Moderator
Richard S. Davidson, MD, ABO
Panelists
Helga P. Sandoval, MD, MSc
Karolinne M. Rocha, MD, PhD, ABO
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Chunchun He, MD, PhD
Purpose
to compare the efficacy and safety in astigmatism correction and the postoperative visual outcomes between the implantation of a trifocal(TFL) toric IOL and TFL IOL implantation with limbal relaxing incision (LRI) in patients with moderate corneal astigmatism(CA), and to evaluate the long-term rotational stability of the toric IOL.
Methods
This retrospective observational case study enrolled presbyopic patients with CA between 1 to 2D. 15 patients with 25 eyes received TFL toric IOL (939MP, Carl Zeiss, Germany), and 16 patients with 25 eyes received TFL IOL (839MP, Carl Zeiss, Germany) implantation along with LRI. Post-op evaluations included uncorrected near, intermediate, and distance visual acuity, CDVA, manifest refraction, and defocus curve at 3 months post-op. The toric IOL axis position was evaluated by retroillumination image at 3 months post-op and compared to pre-op planned axis. Subjective satisfaction was evaluated with questionnaires. Comparisons were made between two groups. Adverse events were also evaluated.
Results
In TFL toric group, post-op CDVA, UDVA, UNVA, and UIVA at 3 months were -0.05�0.07, -0.01�0.07, 0.09�0.02, and 0.10�0.01 logMAR. While in TFL+LRI group, post-op CDVA, UDVA, UNVA and UIVA at 3 months were 0.06 � 0.10, 0.11�0.07, 0.1�0.08, and 0.15�0.07 logMAR. The 3 months post-op spherical equivalent of manifest refraction was 0.13�0.18D, and 0.5�0.35D in TFL toric and TFL+LRI group, and the refractive cylinder was 0.14+0.16D, and 0.38+0.42D in TFL toric and TFL+LRI group. A smooth range of good VA was found on the defocus curves in both groups. The mean Toric deviation from the planned axis was 2.9�2.4�. Subjective satisfactions showed no significant differences between both groups.
Conclusion
implantation of a diffractive TFL toric IOL for presbyopia correction provided good refractive and visual outcomes, and high level of visual quality and patient satisfaction after surgery. Compare to LRI, TFL toric IOL provided better BCVA, UCVA, and intermediate VA. However, the rotational stability needs to be observed in long term.
Presenting Author
Ali Nowrouzi, MD, FEBO, FRCS
Purpose
To evaluate and compare postoperative visual function and patient satisfaction after implantation of extended depth of focus (EDOF) IOLs with central, higher-order aberration segment versus a continuous transitional focus technology in patients with a pupil size of less than 2.5mm
Methods
Retrospective case series N= 250 patients with Implantation of extended depth of focus (EDOF), and continuous transitional focus technology (CTF) IOLs. Group 1: 150 patients (60%), EDOF IOLs with a central, higher-order aberration segment (Vivity and Luxsmart). Group 2: 100 patients (40%), continuous transitional focus technology (CTF)(Precizon Presbyopic). To determine patients� visual function and satisfaction after implantation of IOLs in patients with a Photopic pupil size of less than 2.5mm (Pentacam Meseaurment). VF-14 questionnaire (modified questionnaire asking the same items without spectacles).
Results
IOL power selection had been aimed at emmetropia. Three months after the IOL implantation, seven patients (2.8%) were found in the EDOF IOLs group with a photopic pupil size of less than 2.5 mm (preoperative study) and a mean myopic subjective refractive error of (-0.50 +/-0.25). Six patients (2.4%) underwent laser treatment for the myopic error and dissatisfaction with the uncorrected distance visual acuity. In the group of CTF IOLs, ten patients (4%) were detected with a photopic pupil size of less than 2.5 mm and a mean myopic subjective refractive error of (-0.25 +/-0.25) None of these patients underwent laser treatment because of dissatisfaction (p< />
Conclusion
In patients with a photopic pupil size of less than 2.5mm, CTF IOLs result in less myopic shift and patient dissatisfaction than the IOLs group with a central, higher-order aberration segment. IOLs with CTF technology are less pupil-dependent. Pupil size evaluation is highly recommended in the preoperative planning of premium IOLs.
Presenting Author
Matin Khoshnevis, MD, CMP
Purpose
To retrospectively evaluate monocular uncorrected visual acuities (including UCDVA, UCIVA, UCNVA and Spherical Equivalents) as well as Patient Satisfaction, Spectacle Independence, and Visual Disturbances following implantation of a segmented multifocal IOL.
Methods
A retrospective evaluation of a surgeon�s first eighty (80) eyes implanted with a segmented multifocal IOL (ClearView 3; Lenstec Inc, St. Petersburg, FL). This retrospective chart review was conducted on these patients in which monocular uncorrected visual acuities at all distances (distance, intermediate and near) and postoperative Spherical Equivalents were evaluated. The results of a Patient Reported Outcomes (Patient Satisfaction, Spectacle Independence, and Visual Disturbances) questionnaire will also be presented and discussed.
Results
The mean postoperative monocular UCDVA was 20/22, UCIVA 20/18 and UCNVA 20/20 (J1). 83% of the eyes achieved a postoperative UCDVA of 20/25 or better, 100% UCIVA of 20/20 or better and 94% UCNVA of 20/25 (J2) or better. The mean manifest refraction SE was +0.10D (StdDev. 0.21D). 91.6% reported that rarely to never wear spectacle correction while 97% are either satisfied or extremely satisfied with their vision. Reports of glare and halos along with other visual disturbances were low and had a direct association with PCO.
Conclusion
The use of segmented bifocal IOLs for patients with a history of cataracts provides satisfactory visual outcomes with minimal visual disturbances and high patient satisfaction.
