SPS-108 Trifocal IOLs | ASCRS
2020 ASCRS Virtual Annual Meeting

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Papers in this Session
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The Panoptix Trifocal IOL: A Study of Patient Satisfaction, Visual Disturbances, and Uncorrected Visual Performance
Authors
John A. Hovanesian, MD
Quentin B. Allen, MD
Michael Jones, MD

Purpose
To determine how patient satisfaction, visual disturbances, and spectacle independence compare between an FDA approved trifocal lens and other multifocal lenses using a validated patient-reported outcome instrument.

Methods
We administered a questionnaire instrument in 60 patients who underwent bilateral cataract surgery with the Panoptix trifocal implant at least 2 months previously. Patients with significant ocular pathology, PCO, or with residual refractive error of ≥ 0.5 D of sphere or 0.75 D of cylinder were excluded. Questions explored satisfaction, need for glasses for any activity, and incidence and severity of glare and haloes in Panoptix patients. These responses were compared to responses to the same questionnaire among patients who had mini-monovision with 2.5-add multifocal, mixed 2.5- and 3.0-add multifocals, and patients with bilateral 3.0-add multifocal lenses.

Results
Thirty-six patients had Panoptix, 102 had ActiveFocus 2.5 mini-monovision, & 89 had paired ReSTOR 2.5 and 3.0 IOLs. Full spectacle independence was seen in 83%, 27%, and 31%, respectively (P<0.0001). Top box satisfaction was in 83%, 75%, and 74% (P<0.32, NS). “Very satisfied” or “satisfied” was reported in 97%, 93%, and 92% (P<0.38, NS). Glare and haloes were reported “not at all” or “just a little” by 72%, 74%, and 71%, respectively (P<0.82, NS). Among patients requiring glasses for any activity, Panoptix patients required them only for reading, while patients with the other lenses required them for reading, driving, TV, and sports/hobbies (P<0.05).

Conclusion
Panopitix gives a highly significant improvement in spectacle independence relative to earlier multifocals. Only reading required spectacles among Panoptix patients, whereas other IOLs required spectacles for more activities. Satisfaction is higher with Panoptix but not significantly. Glare and haloes are comparable to previous generation lenses.
Enhancing Near and Intermediate Vision with with a New Paired Trifocal Lens Implant.
Authors
Sheraz M. Daya, MD, FRCSEd, FRCOphth, FACS
Marcela Espinosa, MD
Saj Khan, FRCSEd

Purpose
Report the visual and refractive outcomes of a paired trifocal lens implant (Artis Symbiose) with one more dominant intermediate vision (Artis Mid) and the other for dominant for near vision (Artis Plus).

Methods
Review of Fifty patients (100 eyes)undergoing bilateral cataract or refractive lens exchange surgery with implantation of the Artis Plus in the non-dominant eye and Artis Mid in the dominant eye. Measures include monocular and binocular defocus curves, refractive outcomes, UDA, BSCVA, uncorrected vision at 40, 60 and 80cm as well as patient satisfaction

Results
103 eyes of 54 patients mean of 63 years (47 to 79) were implanted. 49 patients (98 eyes) bilaterally and 5 eyes unilaterally. At 1M (n=59) SE was 0.11D (SD 0.54) cyl -0.27 (SD 0.33). 83% were ±0.50D and 100% ±1.00D. 81% had Binocular UDVA ≥20/20 100% ≥20/25 UNVA was 20/20 or better in 62%, and ≥20/25 in 86% UIVA at 60cm was ≥20/20 in 67% and 20/25 in 97% and at 80cm 97% were ≥20/20 and 50% ≥20/15. Defocus curves of each type of lens was consistent with cumulative flattening when checked binocularly. Data at 3M showed further improvement in unaided acuity at all distances demonstrating the benefit of neuro-adaptation. All patients were able to drive within days of surgery

Conclusion
Recipients of the Artis Symbiose lens system reliably benefited early with good binocular distance, intermediate and near vision and further improvement with time.
One Year Follow up with the Enhanced LIGHT Energy Trifocal IOL
Authors
Gabriel Quesada, MD
Rodrigo A. Quesada, MD
Kevin L. Waltz, MD, OD
John A. Vukich, MD

Purpose
To report an overview of the optical characteristics and clinical performance of a new trifocal Enlighten IOL over a one year period, treating presbyopia concurrent with cataract surgery.

Methods
Prospective, consecutive adult patients undergoing bilateral cataract surgery with bilateral implantation of the study IOL, in a private practice in El Salvador. A total of 20 eyes in 10 patients underwent: monocular defocus curve; monocular and binocular uncorrected visual acuity in photopic and mesonic conditions, for far (4m), intermediate (60 cm) and near (33 cm) distances and binocular contrast sensitivity. Patients completes a one month, 3 months, 6 months and 12 months follow up after surgery.

Results
20 eyes of 10 patients were analyzed. Mean binocular uncorrected visual acuity in photopic conditions was 0.03 LogMAR for far, 0.12 for intermediate and 0.02 for near distances. All patients achieved a binocular uncorrected visual acuity better than 0.3 LogMAR (20/30 Snellen) for distance and near vision and 94.8% of patients for intermediate vision. Mesopic bioncular visual acuity values were similar. Monocular defocus curves showed best visual acuity at a vergence of 0.00D. 94.8% of the patients reportes never using spectacle correction.

