Depth of field measures in pseudophakic eyes implanted with different type of presbyopia-correcting IOLS

Abstract

To evaluate depth of field (DOF) provided by different presbyopia-correcting intraocular lens (IOL) designs, comparing the results obtained using different criteria for defining the defocus tolerance. A total of 150 eyes undergoing cataract surgery were enrolled and divided into 6 groups depending on the IOL implanted: AT.LISA Tri (Carl Zeiss Meditec), FineVision (PhysIOL), PanOptix (Alcon Laboratories), Tecnis Symfony (Johnson & Johnson Vision), Miniwell (SIFI MedTech) and Tecnis Synergy (Johnson & Johnson Vision). Subjective DOF was obtained from defocus curves with absolute and relative criteria of tolerance of 0.1 logMAR. Aberrometry was also measured and the visual strehl optical transference function (VSOTF) with percentage of degradation of 90%, 80% and 60% was used to quantify objectively the DOF. Tecnis Symfony, Tecnis Synergy and Panoptix IOL groups showed better subjective and objective DOF compared to the rest of IOL groups, being these differences statistically significant differences (p < 0.001). Comparison between subjective and objective DOF showed that subjective measures were higher for all IOLs, being also these differences statistically significant for all groups (p < 0.001). A moderate significant correlation was found between absolute subjective criteria and VSOTF60% (r = 0.73, p < 0.05). Objective and subjective measures of DOF are not comparable due to differences in methodologies and criterions to define the level of degradation tolerance. Nevertheless, both objective and subjective measures showed a trend to a greater DOF for Tecnis Symfony and Tecnis Synergy IOLs compared to most of trifocal diffractive designs, with the exception of PanOptix.

Depth of field and visual performance after implantation of a new hydrophobic trifocal intraocular lens

“…Defocus curves were obtained monocularly from all participants under photopic conditions at 3 months post-operatively, following the methodology described by the authors in previous reports [ 10 ]. The step size in diopters was 0.50 D, ranging from + 3.00 to − 5.00 D. VA was measured in logMAR scale, and the optotype used was ETDRS (Precision Vision, Illinois, USA) at 4 m. All participants were measured with the best correction for distance to compensate any residual refractive error.…”

“…Subjective tolerance to defocus was determined from the analysis of defocus curves, using both absolute and relative criteria. Absolute criterion was obtained from those vergences (in D) which provided visual acuity values ≤0.1 logMAR and relative criterion was obtained considering those vergences (in D) which provided a decay of 0.1 logMAR from the best visual acuity of each subject, as used by the authors in previous studies [ 8 , 10 ]. Additionally, a second less restrictive criterion was applied to determine absolute DOF, considering those vergences that provided visual acuity values ≤0.3 logMAR [ 11 ], and the more restrictive relative criterion considering those vergences (in D) which provided a decay of 0.04 logMAR from the best visual acuity of each subject [ 4 ].…”

“…The determination of through-focus visual acuity at different distances (defocus curve) is an increasingly common clinical procedure that proved to be very useful for the assessment of the clinical performance of an IOL at different vergences, particularly those designs aimed to compensate presbyopia (i.e. bifocal, trifocal or enhanced depth of focus IOLs) [ 4 – 10 ]. Among the metrics that can be extracted from the data contained within the defocus curve, the depth of field (DOF) that the lens implanted provides to the patient is one that better allows characterizing the clinical behavior of the IOL.…”

“…However, it is important to define the visual acuity criterion being considered as cutoff value. Previous recent reports used 0.1 logMAR as the threshold to define the defocus tolerance [ 8 , 10 ], however, other values of visual acuity may be used and hence different DOF values can be obtained in the peer-review literature of presbyopia-correcting IOLs. Other authors used a less restrictive criterion to define absolute DOF, suggesting visual acuity values ≤0.3 logMAR [ 11 ] since that value is considered as nominally an adequate standard of distance vision for driving, or a more restrictive relative criterion considering a decay of 0.04 logMAR from the best visual acuity as the landmark for individual tolerance [ 4 ].…”

Preliminary Evaluation of the Clinical Benefit of a Novel Visual Rehabilitation Program in Patients Implanted with Trifocal Diffractive Intraocular Lenses: A Blinded Randomized Placebo-Controlled Clinical Trial

“…Indeed, multifocal IOLs are superior to conventional monofocal IOLs in terms of spectacle independence [1]. Among multifocal implants, trifocal diffractive IOLs have been shown to provide a wide range of focus, with good levels of distance, intermediate visual acuity, and near visual acuity, thus making them one of the most effective options for presbyopia correction [2][3][4]. However, multifocal IOLs are associated with a higher prevalence of visual disturbances, including suboptimal visual acuity, decreased contrast sensitivity [5,6], and haloes or glare [7], thus leading to patient dissatisfaction [8] and in the most severe cases to IOL explantation [9].…”