Both refractive rotationally asymmetric multifocal IOLs provided an excellent level of quality of vision 12 months postoperatively. Both IOL models restored distance, intermediate, and near visual function; however the IOLs in Group B provided better near visual performance.

This asymmetric multifocal IOL provided excellent unaided vision with no significant difference in near, intermediate, and distance vision 3 months and 12 months postoperatively. However, there was a significant improvement in subjective outcomes at the second postoperative assessment, during which patients reported a significantly better QoV score and less blurred vision.

None of the authors has a financial or proprietary interest in any material or method mentioned.

PURPOSE: To evaluate postoperative visual performance and patient-reported outcomes following combined implantation of an extended depth of focus (EDOF) intraocular lens (IOL) and a trifocal IOL. METHODS: The study enrolled consecutive patients undergoing refractive lens extraction or cataract surgery with combined implantation of an EDOF IOL (dominant eye) and a trifocal IOL in the nondominant eye. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, uncorrected intermediate (UIVA) and near (UNVA) visual acuities, defocus curves, and subjective questionnaires were evaluated 1 month postoperatively. RESULTS: The study enrolled 100 consecutive patients (200 eyes). The postoperative mean binocular UDVA, UIVA, and UNVA were −0.08 ± 0.07, 0.13 ± 0.12, and 0.17 ± 0.11 logMAR, respectively. The percentage of eyes within ±0.50 and ±1.00 diopters of the refractive target was 65% and 96% with EDOF IOLs, and 76% and 99% with trifocal IOLs, respectively. Of all patients, 91% were satisfied or more than satisfied with the procedure, and 87% of patients were spectacle free for near vision. On a scale from 0 (not at all) to 3 (very), mean scores of 0.52 ± 0.83, 0.71 ± 0.83, and 0.34 ± 0.73 were reported for glare, halos, and starbursts. The mean daytime and nighttime Quality of Vision scores were 9.13 ± 0.91 and 7.96 ± 1.57, respectively. CONCLUSIONS: The combination of an EDOF IOL and a trifocal IOL provides good unaided visual acuity for distance and near. This IOL combination provides high postoperative satisfaction and functional vision, but some early visual side effects were reported. [ J Refract Surg . 2020;36(5):326–333.]

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The rotationally asymmetric multifocal IOL provided excellent optical performance during 18-months follow-up. The preoperative photopic pupil is an important parameter for consideration of this type of IOL because smaller pupils have a significant negative subjective impact on QoV.

None of the authors has a financial or proprietary interest in any material or method mentioned.

PurposeTo highlight the potential shortcomings associated with the current use Rasch analysis for validation of ophthalmic questionnaires, and to present an alternative application of Rasch analysis to derive insights specific to the cohort of patients under investigation.MethodsAn alternative application of Rasch analysis was used to investigate the quality of vision (QoV) for a cohort of 481 patients. Patients received multifocal intraocular lenses and completed a QoV questionnaire one and twelve months post-operatively. The rating scale variant of the polytomous Rasch model was utilized. The parameters of the model were estimated using the joint maximum likelihood estimation. Analysis was performed on data at both post-operative assessments, and the outcomes were compared.ResultsThe distribution of the location of symptoms altered between assessments with the most annoyed patients completely differing. One month post-operatively, the most prevalent symptom was starbursts compared to glare at twelve months. The visual discomfort from the most annoyed patients is substantially higher at twelve months. The current most advocated approach for validating questionnaires using Rasch analysis found that the questionnaire was “Rasch-valid” one month post-operatively and “Rasch-invalid” twelve months post-operatively.ConclusionThe proposed alternative application of Rasch analysis to questionnaires can be used as an effective decision support tool at population and individual level. At population level, this new approach enables one to investigate the prevalence of symptoms across different cohorts of patients. At individual level, the new approach enables one to identify patients with poor QoV over time. This study highlights some of the potential shortcomings associated with the current use of Rasch analysis to validate questionnaires.