PurposeTo compare two different diffractive trifocal intraocular lens (IOL) designs, evaluating longer-term refractive outcomes, visual acuity (VA) at various distances, low contrast VA and quality of vision.Patients and methodsPatients with binocularly implanted trifocal IOLs of two different designs (FineVision [FV] and Panoptix [PX]) were evaluated 6 months to 2 years after surgery. Best distance-corrected and uncorrected VA were tested at distance (4 m), intermediate (80 and 60 cm) and near (40 cm). A binocular defocus curve was collected with the subject’s best distance correction in place. The preferred reading distance was determined along with the VA at that distance. Low contrast VA at distance was also measured. Quality of vision was measured with the National Eye Institute Visual Function Questionnaire near subset and the Quality of Vision questionnaire.ResultsThirty subjects in each group were successfully recruited. The binocular defocus curves differed only at vergences of −1.0 D (FV better, P=0.02), −1.5 and −2.00 D (PX better, P<0.01 for both). Best distance-corrected and uncorrected binocular vision were significantly better for the PX lens at 60 cm (P<0.01) with no significant differences at other distances. The preferred reading distance was between 42 and 43 cm for both lenses, with the VA at the preferred reading distance slightly better with the PX lens (P=0.04). There were no statistically significant differences by lens for low contrast VA (P=0.1) or for quality of vision measures (P>0.3).ConclusionBoth trifocal lenses provided excellent distance, intermediate and near vision, but several measures indicated that the PX lens provided better intermediate vision at 60 cm. This may be important to users of tablets and other handheld devices. Quality of vision appeared similar between the two lens designs.

PurposeThe aim of this study was to compare a new diffractive trifocal toric lens with an apodized diffractive bifocal toric lens in terms of refractive and visual acuity (VA) outcomes, including low-contrast VA (LCVA), as well as the patient’s visual function 3 months after implantation.Patients and methodsThis is a randomized prospective study involving bilateral implantation of a trifocal toric or a bifocal toric lens. At 3 months postoperatively, the subject’s vision was tested both uncorrected and with his/her best distance correction at: distance (4 m), intermediate (63 cm), and near (40 cm). Binocular defocus curves were measured with no correction and with the subject’s best distance correction in place. Quality of vision was measured using the National Eye Institute Visual Function Questionnaire.ResultsA total of 22 patients were enrolled (eleven in each group). There was no statistically significant difference in the absolute change in measured rotation between 1 month and 3 months postoperatively between the two intraocular lens (IOL) groups (P=0.98). At 3 months, the postoperative refraction and distance VA by eye were similar between groups. There was no statistically significant difference in the measured LCVA between groups (P=0.39). The defocus curve showed that at 67 cm, the trifocal toric lens had statistically significantly better VA when compared to the bifocal toric lens. There were no statistically significant differences by group for any of the National Eye Institute Visual Function Questionnaire scores (P>0.26 in all cases).ConclusionThe trifocal toric IOL improved the intermediate vision without negatively impacting visual function and distance, near, or low-contrast VA when compared to a bifocal toric IOL. The toric component of the trifocal lens effectively reduced astigmatism and provided good rotational stability.

PurposeTo compare the visual acuity (VA) and quality of vision between bilateral implantation of a trifocal intraocular lens (IOL) and blended bifocal IOLs with an intermediate add in the dominant eye and a near add in the nondominant eye.Patients and methodsPatients with either trifocal or blended bifocal IOLs implanted were recruited after surgery. Subjects returned for a single diagnostic visit between 3 and 24 months after surgery. VA was tested at various distances, including low-contrast acuity and acuity at their preferred reading distance. A binocular defocus curve was obtained, and subjective visual function and quality of vision were evaluated.ResultsTwenty-five trifocal subjects and 30 blended bifocal subjects were enrolled. There were no significant differences in low-contrast acuity, preferred reading distance, or acuity at that reading distance. Binocular vision at 4 m, 60 cm, and 40 cm was not statistically significantly different. The trifocal provided statistically significantly better visual acuity (P<0.05) at vergences from −0.5 to −1.5 D (from 2 m to 67 cm viewing distance, P<0.05). There was no statistically significant difference in the near vision subscale scores of the 39-question National Eye Institute Visual Function Questionnaire or the overall scores of the Quality of Vision questionnaire, though significantly more trifocal subjects reported that the observed visual disturbances were “bothersome” (P<0.05).ConclusionBoth lens modalities provided subjects with excellent binocular near and distance vision, with similar low rates of visual disturbances and good reported functional vision. The trifocal IOL provided significantly better intermediate VA in the viewing distance range of 2 m to 67 cm, corresponding to viewing things such as a car dashboard or grocery shelf. VA was similar between groups at viewing distances from 60 to 40 cm, corresponding to computer or reading distance.

