Residual Astigmatism Threshold and Patient Satisfaction with Bifocal, Trifocal and Extended Range of Vision Intraocular Lenses (IOLs)

Abstract

Purpose: To compare the impact of induced astigmatism with four different types of multifocal intraocular lenses (MIOLs). Method: Prospective, comparative, interventional, mono-centered study, including 80 eyes of patients with implantation of four different MIOLs: AcrySof ReSTOR +2.5 D (20 eyes), AcrySof ReSTOR +3.0 D (20 eyes), AcrySof Panoptix (20 eyes) (Alcon Laboratories, Inc., Fort Worth, TX, USA), and Tecnis Symfony ZRX00 (Abbott Medical Optics, Santa Ana, USA) (20 eyes). Patients were followed up for 3 months after surgery. Major parameters were uncorrected (UDVA) and corrected (CDVA) distance visual acuity, subjective refraction and patient satisfaction. Results: Differences between IOLs with regard to the impact of the cylinder sign and axis on visual acuity and patient satisfaction were not significant. With mild added negative cylinder, AcrySof ReSTOR +2.5 D and Tecnis Symfony IOLs maintained the baseline visual acuity, while it was mildly reduced with AcrySof ReSTOR +3.0 D and Panoptix IOLs. With moderate induced cylinder, the Tecnis Symfony IOL maintained good visual acuity and patient associated satisfaction. Panoptix IOL was the IOL most affected by the induced astigmatism with regard to dissatisfaction and visual acuity. The highest tolerance to the astigmatic distortion and blurriness induced with a −1.50 D cylinder was obtained with the Tecnis Symfony IOL. Tecnis Symfony IOL showed less dissatisfaction and less reduction of visual acuity than the other MIOLs. Conclusion: Simulated residual cylinders after the implantation of the Tecnis Symfony IOL up to 1.0 D have a very mild and not clinically relevant impact on visual acuity or patient satisfaction. The ERV IOL showed a better tolerance to unexpected postoperative residual errors than diffractive bifocal and trifocal IOLs.

Small-aperture intraocular lens tolerance to induced astigmatism

“…The impact on acuity for the same diopter of induced astigmatism in multifocal IOLs ranges from 20/29 to 20/40. 8 For astigmatic defocus >1.00 D, acuity results, at least in this series and as reported by Dick et al, 6 appear to be better with the IC-8 IOL compared to the Symfony IOL or multifocal IOLs. Acuity with 1.50 D cylinder was 20/24 with the IC-8 IOL, 20/29 with the Symfony IOL, and worse than 20/30 with multifocals IOLs.…”

“…When comparing induced astigmatism up to 1.00 D with minus cylinder, the effect of astigmatic defocus on acuity with the IC-8 IOL agrees well with the Symfony IOL. 8 BCDVA was 20/24 with the IC-8 IOL and 20/25 with the Symfony IOL for 1.00 D induced cylinder. The impact on acuity for the same diopter of induced astigmatism in multifocal IOLs ranges from 20/29 to 20/40.…”

“…Acuity with 1.50 D cylinder was 20/24 with the IC-8 IOL, 20/29 with the Symfony IOL, and worse than 20/30 with multifocals IOLs. 8 …”

“…Carones et al 8 compared the impact of induced astigmatism with 2 multifocals (AcrySof ReSTOR +2.50 D and AcrySof ReSTOR +3.00 D; Alcon, Fort Worth, TX, USA), a trifocal (AcrySof PanOptix, Alcon), and the extended range of vision (Tecnis Symfony ZRX00, J&J Vision, Santa Ana, CA, USA) IOLs. The results of the study showed the Symfony IOL to be tolerant to up to 1.00 D of astigmatism and be the least sensitive to induced blurriness and change in satisfaction scores, when compared to the multifocals and the trifocal IOLs.…”

“… 7 Similarly, the Symfony IOL (J&J Vision, Costa Mesa, CA, USA) has been shown to tolerate up to 1.00 D of astigmatism. 8 Laser in situ keratomileusis, photo-refractive keratectomy arcuate corneal incisions, piggy-back IOLs, and IOL exchange are some of the techniques used to correct residual refractive error when spectacle independence is desired after cataract surgery. 9 – 11 …”