Conclusion
This new trifocal Enlighten IOL achieved excellent uncorrected distance, intermediate and near vision without compromising the quality of vision. The similar values achieved in mesonic and photopic conditions of binocular uncorrected visual acuity and contrast sensitivity suggest low pupillary dependence for light distribution.
Early Real World Outcomes of the First U.S. Approved Trifocal IOL
Authors
Sheri L. Rowen, MD, ABO
Duna Raoof, MD

Purpose
To Learn about the outcomes of the first Trifocal lOL by a statistical anaysis of visual outcomes and patient satisfaction. There will be at least 100 patients to include Distance, Intermediate and Near Vision measurements. These patients comprise all appropriate candidates including virgin corneas, post refractive, and mixed & matched IOL's

Methods
This is a prospective study to include data from 2 surgeons from a single center for a good sample size. All 1 month and 3 month data will be reported when possible. Techniques will include Manual and Femto assisted cataract surgery, with and without ORA. The visual outcome measurements will include Distance, Intermediate and Near. These will include both monocular and binocular uncorrected and distance corrected vision. A Patient satisfaction survery will be reported as well. Subsets will be broken down to include post refractive surgery, pre treatment for dry eye, and mixed and matched IOL's.

Results
At 1-3 months, 85% of patients had DCVA > or = to 20/25. 72% had 20/20 or better UCIVA. 100% of patients could see J2 with DCNVA. Patient survey revealed 95% had none to mild Glare, with 5% having Moderate glare. 68% reported None to mild halos with 31% moderate. No reports of disabling halos or positive Dysphotopsias were found.79% never use glasses, and 21% use them rarely for fine near tasks. 86% reported an 8-10 level of happiness on a 1-10 scale, and 92% had an 8-10 quality of vision on a 1-10 scale with 10 being the best. 95% would have the same lens again.

Conclusion
In conclusion, the patients who present to any practice whether post lasik or virgin eyes, will have similar results to the FDA study. They have extremely high patient satisfaction and excellent vision. Even with mild to moderate halos, these patients would still have the same lens again and are very happy with their results.
Trifocal IOLs to Correct Refractive Defects and Presbyopia after Cataract Surgery : New Guidelines for Use in the Majority of Patients
Authors
Matteo Piovella, MD
Barbara Kusa, MD

Purpose
To evaluate results in cataract eyes after phaco and trifocal/trifocal toric IOLs implantation to provide intermediate distance. Postop refractive plano results provide high quality of vision and patients satisfaction. New center organization and eyes evaluation are key points to spread the use of trifocal lenses to the majority of patients

Methods
378 Eyes with cataract were implanted with trifocal presbyopic IOLs (Carl Zeiss Meditec) 184 eyes implanted with TRIFOCAL IOL (48.7%) 194 eyes implanted with TORIC TRIFOCAL IOL (51.3%) Bilateral implant 178 patient 74 Patients implanted with both TRIFOCAL IOLs(41.5%) 78 Patients impklanted with both TORIC TRIFOCAL IOLs (43.8%) 26 Patients implanted with TRIFOCAL IOL in one eye and TORIC TRIFOCAL IOL in the other eye (14.7%) Mean Age 67.29 ± 11.66 IOL calculations were performed adopting most advanced biometry instruments and total astigmatism axis alignment performed with digital system. Tears film quality and MGD was always detected Lipiflow and Blephex were applied on large scale

Results
At 5 years monocular Trifocal IOLs results are UCDVA 20/22 ± 2.40 UCIVA 20/24 ± 3.13 UCNVA 20/27 ± 5.37 , monocular Toric Trifocal IOLs are UCDVA 20/20 ± 3.25 UCIVA 20/35 ± 4.75 UCNVA 20/29 ± 2.56 Binocular results (178 patients) are UCDVA was 20/20, intermediate 20/20 and near vision 20/24 96 % OF PATIENTS IN THE RIGHT RANGE (Almost One Eye in the Right Range Sphere Equivalent Within - ±0.50 Sph) Toric IOLs correction is mandatory when 0.75 D of corneal astigmatism is detected. It is necessary to determinate total corneal astigmatism to provide best refractive postoperative outcomes. We have adopted IOL Master 700 TK for the purpose to measure anterior and posterior corneal curvature

Conclusion
AT LISA tri toric 939MP and AT LISA tri 839 MP trifocal IOLs are the most efficient today development of multifocal IOLs family. Clinical outcomes indicate that this is an effective multifocal design to correct refractive defects and to defeat presbyopia after cataract surgery. Data show that it is possible to adopt them in the majority of patients
Outcomes of Unilateral Refractive Lens Exchange with a Trifocal Intraocular Lens in Hyperopic Presbyopic Patients
Authors
Dagny Zhu, MD, ABO
Jeffrey C Chan

Purpose
Outcomes of unilateral refractive lens exchange (RLE) with implantation of a trifocal intraocular lens (IOL) are limited. The purpose of this study was to evaluate the visual outcomes and patient satisfaction following unilateral implantation of a diffractive trifocal IOL in the non-dominant eye of hyperopic patients with presbyopia.

