SPS-202 Presbyopia-correcting IOLs | ASCRS
2020 ASCRS Virtual Annual Meeting

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Papers in this Session
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Comparison of Clinical Outcomes of Mix-and-Match (with EDoF & Bifocal IOLs) & Bilateral Trifocal IOLs.
Author
Chul Young Choi, PhD, MD

Methods
This prospective comparative study was performed to compare the clinical outcomes of two groups, with each group comprising of 25 patients with bilateral age-related cataract. Patients in Group 1 received the Tecnis® Symfony ZXR00 in the dominant eye and the Tecnis® ZLB00 (+3.25 add) in the non-dominant eye, while patients in Group 2 underwent bilateral implantation of the PanOptix® IOL. Following outcomes were assessed preoperatively and at 1-, 3-, and 6-months postoperatively: UDVA, CDVA, UIVA, UNVA, monocular and binocular defocus curves, contrast sensitivity (CSV-1000), reading speed test with Korean, “HanGul”, subjective questionnaires and Visual Functioning Questionnaire (VFQ-25).

Results
At 6-months postoperatively, mean decimal outcomes of binocular UDVA, UIVA, and UNVA of Groups 1 and 2 were 1.12/0.95/0.87 and 1.01/0.95/0.90, respectively. The percentage of spectacle independence in both groups showed a different pattern depending on the focus. Both groups demonstrated an overall improvement in the VFQ-25 questionnaire and the reading speed test using the Korean language showed similar or better outcomes within the range (0.1-0.8) in Group 1.

Conclusion
Mix-and-Match of an EDof and a bifocal IOL presents an effective option for improving near vison with excellent far and intermediate distance vision, while bilateral implantation of a trifocal IOL seems to be more suitable for enhancing near vision. Consequently, an individualized selection is crucial to achieve maximal patient satisfaction.
Early Clinical Outcomes of a Post-Operative Adjustable Intraocular Lens
Authors
Kathleen J Jee, MD
Shamik Bafna, MD
William F. Wiley, MD
Kayla L. Karpuk, OD

Purpose
To evaluate the targeted refractive outcomes and visual outcomes achieved after implantation and adjustment of the Light Adjustable Lens (LAL, RxSight) after cataract surgery.

Methods
In this single-center, consecutive, retrospective case series, patients who underwent cataract extraction with implantation of the LAL were included. Primary outcome measures included best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), mean manifest refraction spherical equivalent (MRSE) and the number of patients within ±0.5D and ±1.0D of refractive target. Data was collected preoperatively and following final postoperative adjustment with the light delivery device (LDD).

Results
This study comprised 24 eyes of 12 patients (with plan to update with additional data prior to presentation). Following the final postoperative adjustment with the LDD, the mean MRSE was -0.29 D, with 100% of eyes within ±0.5D of the refractive target. 90% of eyes achieved UCVA of 20/25 or better, and 100% were 20/40 or better. No eyes had loss of BCVA or any complications. Data will be updated prior to presentation at the ASCRS 2020 meeting.

Conclusion
The LAL provides excellent visual and refractive outcomes in patients wanting to achieve targeted distance or near vision with a reduced dependency on glasses.
Evaluation of Inducing Edf Pattern Postoperatively on Light Adjustable Lens (No Audio)
Author
Arturo S. Chayet, MD

Purpose
To compare results of using a post-operatively induced EDF pattern on a Light Adjustable Lens and a trifocal IOL in the treatment of Presbyopia

Methods
Twenty subjects were implanted bilaterally with Light Adjustable Lenses. Three weeks post-operatively, their manifest spherical and cylindrical refractive error was treated to emmetropia. Prior to lock-in, a new light treatment was administered to their undilated eye aligned to the center of their pupil along their visual axis. This treatment created a smoothly tapered power add of +1.25 D over the central 1.25 mm.

Results
After lock-in, none of the 20 subjects reported significant glare or halos. Simultaneous, binocular, uncorrected was evaluated at distance (4 m), intermediate (66 cm) and near (40 cm). All subjects saw 20/25 (100%) or better. 19/20 (95%) subjects saw 20/20 or better. 8/20 (40%) subjects saw 20/16 or better. This compares favorably with published and measured data of tri-focal IOLs.

Conclusion
First evaluation of the Light Adjustable Lens using this novel presbyopia correcting light treatment demonstrated excellent uncorrected vision at all distances with no noticeable visual side effects.
Long-Term Clinical Outcomes after Different Types of Mix and Match Cataract Surgery in Asian Patients : Bilateral Dmfs Vs Edof with DMF IOL
Authors
Hoseok Chung, MD
Hungwon Tchah, MD, PhD
Jae Hyuck Lee, MD
Su Young Moon, MD
Hun Lee, MD
Jae Yong Kim, MD, PhD

Methods
Group 1, two DMF IOLs were implanted bilaterally in 18 patients. Tecnis +2.75 diopter(D) multifocal IOL was implanted in the dominant eye and Tecnis +4.00 D multifocal IOL was implanted in the non-dominant eye. Group 2, thirty-seven patients with bilateral cataract were enrolled and followed. Tecnis symfony EDOF IOL was implanted in the dominant eye and Tecnis +3.25 D multifocal IOL was implanted in the non-dominant eye. Binocular uncorrected distance visual acuity(UDVA), uncorrected intermediate visual acuity(UIVA), uncorrected near visual acuity(UNVA), defocus curve, contrast sensitivity, satisfaction score and stereopsis were evaluated at 6 months after surgery.

