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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 19  |  Issue : 4  |  Page : 243-245

Visual performance after trifocal versus extended range of vision presbyopia-correcting intraocular lenses


Department of Ophthalmology, Alexandria University Hospital, Alexandria, Egypt

Date of Submission26-Aug-2018
Date of Acceptance21-Sep-2018
Date of Web Publication20-Dec-2018

Correspondence Address:
Ahmed Abd El Kareem El-Massry
398 Abou Quer, Qism Sidi Gaber, Alexandria
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/DJO.DJO_43_18

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  Abstract 


Purpose The purpose of this article is to compare visual outcomes after cataract surgery with implantation of two intraocular lenses (IOLs): extended range of vision and trifocal.
Patients and methods A prospective study comprising 14 patients (26 eyes) was conducted. Phaco-emulsification followed by implantation of Finevision IOL was performed in eight patients (15 eyes) and Symfony IOL in six patients (11 eyes). The following outcomes were assessed after 3 months from surgery: uncorrected and best-corrected monocular distance, intermediate and near visual acuities and spherical equivalent refraction.
Results The mean values for the Finevision group and the Symfony group, respectively, were uncorrected visual acuity (UCVA) for far 0.05±0.08 logMAR and 0.02±0.04 logMAR; UCVA for intermediate 0.23±0.05 logMAR and 0.4±0.06 logMAR; UCVA for near 0.19±0.10 logMAR and 0.42±0.06 logMAR; best-corrected visual acuity (BCVA) for far −0.03±0.08 logMAR and −0.03±0.05 logMAR; BCVA for intermediate 0.22±0.04 logMAR and 0.4±0.06 logMAR; BCVA for near 0.19±0.07 logMAR and 0.41±0.05 logMAR. Finevision group was statistically significant (P<0.05) better than Symfony group in UCVA and BCVA for near and intermediate.
Conclusion Both the Finevision IOL and the Symfony IOL are excellent presbyopia-correcting IOLs. In our study, they provided excellent visual acuities at all distances. The Finevision group had better near and intermediate visual acuities.

Keywords: cataract, Finevision, intraocular lens, presbyopia, Symfony


How to cite this article:
El-Massry AA, Shama AE, Kandil HW, Ghoneem MH. Visual performance after trifocal versus extended range of vision presbyopia-correcting intraocular lenses. Delta J Ophthalmol 2018;19:243-5

How to cite this URL:
El-Massry AA, Shama AE, Kandil HW, Ghoneem MH. Visual performance after trifocal versus extended range of vision presbyopia-correcting intraocular lenses. Delta J Ophthalmol [serial online] 2018 [cited 2020 Feb 23];19:243-5. Available from: http://www.djo.eg.net/text.asp?2018/19/4/243/248090




  Introduction Top


Presbyopia is a condition that affects the accommodation properties of the eye. Presbyopia normally develops as a person ages and is associated with a natural progressive loss of accommodation. The presbyopic eye often loses the ability to rapidly and easily refocus on objects at varying distances. The effects of presbyopia usually become noticeable after the age of 45 years. By the age of 65 years, the crystalline lens has often lost almost all elastic properties and has only limited ability to change shape [1].

With the advent of new intraocular lens (IOL) technology, higher spectacle independence after cataract surgery is now possible. Currently, IOLs are able to compensate not only for spherical errors but also for astigmatism and presbyopia, providing a complete restoration of the visual function [2].

The Finevision IOL (PhysIOL SA) design is a combination of two independent diffractive bifocal profiles to yield a single diffractive pattern. The first pattern is designed with an add of 3.5 D and the second pattern with an add of 1.75 D. This allows the second order of diffraction of the second pattern to add to the first order of diffraction of the first pattern. This allows the Finevision to theoretically reduce lost energy to ∼15% [3].

