Perception of Trifocal IOL Performance in Young Adults with High Astigmatism and Hyperopia and its Improvement Using Small Incision Lenticule Extraction

Abstract

Background: Hyperopia is a kind of refractive error in which incoming light is focused behind, instead of on, the retina wall due to insufficient accommodation by the lens. It is likely affected by ethnicity, geography, and a family history of hyperopia or accommodative esotropia and is categorized as low (≤ 2.00D), moderate (2.00–4.00 D), and high (> 4.00D). Beyond hyperopia refractive error, patients may have poor accommodative function or visual perceptual skills. Objective: This study aimed to present the latest approaches to planning trifocal intraocular lens (IOL) and toric trifocal IOL implantation for residual refractive errors in young adults with high astigmatism and hyperopia and increase the patients’ best visual outcome and satisfaction using Small Incision Lenticule Extraction (SMILE) after implantation. Methods: Eighty eyes of 40 consecutive patients who underwent refractive lensectomy were included in this retrospective study. It included patients aged 20–45 years seeking spectacle independence with pre-operative high spherical hypermetropia of 4D or higher and astigmatism of 3D or higher. Patients’ treatment status was categorized as trifocal IOL (n=40) and toric trifocal IOL (n=40).The mean patient follow-up time was six months after IOL implantation. First, we assessed visual acuity and satisfaction for both groups and then examined laser vision correction results of patients who were dissatisfied after IOL implantation (trifocal IOL group) and underwent SMILE surgery to increase satisfaction level. Results: There were no statistically significant differences between trifocal IOL and toric trifocal IOL for near (UNVA), intermediate (UIVA), and distance (UDVA) uncorrected visual acuity. Comparisons related to patient satisfaction six months after IOL implantation were statistically significant for using a computer and night driving. In the trifocal IOL group, compared to pre-operative values, sphere and cylinder at six months were significantly improved. Conclusion: In young adults, toric trifocal and trifocal IOL provided sufficient results in visual acuity; however, patients were dissatisfied after implantation. This study reported patient satisfaction levels, including quality of life and life without glasses by using Small Incision Lenticule Extraction (SMILE) surgery.

Encouraging Visual Outcome of a New Accommodative Intraocular Lens: A Retrospective Long-Term Study with a Mean Follow-Up of 5.3 Years

“…Therefore, we assume that patient satisfaction should be better compared to trifocal lenses. In addition, dependence on spectacles may also reduce patient satisfaction [29]. Regardless of reports in the literature about insufficient spectacle independence of AIOLs, almost 70% of patients in our cohort were completely independent of spectacles at the time of postOP 2 follow-up.…”

“…The literature also reports a particularly good distance visual acuity of the trifocal lenses, whereas the near visual acuity usually shows the worst results within the three optic planes. Thus, near visual acuity of greater than 0.1 logMAR [24] [25] [26] [27] is frequently reported, in some cases even greater than 0.2 logMAR [28] [29]. Hence, trifocal lenses only partially fulfill their actual purpose (i.e.…”

“…The aim of cataract surgery is to restore emmetropia, but after lens implantation refractive errors may still be present and influence the visual outcome [29].…”

SMILE for the Treatment of Residual Refractive Error After Cataract Surgery

“…Additionally, corneal refractive surgeries are performed. Methods such as small-incision lenticule extraction (SMILE) and femtosecond LASIK (FS-LASIK) are practical and comfortable options for patients who are not satisfied with their visual acuity after cataract surgery [ 3 , 4 ]. This study aimed to provide evidence to support SMILE as an alternative and comfortable option for both patients and surgeons for improving both the visual outcome and patient satisfaction after trifocal IOL implantation.…”