Comparison of visual performance between bifocal and extended-depth-of-focus intraocular lenses

Abstract

We compared the visual performance of a bifocal intraocular lens (IOL) (ZMB00) and an extended-depth-of-focus (EDOF) IOL (ZXR00V) by evaluating postoperative parameters at 10 weeks after the last surgery in cataract patients who underwent bilateral ZMB00 or ZXR00V implantation between 2011 and 2020. The right and left lenses were implanted within 3 months of each other. The study enrolled 1536 eyes from 768 patients; the ZMB00 group comprised 1326 eyes of 663 patients (age: 67.0 ± 7.8 years; female/male, 518/145), and the ZXR00V group comprised 210 eyes of 105 patients (age: 67.8 ± 6.9 years; female/male, 39/66). A linear mixed-effects model using data for both eyes, with strict adjustments for sex, age, subjective refraction spherical equivalent, subjective refraction cylinder, corneal astigmatism, axial length, corneal higher-order aberrations and pupil diameter, ensured statistical validity. Uncorrected near visual acuity, corrected near visual acuity, and near spectacle independence were significantly better in the ZMB00 group (p < 0.00068, Wald test) than in the ZXR00V group. Contrast sensitivity (visual angle of the test target: 4.0°/2.5°/1.6°/1.0°/0.7°) and contrast sensitivity with glare (4.0°/2.5°/1.6°/1.0°/0.7°) were significantly better in the ZXR00V group (p < 0.00068, Wald test) than in the ZMB00 group. Uncorrected intermediate visual acuity, contrast sensitivity with glare (6.3°), and the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) scores for General Vision were slightly but significantly better in the ZXR00V group than in the ZMB00 group (p < 0.05, Wald test). At high-performance levels, the two IOL groups had different characteristics regarding various visual performance parameters.

Comparative Visual Performance of Ultraviolet Light-Filtering and Violet Light-Filtering Monofocal Intraocular Lenses of the Same Material and Basic Design

“…At a superior level of performance, the two groups of IOLs exhibited distinctive attributes with respect to diverse vision-related parameters. in our previous study [10][11][12] . Participants were recruited for enrollment in a consecutive case series study (outpatients with or without a doctor's referral).…”

“…The patient demographic variables and pre and postoperative visual parameters used in the study are presented in Supplementary Multiple regression analysis was conducted on all postoperative parameters of the two groups 10 weeks after surgery in both eyes in the same way as in our previous studies [10][11][12] , i.e., we ensured statistical validity through a linear mixed-effects model using data for both eyes, with strict adjustments for sex, age, subjective refraction spherical equivalent, subjective refraction cylinder, corneal astigmatism, axial length, corneal higher-order aberrations, and pupil diameter. The parameters were adjusted by multiple regression according to the explanatory variables in Table 1.…”

“…Preoperative examinations were conducted as described in our previous study [10][11][12] . All patients underwent full ophthalmologic examinations, including evaluations of the corneal curvature radius, corneal astigmatism, axial length, refractive status, ocular aberrations, pupil diameter, distance/intermediate/near visual acuity, contrast sensitivity, and contrast sensitivity under glare, as well as anterior segment evaluations using a slit lamp, tonometry and indirect fundoscopy.…”

“…Axial length was measured using IOL Master 700 (Carl Zeiss Meditec AG, Jena, Germany) and AL-3000 (TOMEY, Nagoya, Japan) biometers. Contrast sensitivity and contrast sensitivity under glare (visual angle of the test target: 6.3°/4.0°/2.5°/1.6°/1.0°/0.7°; 13 contrast levels: 0.01 to 0.64 contrast or 2.00 to 0.34 log10CS) were measured using a CGT-1000 contrast glare tester (Takagi Seiko, Nakano, Japan) [10][11][12][13]19 , and the pupil diameter and ocular aberrations were measured using a KR-1W Wavefront Analyzer (Topcon, Tokyo, Japan). All measurements were taken by experienced technicians.…”

“…To our knowledge, no studies have undertaken a detailed, comprehensive clinical comparison of these two IOLs on a large scale under a strictly controlled analysis. Previously, we retrospectively compared the visual performance of several other combinations of the two IOLs based on a large set of patient data; in those studies, detailed statistical analysis with a linear mixed-effects model using data for both eyes, with strict adjustments for sex, age, subjective refraction spherical equivalent, subjective refraction cylinder, corneal astigmatism, axial length, corneal higher-order aberrations, and pupil diameter, successfully unveiled the different characteristics of the different lenses [10][11][12] . In this study, using the same rigorous statistical analysis as in our previous report [10][11][12] , we comprehensively compared the clinical performance of the ZCB00 group and the ZCB00V group in a large cohort of patients who underwent cataract surgery over a decade of clinical practice at a single hospital to clarify which product might be preferable for a patient undergoing cataract surgery and to investigate the potential effects of blue-light transmitting, violet lightltering IOL yellow tinting on comprehensive visual performance.…”