PurposeThe purpose of this study was to provide clinical outcomes data related to secondary intraocular lens (IOL) implantation for the correction of residual refractive error after cataract surgery.Patients and methodsA chart review was conducted to identify all eyes implanted with the monofocal spherical or toric AddOn® secondary IOL. Data were collated from charts where uncomplicated initial cataract surgery was completed. Measures of interest included the original IOL implanted, the postoperative refractive error (before secondary IOL implantation) and the associated corrected and uncorrected visual acuities (VAs). Postoperative data of interest included the residual refractive error, the best-corrected visual acuity (BCVA) and uncorrected visual acuity (UCVA).ResultsRefractive and VA data from 1 week to 3 months post-surgery were available for 46 of 70 eyes implanted with a secondary IOL by one surgeon at one practice between 4/15 and 3/17. There was a statistically significant improvement in UCVA of about 2 lines after surgery (p<0.01), with no change in BCVA (p=0.94). No eyes lost a line of BCVA. There was a statistically significant reduction in the absolute magnitude of the residual spherical equivalent refractive error (p<0.01). In the 10 cases with a toric secondary IOL, there was a statistically significant reduction in refractive cylinder (p<0.01).ConclusionThe secondary IOL studied here appears to be a viable surgical option to correct residual refractive error after primary IOL implantation.

Purpose: To quantify the changes in the binocular defocus curve associated with the Vivity™ non-diffractive extended vision intraocular lens when the dominant eye was targeted for emmetropia and the non-dominant eye was artificially targeted for slight myopia using spectacles. Patients and Methods: This was a non-interventional research study of the corrected binocular defocus curve associated with binocular emmetropia (Setting A) and with emmetropia in the dominant eye and two different levels of myopia simulated in the non-dominant eye (−0.50 D, Setting B and −1.00 D, Setting C). Subjects were patients implanted with the AcrySof ® IQ Vivity ® intraocular lens in both eyes 3 to 12 months previously. Using the defocus data, the percentage of subjects with a continuous 2.5 D range of vision (distance to 40 cm) was calculated for various levels of minimum visual acuity (VA). Results: Forty subjects were enrolled. The mean spherical equivalent refraction was −0.06 D ± 0.36 D, with 0.37 D ± 0.29 D of refractive cylinder. There was no statistically significant difference in the mean VA at −0.25 D or at −0.50 D vergences between the test Settings, but there was a statistically significant difference at all other vergences. Differences were particularly noticeable at −2.00 D, −2.50 D and −3.00 D, where higher myopia in the nondominant eye yielded better binocular VA. A 2.5 D range of functional vision (20/25) was achieved by 38% of subjects at Setting A, 68% of subjects at Setting B and 85% of subjects at Setting C. At setting C, all but one subject (39/40, 97.5%) had a 2.5 D range of vision with a VA of 20/32 or better. Conclusion: Significant gains in binocular near vision, with only a nominal effect on distance vision, can be achieved with the Vivity IOL by leaving the non-dominant eye of patients with 0.50 D or 1.00 D of myopia.