Methods
This is a single-center, retrospective case series. Hyperopic presbyopic patients who underwent unilateral femtosecond-laser assisted RLE with implantation of a diffractive trifocal IOL (Alcon Panoptix) in the non-dominant eye were evaluated. The contralateral eye was corrected with keratorefractive surgery if needed. Inclusion criteria were hyperopia over +1.00 D and presbyopia (J3 or worse). Primary outcome measures were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA). Secondary outcomes were spherical equivalent (SE) and patient questionnaire. Three and six months data will be evaluated.

Results
At 1 month, preliminary results from 15 eyes of 15 patients (average age 53.2 ± 4.1 years) showed a change in monocular UDVA from 0.50 ± 0.25 logMAR preoperatively to 0.11 ± 0.21 logMAR postoperatively (p <0.01). UIVA and UNVA improved postoperatively to 0.05 ± 0.12 logMAR and 0.08 ± 0.10 logMAR, respectively (p < 0.005). 100% (15/15) of eyes were within ±1.00 D of emmetropia and 87% (13/15) of eyes achieved an UNVA of J2 (snellen 20/30) or better. There were no intraoperative complications and no IOL exchange was required. More cases will be reviewed and final outcomes including spectacle independence, visual disturbances, and patient satisfaction will be assessed after 3 and 6 months.

Conclusion
Unilateral RLE with a diffractive trifocal IOL (Alcon Panoptix) in hyperopic presbyopic patients is safe and effective. Final conclusions will be made after 3 and 6 months.
Clinical Outcomes of Bilateral Trifocal IOL Implantation Using a Cataract Refractive Surgical Suite
Authors
John F. Blaylock, MD
Shaun Z Sun, PhD
Longlong Huang, PhD

Purpose
To evaluate refractive outcomes (measured by MRSE) following implantation with a single-piece diffractive trifocal intraocular lens (IOL) using a femtosecond laser, digital registration, and intraoperative aberrometry (IA).

Methods
Single surgeon, unmasked, single site. Retrospective study examining 130 eyes of 65 consecutive patients implanted bilaterally with a trifocal IOL (PanOptix: Alcon Vision) in cases involving femtosecond laser, digital registration, and IA (LenSx, Verion, and ORA with VerifEye+). Patients were unmasked to whether they received a non-toric or toric lens in either eye. Patients were implanted with IOL power as recommended by ORA system (targeted for emmetropia OU). Post-op MRSE, post-op residual astigmatism (PRA), monocular UCVA, and binocular UIVA and UNVA, was recorded at 3 months postoperatively.

Results
At 3 months post-operatively, 91.5% of eyes had MRSE of +/- 0.50D. The mean MRSE was 0.0085D (with a SD of 0.3034D). PRA showed: 85.4% of eyes at 0.00D, 90.0% within 0.25D, and 97.7% within 0.50D, with 2.31% > 0.75D. UCVA showed 82.3% of eyes reaching 20/25 or better, 59.2% of eyes at 20/20, and 11.5% of eyes achieving 20/15 line of vision. UIVA showed 99.2% of eyes reaching 20/25 or better, 95.4% of eyes at 20/20, and 67.7% of eyes achieving 20/15 line of vision. UNVA showed 90% of eyes reaching 20/25 or better with 66.2% of eyes achieving 20/20 line of vision. A linear relationship was found between PRA and UCVA (0.4458 correlation).

Conclusion
These results further demonstrate that the combination use of FLACS, digital registration, and IA during trifocal non-toric and toric implantation can provide excellent refractive and visual outcomes for presbyopic correction.
Astigmatic Results of a Diffractive Trifocal IOL Following Intraoperative Aberrometry (IA) Guidance
Author
John F. Blaylock, MD
Purpose
To determine if intraoperative guidance improves astigmatic outcomes for trifocal toric IOL implantation.

Methods
Retrospective study examining 46 eyes of 23 consecutive patients implanted with a trifocal IOL (PanOptix: Alcon Vision) in cases involving IA (ORA System with VerfiEye+). Cylinder power was determined by IA. Postop UDVA and subjective refraction findings to determine Postop Residual Astigmatism (PRA) were collected at 3 months.

Results
Interim results show the following: 93% of eyes had PRA ≤ 0.50D. Cylinder power was changed in 61% of cases based upon IA. Back calculating using the preop cylinder power, 70% of the cases would have had PRA ≤ 0.50D (p=0.002). Mean PRA was 0.08D±0.25 for IA and 0.42D±0.41 for the back calculation (p=0.008). Cumulative post-op monocular UDVA (LogMAR): 63% 0.0 or better, 78% 0.1 or better, 100% 0.18 or better. Mean post-op monocular UDVA: 0.027±0.10.

Conclusion
In this study, the proportion of eyes with PRA ≤0.50D and mean PRA was lower using IA versus the pre-operative planned cylinder power, demonstrating that cylinder power selection is more accurate following IA recommendation.

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