The Symfony IOL (Abbott Medical Optics Inc.) has a diffractive echelette on the posterior optic surface which is claimed to extend its single focal point. It is also claimed to correct the linear chromatic aberrations of the cornea for better contrast sensitivity [4].

The aim of our study was to compare the subjective and objective visual performance of Finevision trifocal IOL and Symfony extended range of vision IOL after phaco-emulsification cataract surgery.


  Patients and methods Top


The study was conducted as a prospective randomized interventional study which included 26 eyes of 14 patients who underwent phaco-emulsification surgeries. Eight patients (15 eyes) were implanted with the Finevision IOL (PhysIOL SA, Liège, Belgium) and six patients (11 eyes) were implanted with the Symfony IOL (Abbott Medical Optics Inc.).

The study adhered to the tenets of the Declaration of Helsinki and its amendments and was approved by the local ethics committee. Written informed consent was provided by all patients before enrollment into the study.

Patients with cataract requesting independence from spectacles and who had corneal astigmatism of less than 1 D were included in the study. Exclusion criteria were patients with unrealistic expectations, ocular pathology besides cataract, previous refractive surgery, history of ocular trauma, and patients who had any intraocular or postoperative complications.

Preoperatively all the patients underwent a complete ophthalmologic examination. Refractive status and uncorrected and corrected near and distance visual acuities were measured. All patients underwent preoperative biometry and keratometry using LENSTAR (Haag-Streit, USA). Emmetropia was aimed for in all eyes. Barrett Universal II formula was used for Finevision group, and Haigis formula was used for the Symfony group.

At 3 months postoperatively, patients were examined for distance (4 m), intermediate (65 cm), and near (35 cm) visual acuities by logMAR using ETDRS visual acuity charts.


  Results Top


A total of 15 eyes of eight patients (seven males and one female) were implanted with the Finevision IOL and 11 eyes of six patients (two males and four females) were implanted with the Symfony IOL. The mean age for the Finevision group was 57.0±8.05 years whereas the mean age for the Symfony group was 56.83±8.30 years (P=0.971).

Preoperatively the mean axial length for the Finevision group was 24.25±1.27 mm whereas that of the Symfony group was 24.0±1.82 mm (P=0.686). Mean preoperative corneal astigmatism was 0.52±0.18 D for the Finevision group, whereas it was 0.48±0.24 D for the Symfony group (P=0.646).

Postoperatively, in the Finevision group, mean residual sphere, residual cylinder, and spherical equivalent were −0.15±0.36, −0.43±0.44, and −0.37±0.27 D, respectively. In the Symfony group, mean residual sphere was −0.14±0.30 D, with a residual cylinder of −0.30±0.40 D and spherical equivalent of −0.28±0.29 D (P=0.894, 0.424, and 0.395, respectively).

The mean values for the Finevision group and the Symfony group, respectively, were uncorrected visual acuity (UCVA) for far 0.05±0.08 logMAR and 0.02±0.04 logMar; UCVA for intermediate 0.23±0.05 logMAR and 0.4±0.06 logMAR; UCVA for near 0.19±0.10 logMAR and 0.42±0.06 logMAR; best-corrected visual acuity (BCVA) for far −0.03±0.08 logMAR and −0.03±0.05 logMAR; BCVA for intermediate 0.22±0.04 logMAR and 0.4±0.06 logMAR; and BCVA for near 0.19±0.07 logMAR and 0.41±0.05 logMAR. Finevision group was statistically significant (P<0.001) better than Symfony group in UCVA and BCVA for near and intermediate, whereas no statistically significant difference was found between both groups regarding UCVA and BCVA for far (P=0.059 and 0.806, respectively).


  Discussion Top


Our study showed inferior uncorrected distance visual acuity with the Finevision IOL compared with Cochener et al. [5] (mean, 0.01±0.06 logMAR) and Ruiz-Mesa [6] (mean, 0.01±0.03 logMAR). This difference is attributed to the residual refractive error in our study. The mean residual spherical equivalent was −0.15±0.25 D with Ruiz-Mesa [6] and 0.11±0.36 D with Cochener et al. [5].