Results
In group 1, the mean postoperative binocular UDVA was 0.02±0.02 logMAR. UIVA was 0.14±0.07, and UNVA was 0.11±0.06 logMAR. In group 2, the mean postoperative binocular UDVA was 0.03±0.04 logMAR. UIVA was 0.07±0.08, and UNVA was 0.16±0.10 logMAR. UIVA of group 2 was better than that of group 1, which was statistically significant(p=.010), and UNVA of group 1 was better than that of group 2, which was not statistically significant(p=.107). In both groups, about 80% of subjects reported they were very satisfied with their vision and about 20% of subjects reported glare and halo symptoms, which were reported less in group 2 than in group 1. About 5% of subjects occasionally needed near glasses.

Conclusion
Both bilateral mix-and-match implantation of +2.75 D and +4.00 D diffractive multifocal IOLs and implantation of extended depth of focus and +3.25 D diffractive multifocal IOL showed good near, intermediate, and far vision. Patients expressed a high degree of satisfaction with low incidence of glare and halos and low dependence on reading glasses.
Light Adjustable Lens: Impact on Elective Refractive Cataract Surgery (No Audio)
Author
John F. Doane, MD

Purpose
To introduce early commercial clinical experience of the first post implantation refraction adjustable intraocular lens implant. To explain preoperative conditions of patients for the light adjustable lens and the refractive predictability of the technology.

Methods
Patients were implanted with the LAL based upon four entry criteria questions? Had they had prior corneal refractive surgery? Would they be interested in minimizing spectacles and would they be able to tolerate any amount of monovision? Would they be disappointed if they needed spectacles or contacts to see well at distance postoperatively. Lastly, did they answer to the affirmative for more than one question above? After implantation, refractive predictability, uncorrected and corrected distance and near vision for each eye seperately and both eyes together were recorded. Patients completed subjective questionnaire evaluation 1 month after final lock-in of refraction.

Results
Nine months after the introduction of the Light Adjustable Lens ( LAL ) in commercial clinical practice the percentage of monofocal spherical IOl's implanted where 71% compared to 68.6% prior. Presbyopic IOL ( multifocal and EDOF ) implantation revealed a 54% decrease from 22.5% of IOL implantations to 12.2% after the introduction of the LAL. Toric monofocal implantations were 7.6% of all IOL implantations prior to LAL and 0% after introduction. Total premium IOL implantations prior to LAL introduction were 22.5% of all cases prior and 29% after representing a 29% increase in premium IOL implantations.

Conclusion
The introduction of the Light Adjustable Intraocular Lens Implant significantly changed the IOL's selected in a single site, single surgeon practice. It was notable that monofocal toric implants went to 0% and prior radial keratotomy patients became suitable candidates for premium IOL implantation.
Long-Term Uveal and Capsular Biocompatibility of a New Fluid-Filled, Modular Accommodating Intraocular Lens
Authors
Liliana Werner, MD, PhD
Sneha Bontu, MD
Sean J. Kennedy, MD
Nick Mamalis, MD
Nathan C. Ellis, MD
Kai M. Kamae
Bill F Jiang
Daniel G Brady, BEng, MBA

Purpose
To evaluate long-term uveal and capsular biocompatibility of a new accommodating modular intraocular lens (IOL), consisting of a base lens and a fluid lens, in a rabbit model.

Methods
Bilateral phacoemulsification was performed on 8 rabbits; one eye received the test lens (Juvene, LensGen) and the other a hydrophobic acrylic control lens (SA60AT, Alcon). Slit lamp examinations were performed at postoperative weeks 1 and 4, and at months 2, 3, and 6. The rabbits were sacrificed at 6 months. After gross examination from the Miyake-Apple view, test and control IOLs were removed for implant cytology. All globes were then sectioned and processed for histopathologic examination.

Results
Uveal biocompatibility was similar between test and control lenses as shown in clinical and pathologic exams up to six months postoperatively. Anterior capsule opacification appeared absent in the test group, and posterior capsule opacification (PCO) was significantly less in comparison to the control group throughout the study. At the gross examination at 6 months, central PCO was scored as 0.12 +/- 0.23 with test lenses, and as 4.0 +/- 0 with control lenses (P < 0.0001 two-tail; Paired T-Test). Histopathologic examination confirmed the relative lack of capsular opacification in test eyes in comparison to controls, and the absence of untoward inflammatory reaction or toxicity in all eyes.

Conclusion
The Juvene IOL maintains an expanded capsular bag secondary to the base lens component, without significant contact with the edge of the anterior capsule . This appears to prevent overall capsular bag opacification while retaining uveal and capsular biocompatibility. The modular design allows for easy exchange of the fluid lens, if necessary.

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