of Combined Implantation of an Extended Depth of Focus IOL and a Trifocal IOL in a Korean Population

Abstract

Purpose. To evaluate monocular and binocular visual performance and patient-reported outcomes following combined implantation of a diffractive extended depth of focus (EDoF) IOL (Carl Zeiss AT LARA 829MP) and a diffractive trifocal IOL (Carl Zeiss AT LISA tri 839MP). Methods. This prospective study enrolled consecutive patients undergoing lens phacoemulsification of cataract and combined implantation of an EDoF IOL in the dominant eye and a trifocal IOL in the nondominant eye. Assessment included uncorrected visual acuity at near distances (UNVA), intermediate distances (UIVA), and far distances (UDVA), uncorrected defocus curve, contrast sensitivity (CS), reading speed, and patient satisfaction, evaluated six months after the surgery with the Visual Function Questionnaire (VFQ-25). Results. A total of 25 patients were enrolled. At six months postoperatively, outcomes of binocular UNVA, UIVA, and UDVA were superior to those of monocular outcomes. The binocular defocus curve showed significantly better results in comparison with the AT LISA tri IOL eyes at defocus levels of −1.0 D and −1.5 D ( P = 0.008 and P = 0.002 , respectively) and compared to the AT LARA IOL eyes at defocus levels of −3.0, −3.5 D, and −4.0 D ( P = 0.019 , P = 0.019 , and P = 0.035 , respectively). All of the patients were spectacle-free at far and intermediate distances, while 4% of patients needed spectacles at the near distance. Reading speed showed a rather high and gentle slope curve between 0.1 logMAR and 0.4 logMAR, and optical phenomena were improved after combined implantation of IOLs except halos. There were no significant differences in CS between the binocular and monocular results of each IOL. Conclusions. The combined implantation of an EDoF IOL and a trifocal IOL seems to be a good option for patients with demands for spectacle independence in their daily life, with minimal photic phenomena.

Visual Performance, Satisfaction, and Spectacle Independence after Implantation of a New Hydrophobic Trifocal Intraocular Lens

“…In a study assessing patient-reported spectacle independence 6 years after implantation of a trifocal IOL, Fernandez et al [ 19 ] used the same questionnaire and reported the total spectacle independence for far and intermediate distance vision, but 19.4% of subjects reported a need for spectacle use for near vision, 6.5% reported this aid was sometimes needed, and 12.9% rarely needed it. Song et al [ 20 ] reported good visual outcomes by combining a trifocal and an EDOF IOL using the Visual Function Questionnaire (VFQ-25). Only 4% of patients needed spectacles at the near distance.…”

Clinical outcomes of bilateral implantation of new generation monofocal IOL enhanced for intermediate distance and conventional monofocal IOL in a Korean population

“…The binocular reading speed at 40 cm was measured at 3-months postoperatively as described by the Korean Reading Speed Application tester [ 5 , 6 ]. Letter sizes from 0.0 logMAR to 1.0 logMAR were displayed in steps of 0.1 logMAR.…”

“…Previously, we performed a combined implantation of trifocal and EDoF IOLs in cataract patients and observed good visual outcomes in far to near distances as well as a high spectacle independence [ 5 ]. In another study, we compared the visual function in patients who underwent either blended implantation of bifocal and EDoF IOLs or bilateral implantation of trifocal IOLs, and we reported satisfactory spectacle-independent vision at far, intermediate, and near distances in both groups [ 6 ].…”

Clinical outcomes of bilateral implantation of new generation monofocal IOL enhanced for intermediate distance and conventional monofocal IOL in a Korean population

“…Previously, we performed a combined implantation of trifocal and EDoF IOLs in cataract patients and observed good visual outcomes in far to near distances as well as a high spectacle independence [4]. In another study, we compared the visual function in patients who underwent either blende implantation of bifocal and EDoF IOLs or bilateral implantation of trifocal IOLs and we reported satisfactory spectacle independent vision at far, intermediate, and near distances in both groups [5].…”

“…The binocular reading speed at 40 cm was measured at 3-months postoperatively as described by the Korean Reading Speed Application tester [4,5]. Letter sizes from 0.0 logMAR to 1.0 logMAR were displayed in steps of 0.1 logMAR.…”