As for intermediate and near UCVA with the Finevision IOL, our study was again inferior to the results of Ruiz-Mesa [6], with mean UCIVA of 0.23±0.05 logMAR compared with 0.11±0.08 logMAR and mean UCNVA of 0.19±0.10 logMAR compared with 0.06±0.07 logMAR. The results of Cochener et al. [7] for UCIVA (0.08±0.10 logMAR) and UCNVA (0.00±0.04) were also better than our results, but this difference could be attributed to the method used to obtain the intermediate and near visual acuities. Cochener et al. [7] used a near optotype using the minimum angle of resolution scale, whereas we used ETDRS charts in our study.

As for the Symfony IOL group, our study showed similar results regarding uncorrected distance visual acuity with Ruiz-Mesa [6], with mean of 0.02±0.04 logMAR compared with 0.01±0.02 logMAR. As for UCIVA and UCNVA with the Symfony IOL, our study was again inferior to Ruiz-Mesa [6] results (0.09±0.08 logMAR for intermediate and 0.17±0.06 logMAR for near). In our study, we had slightly more residual refractive error compared with Ruiz-Mesa [6] (−0.19±0.18 D spherical equivalent). Moreover, residual postoperative cylinder was higher in our study (−0.35±0.46 D compared with −0.16±0.15 D).

Ruiz-Mesa [6] conducted his study at 1 year after surgery, whereas our study was done after 3 months postoperatively. This could be a contributing factor to the different results attained owing to neuroadaptation or some sort of perceptual learning as hypothesized by Martins Rosa [7].

The small sample size was one of the limitations of our study. Moreover, pupil size was not measured for our patients, and this could have affected the visual performance in such IOLs.


  Conclusion Top


Both the Finevision IOL and the Symfony IOL are excellent presbyopia-correcting IOLs. In our study, they provided excellent visual acuities at all distances. The Finevision group had better near and intermediate visual acuities.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Weeber HA. Multi-ring lens, systems and methods for extended depth of focus. Patent application publication; 2016. Available at: https://patentimages.storage.googleapis.com/11/ea/32/2a98fb75a39a84/US20140168602A1.pdf. [Accessed May 2018].  Back to cited text no. 1
    
2.
Hamid A, Sokwala A. A more natural way of seeing: visual performance of three presbyopia correcting intraocular lenses. Open J Ophthalmol 2016; 6:176–183.  Back to cited text no. 2
    
3.
Gatinel D, Pagnoulle C, Houbrechts Y, Gobin L. Design and qualification of a diffractive trifocal optical profile for intraocular lenses. J Cataract Refract Surg 2011; 37:2060–2067.  Back to cited text no. 3
    
4.
Gatinel D, Loicq J. Clinically relevant optical properties of bifocal, trifocal, and extended depth of focus intraocular lenses. J Refract Surg 2016; 32:273–280.  Back to cited text no. 4
    
5.
Cochener B, Vryghem J, Rozot P, Lesieur G, Chevalier JP, Henry JM et al. Clinical outcomes with a trifocal intraocular lens: a multicenter study. J Refract Surg 2014; 30:762–768.  Back to cited text no. 5
    
6.
Ruiz-Mesa R, Abengózar-Vela A, Aramburu A, Ruiz-Santos M. Comparison of visual outcomes after bilateral implantation of extended range of vision and trifocal intraocular lenses. Eur J Ophthalmol 2017; 27:460–465.  Back to cited text no. 6
    
7.
Martins Rosa A, Silva MF, Ferreira S, Murta J, Castelo-Branco M. Plasticity in the human visual cortex: an ophthalmology-based perspective. BioMed Res Int 2013; 2013:568354.  Back to cited text no. 7
    




 

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Abstract
Introduction
Patients and methods
Results
Discussion
Conclusion
References

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