Purpose: To evaluate the rotational stability, visual acuity and refractive error after sulcus implantation of a secondary toric IOL. Setting: One clinical practice in Haugesund, Norway. Design: Non-interventional single-arm diagnostic study. Methods: Eligible subjects who had previous successful primary cataract or refractive lens exchange surgery in one or both eyes and the AddOn ® secondary toric IOL implanted in the sulcus were evaluated at a single postoperative diagnostic visit to measure visual outcomes. Subjects with surgical complications (either primary or secondary) or pathology that would affect best-corrected visual acuity (eg, amblyopia) were excluded. Clinical evaluations at the diagnostic visit included measurement of visual acuity, manifest refraction and IOL orientation. Results: Eighteen eyes were evaluated. After secondary IOL implantation, mean residual refractive astigmatism was significantly reduced (1.66 ± 0.92 to 0.32 ± 0.25 D). There was no appreciable change in the spherical equivalent refraction. Sixteen of 18 eyes (89%) had residual refractive astigmatism ≤0.50D, and no eye had more than 0.75D after secondary IOL implantation. Mean UCVA was 0.00 ± 0.03 logMAR, with no eyes worse than 0.10. Mean BCVA was −0.05 ± 0.03 logMAR (20/20+2), with all eyes having BCVA of 0.00 logMAR. The mean change in orientation was near zero, with a mean absolute change of 4.9 ± 3.7 degrees. Sixteen of 18 eyes (89%) had a lens orientation ≤10 degrees from intended, with no eye oriented more than 13 degrees from intended. Conclusion: The AddOn ® toric sulcus IOL significantly reduced postoperative refractive astigmatism in patients with high astigmatism after their primary cataract or RLE surgery, providing very good uncorrected distance vision.

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ABSTRACT.Purpose: To study the influence of age, gender, intraocular pressure and refraction on optic disc topography in normal subjects. Methods: We studied both eyes of 225 healthy subjects between 20 and 80 years of age using raster tomography (Glaucoma-Scope TM , Ophthalmic Imaging Systems, Sacramento CA, USA) and scanning laser tomography (Heidelberg Engineering, Heidelberg, Germany). We chose to study cup area and maximum cup depth, two variables that are minimally influenced by the operator. Results: Raster and scanning laser tomography results were strongly correlated. Cup area was independent of age, gender and refraction. It was weakly associated with IOP, but this association was significant only when the cup area was measured with scanning laser tomography. Maximum cup depth was independent of age, gender and IOP. It was larger in hypermetropic eyes, although this trend was significant only when maximum cup depth was measured with raster tomography. Conclusion: Our results indicate that optic nerve head topography does not change significantly with age in normal subjects. This information has important implications for follow-up of pathological changes in optic nerve head topography.Key words: normal eyes -age -optic nerve head topography -raster tomography -scanning laser tomography.Acta Ophthalmol. Scand. 1998: 76: 170-175 Copyright c Acta Ophthalmol Scand 1998. ISSN 1395-3907 D etection of progressive changes in optic nerve head topography is important for glaucoma follow-up and management. Modern methods for threedimensional imaging of the optic nerve head have the potential to detect progressive changes, whether they are caused by glaucoma or not.Over the past decades several clinical and histopathological studies have reported progressive changes in optic nerve head topography with age and IOP in normal subjects (Pickard 1948;Bengtsson 1976Bengtsson , 1980Balazsi et al. 1984;Repka et al. 1989;Jonas et al. 1992). The results of more recent studies have been less consistent (Britton et al. 1987;Jonas et al. 1988;Funk et al. 1989;Tsai et al. 1992;. Further studies employing modern methods are therefore needed to establish or rule out disturbing effects of normal aging.Although progressive changes are best studied longitudinally, valuable information may be obtained in cross-sectional studies. We used both raster tomography (GS) (Glaucoma-Scope TM , Ophthalmic Imaging Systems, Sacramento CA, USA) (Hoskins et al. 1993) and confocal scanning laser tomography (HRT) (Heidelberg Retinal Tomograph, Heidelberg Engineering, Heidelberg, Germany) (Burk et al. 1990(Burk et al. , 1993 for objective three-dimensional analysis of optic nerve head topography in a large, representative group of normal subjects covering a wide range of ages. We chose to study cup area and maximum cup depth, two variables that are minimally influenced by the operator and well suited to answer the fundamental questions about age-related changes in optic nerve head topography. Material and Methods Selection of Subjects:We planned t...