Clinical outcomes of bilateral implantation of new generation monofocal IOL enhanced for intermediate distance and conventional monofocal IOL in a Korean population

Abstract

Background To compare the clinical outcomes of bilateral implantation of enhanced intermediate function intraocular lenses (IOLs) and standard monofocal IOLs. Methods In this prospective, randomized, comparative controlled study, we compared the visual outcomes of patients who underwent bilateral cataract surgery at the Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, with either enhanced monofocal IOLs (Tecnis Eyhance, ICB00, Johnson and Johnson Vision Care, Inc) (Group 1) or standard monofocal IOLs (Tecnis, ZCB00, Johnson and Johnson Vision Care, Inc) (Group 2). The assessment included monocular and binocular uncorrected distance visual acuity (UDVA), uncorrected intermediate (UIVA at 60 cm) and near (UNVA at 40 cm) visual acuity, uncorrected defocus curves, contrast sensitivity testing (CST), and reading speed test using Quality of vision was evaluated using the Visual Function Questionnaire (VFQ-25). Results At 3-months postoperatively, monocular and binocular outcomes of UIVA and UNVA were statistically significantly better in Group 1 (P < 0.05). The binocular uncorrected defocus curve of Group 1 showed statistically significantly better outcomes at vergence ranges of -1.5 to -4.0 D (P < 0.05). Significantly higher reading speed test was also observed in Group 1 in all ranges tested (1.0 to 0.1 LogMAR) (P < 0.05). There were no statistically significant differences in CST between groups. Conclusions Bilateral implantation of enhanced monofocal IOLs provided better vision at intermediate and near distances compared to standard monofocal IOLs, while maintaining good distance vision and contrast sensitivity.

Comparative Analysis of Clinical and Patient-Reported Outcomes of a New Enhanced Monofocal IOL and a Conventional Monofocal IOL

“…one Snellen line) and a mean difference in binocular UIVA of −0.17 logMAR (almost two Snellen lines). The larger difference in binocular UIVA could be attributed to a more myopic residual manifest spherical equivalent reported in most of the available comparative studies, 7 , 9 , 10 , 14 , 18 , 21 which was, on average, higher than the residual myopia in the non-dominant eye in the current study. On the other hand, a meta-analysis of Redruello-Guerrero et al 37 focused on distance-corrected intermediate vision (DCIVA) comparison and found −0.21 logMAR difference between ZCB00 and ICB00 models in binocular DCIVA 2 weeks to 1 month postoperatively, and −0.11 logMAR difference six months postoperatively.…”

“…Although there might be some variation in the level of improved intermediate or near vision comparing Tecnis ICB00 and ZCB00 model between available studies, whenever intermediate vision was evaluated with patient-reported outcomes (satisfaction or spectacle independence), Tecnis Eyhance was always superior. 7 , 8 , 10–12 , 14 , 18 , 20 , 28 Most importantly, the published studies strongly agree that there is no difference between the two lenses in the perception of visual phenomena or satisfaction with distance vision. 7–12 , 17 , 20 , 21 Our study corroborated these findings in a larger population patients, finding no difference in overall satisfaction with vision or difficulties with optical side effects.…”

“…The currently available meta-analyses do not report on Eyhance near vision outcomes due to the lack of UNVA data in the studies. However, in the few available studies with near vision outcomes, 10 , 11 , 13 , 17 , 20 , 21 monocular UNVA for Eyhance IOL ranged from 0.20 ± 0.14 logMAR for a study with slightly myopic residual MSE (−0.47 ± 0.29 D) 10 to 0.62 ± 0.15 logMAR for a study with the mean MSE close to emmetropia (−0.02 ± 0.84 D). 17 Nevertheless, as anticipated for a monofocal IOL, the UNVA outcomes of Eyhance were always worse in direct comparison to lenses with a true multifocal design.…”

“…Nonetheless, this topic has already been addressed in several smaller comparative studies. 7 , 8 , 10–14 , 16 , 17 , 20 , 21 Other objective variables evaluating the quality of vision (such as contrast sensitivity or higher-order aberrations) would be valuable, but unfortunately, we were not able to obtain them as the study was retrospective, and these variables were not routinely recorded on our electronic medical record. Even though the equipment, postoperative regimens, and biometry settings are standardized across our clinics, the multi-center and multi-surgeon approach could be perceived as a limitation of the study, as there could be slight variations in the surgical technique among surgeons.…”

Ocular parameters associated with visual performance of enhanced monofocal intraocular lens

“…Many studies have found that intermediate visual acuity is enhanced when ICB00 is inserted compared to a general monofocal IOL [ 6 – 9 ]. Meanwhile, photic phenomena such as glare or halo and contrast sensitivity were found to be comparable to monofocal and more improved than the extended depth of focus (EDOF) [ 10 – 12 ]. However, to our knowledge, no studies exist on the preoperative ocular parameters that affect the quality of near, intermediate, and distance visual acuities of the ICB00 or DIU.…”