The evaluated trifocal diffractive toric IOL provides an effective restoration of the distance, intermediate, and near vision after cataract surgery with good levels of visual quality and minimal photic phenomena.

PURPOSE: To evaluate visual outcomes at different distances (near, intermediate, and far), depth of focus, optical quality, quantitative dysphotopsia, and patient satisfaction in two groups. METHODS: The extended depth of focus (EDOF) only group (n = 40 eyes) was implanted bilaterally with an EDOF intraocular lens (IOL) and the mixed group (n = 40 eyes) was implanted with the same EDOF IOL in the dominant eye and a trifocal IOL in the fellow eye. At the 3-month postoperative visit, refractive outcomes and monocular and binocular uncorrected (UDVA) and corrected (CDVA) distance visual acuities for far UDVA, CDVA, distance-corrected intermediate visual acuity (DCIVA) at 80 cm, uncorrected near visual acuity (UNVA), distance-corrected near visual acuity (DCNVA) at 40 cm, and binocular defocus curve were evaluated. RESULTS: The mean spherical equivalent (SE) 3 months postoperatively was −0.16 ± 0.41 diopters (D) in the EDOF only group and −0.39 ± 0.63 D in the mixed group. In the EDOF only group, binocular visual acuities were: UDVA = −0.04 ± 0.07 logMAR (20/18); CDVA = −0.04 ± 0.06 logMAR (20/18); DCIVA (80 cm) = 0.07 ± 0.19 logMAR (20/23); DCNVA (40 cm) = 0.32 ± 0.15 logMAR (20/42); and UNVA (40 cm) = 0.24 ± 0.17 logMAR (20/35). In the mixed group, binocular visual acuities were: UDVA = 0.03 ± 0.09 logMAR (20/21) ( P = .08); CDVA = −0.01 ± 0.07 logMAR (20/20) ( P = .25); DCIVA (80 cm) = 0.24 ± 0.23 logMAR (20/35) ( P = .08); DCNVA (40 cm) = 0.19 ± 0.07 logMAR (20/31) ( P = .03); and UNVA (40 cm) = 0.18 ± 0.10 logMAR (20/30) ( P = .37). CONCLUSIONS: Effective restoration of visual acuity was demonstrated in both groups, with high levels of visual quality and patient satisfaction. Better results in near visual acuity were demonstrated in the mixed group. [ J Refract Surg. 2019;35(7):408–416.]

PurposeA single eye drop containing 0.01% atropine every evening has previously been found to inhibit myopia progression in young adults. We have tested the short-term effects of very low-dose atropine eye drops on pupil sizes and accommodation in young adult subjects.MethodsFourteen eyes of young adult subjects participated in the clinical observation. A single eye drop was applied with concentrations of either 0.01%, 0.005%, or 0.001% in the evening. Baseline parameters were measured before atropine application. Changes of pupil sizes, under photopic and mesopic conditions, as well as accommodation amplitudes were observed over the next day and analyzed by paired the Wilcoxon signed-rank test.ResultsThe pupil was significantly dilated 12 h after instillation of 0.01% atropine eye drops, both under photopic (3.3 ± 0.5 mm vs. 4.9 ± 0.9 mm) and mesopic (4.8 ± 0.7 mm vs. 6.1 ± 0.7 mm) conditions. Pupil sizes recovered over the day but were still significantly larger in the evening, compared to the baseline parameters measured on the day before (3.9 ± 0.5 mm vs. 5.3 ± 0.6 mm). The subjective near point of accommodation was reduced from 8.0 ± 2.4 to 6.6 ± 2.8 dpt in the morning and to 7.0 ± 2.9 dpt in the evening. At 0.005%, the pattern of results remained still similar, although the magnitude of the effects was generally smaller. At 0.001%, pupil sizes were still weakly significantly larger in the morning.ConclusionsAt a dose of 0.01%, clinically significant short-term effects were detected on pupil size and accommodation for at least 24 h. At the lowest dose of 0.001%, only tiny effects on pupil size were detectable.

Purpose: Intraocular pressure (IOP), medication outcomes at 24 months following trabeculotomy/viscodilation using the OMNI® surgical system as a standalone procedure in medically uncontrolled mild-moderate open-angle glaucoma (OAG). Setting: Surgical center (Duesseldorf, Germany). Design: Retrospective analysis. IOP and medication data were collected before surgery and through 24 months. Safety data included adverse events and the need for additional surgery. Methods: Pre-op medication washout. Goldmann tonometry. Number of medications and adverse events (AE) at each time point. Primary outcomes: changes in IOP and medications. Two-sided paired t-tests compare values at each follow-up with baseline, significance p = 0.05. Secondary outcomes: proportion of eyes with IOP reduction of ≥20%, on fewer medications, and medication-free at each time point. Results: This analysis included data from 38 eyes of 27 subjects. Mean (standard deviation) baseline IOP was 24.6 (3.0) mmHg and through 24 months ranged from 12.6 to 14.9 mmHg (p < 0.0001), representing reductions of 10.0-12.0 mmHg. Mean medications were 1.9 (baseline) and through 24 months ranged from 0.0 to 0.5 (70.6-100% reduction) (p < 0.0001). At Month 24, mean IOP was 14.9 mmHg (−10.0 mmHg), and 100% of eyes achieved IOP reduction >20% from baseline; mean medication use was 0.5 (−1.4 medications, p < 0.0001), 84.6% of eyes using >1 fewer medication, and 57.7% were medicationfree. The most common adverse event was intraoperative hyphema (44.7%); all resolved spontaneously. There were two secondary procedures for IOP control. Conclusion: The OMNI surgical system provides clinically relevant and statistically significant reductions in both IOP and medications with an excellent safety profile and should be considered in phakic or pseudophakic eyes with mild-moderate OAG requiring IOP or medication reduction, or both.

Purpose. To evaluate visual, refractive, and contrast sensitivity outcomes, as well as the incidence of pseudophakic photic phenomena and patient satisfaction after bilateral diffractive trifocal intraocular lens (IOL) implantation. Methods. This prospective nonrandomized study included consecutive patients undergoing cataract surgery with bilateral implantation of a diffractive trifocal IOL (AT LISA tri 839MP, Carl Zeiss Meditec). Distance, intermediate, and near visual outcomes were evaluated as well as the defocus curve and the refractive outcomes 3 months after surgery. Photopic and mesopic contrast sensitivity, patient satisfaction, and halo perception were also evaluated. Results. Seventy-six eyes of 38 patients were included; 90% of eyes showed a spherical equivalent within ±0.50 diopters 3 months after surgery. All patients had a binocular uncorrected distance visual acuity of 0.00 LogMAR or better and a binocular uncorrected intermediate visual acuity of 0.10 LogMAR or better, 3 months after surgery. Furthermore, 85% of patients achieved a binocular uncorrected near visual acuity of 0.10 LogMAR or better. Conclusions. Trifocal diffractive IOL implantation seems to provide an effective restoration of visual function for far, intermediate, and near distances, providing high levels of visual quality and patient satisfaction.