The Effect of Age, Postoperative Refraction, and Pre- and Postoperative Pupil Size on Halo Size and Intensity in Eyes Implanted with a Trifocal or Extended Depth-of-Focus Lens

Abstract

Halos are a chief source of patient dissatisfaction after multifocal intraocular lens (IOL) implantation. The primary purpose of this study was to investigate the influence of age, postoperative refraction, and pre-and postoperative pupil size on postoperative halo size with a trifocal diffractive IOL (AcrySof IQ PanOptix) and extended depth-of-focus (EDOF) IOL (TECNIS Symfony) to determine whether these factors could predict postoperative halo size. Patients and Methods: This single-center, open-label study conducted between October 2018 and April 2020 in Yokosuka, Japan included 160 patients: 80 with PanOptix and 80 with Symfony IOLs. Size and intensity of the halos were examined binocularly using a computer-based simulator (Eyeland Design Network GmbH) and scored from 0 (minimum) to 10 (maximum) at 1, 3, and 6 months postoperatively, along with the change in each variable for both IOLs. The respective correlations of halo size with age, postoperative refraction, pre-and postoperative pupil size, and discomfort level due to the halo were also investigated 6 months postoperatively. Results: Halo size and intensity were significantly mitigated between 1, 3, and 6 months postoperatively. Throughout the observation period, halo size was significantly larger with PanOptix than with Symphony (P < 0.05), and halo intensity was significantly higher with Symphony than with PanOptix (P < 0.05). The pre-and postoperative pupil size correlated positively with halo size, while age and postoperative refraction were negatively correlated, for both IOLs. Conclusion: Understanding the features and predictive preoperative factors of halos in different types of multifocal IOLs may be useful in improving patient satisfaction.

Visual Performance, Satisfaction, and Spectacle Independence after Implantation of a New Hydrophobic Trifocal Intraocular Lens

“…Halo formation results from the superimposition of these out-of-focus images on the focused image projected on the retina [ 25 ]. Teshigwara et al [ 26 ] showed that the change in halo size and intensity of a diffractive trifocal and a hybrid multifocal-EDOF IOLs over time should be considered during treatment planning, and they suggest that age, target refraction, and pre-operative pupil size might be predictive factors for halo size. Rementería-Capelo et al [ 27 ] reported that the mean halo effect after diffractive trifocal implantation was lower when no residual refractive error is induced, with a higher halo perception with defocus, being similar both for negative and positive defocus.…”

Visual results and subjective satisfaction after implantation of two different trifocal diffractive intraocular lenses models (AcrySof IQ PanOptix and AT LISA tri 839 MP)

“…Halo intensity was significantly higher with Symphony than with PanOptix. 11 In addition, Böhm et al didn't show a significant difference in the percentage of patients perceiving halos compared to PanOptic, AT LISA tri, and Symphony. Still, the intensity of haloes was significantly higher in the PanOptic and AT LISA groups without significant differences.…”

“…7 However, only a few comparative studies of this model versus other equivalents are available in the literature. [8][9][10][11][12] With conflicting results, six head-to-head studies evaluated the AcrySof IQ PanOptix and the AT LISA tri 839 MP IOL (Supplemental Table 1). [12][13][14][15][16][17][18] The reduced accuracy of near, distant, and intermediate VA assessment using optotypes is widely established.…”

“…7 However, only a few comparative studies of this model versus other equivalents are available in the literature. 8–12 With conflicting results, six head-to-head studies evaluated the AcrySof IQ PanOptix and the AT LISA tri 839 MP IOL (Supplemental Table 1). 12–18…”

Pupil size measurements with a multifunctional aberrometer/coherence interferometer/tomographer and two infrared-based pupillometers

“…32 In multifocal and extended depth-of-focus IOLs, pupil size (OCT) positively correlated with halo size and patients with small pupils (autorefractor with integrated grid scale) presented with less photic phenomena and higher visual satisfaction after surgery with a further multifocal IOL. 33,34 Therefore, pupil size still remains a controversial, but important topic to refractive procedures. A fitting eye mask, binocular pupil size measurements with relaxed accommodation would be a further approach to ensure precise measurements especially under scotopic and low mesopic conditions.…”