Presenting Author
Jennifer L. Michelson, MD, ABO
Purpose
To retrospectively evaluate visual outcomes (including UCDVA, UCNVA, post-operative Spherical Equivalents), and dysphotopsia complaints in patients with high corneal HOA values including post corneal refractive surgery following implantation of a segmented multifocal intraocular lens.
Methods
Twenty (20) patients with excessive preoperative corneal higher HOA values, some of which were status post corneal refractive surgery, underwent cataract surgery and were implanted with a segmented multifocal IOL (ClearView 3; Lenstec Inc, St. Petersburg, FL). A retrospective chart review was conducted on these patients in which visual outcomes (including UCDVA, UCNVA and post-operative spherical equivalents) and dysphotopsia complaints were evaluated.
Results
Pts were divided into 4 groups: 1) Post refractive w high corneal HOA 2) Post refractive w normal HOA 3) Virgin cornea w high corneal HOA 4) Virgin cornea w normal HOA. RMS >0.21 microns from Z3 and Z4 polynomials were considered high HOA. All pts received the segmented SBL-3 IOL. Post Refractive High corneal HOA (average RMS 0.3108) had UCDVA 0.85 & UCNVA 0.84 compared to Post Refractive Normal HOA (average RMS 0.1779) UCDVA 0.85 and UCNVA 0.86. Virgin Cornea High HOA (average RMS 0.2435) had UCDVA 0.86 and UCNVA 0.83 compared to Virgin Cornea normal HOA (average RMS 0.1549) UCDVA 0.85 and UCNVA 0.87. All Visual Acuity results were statistically significant with p value < 0.05
Conclusion
Pts with high corneal HOA s/p refractive surgery had the same decimal UCDVA as pts who had normal corneal HOA s/p refractive surgery & within 0.02 decimals at UCNVA. Pts with virgin corneas with High corneal HOA were within 0.01 decimal UCDVA as pts who had normal corneal HOA & within 0.04 decimals at UCNVA. SBL-3 generated minimal dysphotpsias
Presenting Author
Camille Bosc, MD
Co-Authors
Jean-Michel Bosc MD
Purpose
The purpose of the present study was to assess the refractive and visual outcomes following cataract surgery and implantation of the Finevision HP trifocal toric intraocular lens (IOL).
Methods
Patients who underwent implantation with the Finevision HP trifocal and Finevision HP trifocal toric (PhysIOL s.a., Liege, Belgium, part of Beaver-Visitec International, Inc. [BVI], Waltham, USA) were retrospectively analyzed in this study. Main outcome measures were refractive error, monocular and binocular uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA) at 40 cm. was also measured. Defocus curve and patient and patient satisfaction questionnaire was also measured.
Results
: In this preliminary study, 90 eyes (45 bilateral patients,12 toric and 78 non-toric) were analyzed after 3 month of follow-up. (30 female/15 male). The mean postoperative spherical equivalent was -0.02�0.42D and the mean refractive cylinder was -0.35�0.35D. 82% of eyes were within �0.50D and 97% within �1.00 D. 98% of eyes showed monocular and binocular UDVA of 20/25 or better, and 88% and 100% of eyes showed monocular and binocular UNVA of 20/25 or better, respectively. 100% of patients achieved 20/25 binocular UDVA and UDNVA. Patients satisfaction questionaries were performed with high rating in all areas.
Conclusion
The preliminary outcomes found in the present study suggests that use of this trifocal toric IOL provides excellent refractive outcomes, stable lens orientation and good visual acuity at different distances.
Presenting Author
Robert Edward T. Ang, MD
Purpose
To evaluate the clinical performance of the investigational Toric and Sphere Implantable Collamer� Lens with Aspheric (EDOF) Optic to correct or reduce myopia with presbyopia with or without astigmatism.
Methods
This exploratory prospective, open-label clinical trial of a Toric EDOF ICL was conducted at one site in the Philippines. A total of 94 eyes (47 phakic subjects) with stable refraction were implanted bilaterally with toric (TEDOF, +1.0D-+3.0D cyl power) and/or spherical (EDOF) ICLs and followed for 6 months. Patients with sight threatening diseases or a history of ocular surgery were excluded. Performance outcomes included uncorrected distance, intermediate and near visual acuity (UDVA, UIVA, UNVA), manifest refraction spherical equivalent (MRSE) prediction error (PE), defocus and contrast sensitivity assessments, astigmatism correction and patient reported outcomes.
Results
Six-month interim data of 72 eyes (49 toric EDOF and 23 spherical EDOF ICL eyes) of 36 completed subjects show binocular uncorrected mean logMAR VA of 0.04�0.07 for distance (UDVA), 0.01�0.08 for intermediate (UIVA) and 0.08�0.10 for near vision (UNVA). Postoperative mean MRSE was 0.02�0.34D at 6 months. In the TEDOF group (eyes with ?1.0D of preoperative cylinder), preoperative and postoperative refractive cylinder (at 6 months) was 1.46�0.63D and 0.42�0.33D, respectively. Patient reported outcomes show high patient satisfaction and NEI RQL-42 analyses demonstrate significant improvements in QOL at the 6 month visit compared to baseline. The data will be updated by February 13, 2025.
Conclusion
The current study has shown that the toric EDOF and spherical EDOF ICL can provide good binocular distance, intermediate and near vision with high patient satisfaction.
Presenting Author
Paul J. Harasymowycz, MD, FRCSC, MSc
Co-Authors
Adam Muzychuk MD, FRCSC
Purpose
To evaluate the effect of residual manifest refraction spherical equivalent (MRSE) on distance-corrected near visual acuity (DCNVA), patient-reported frequency, severity, and bothersomeness of glare and halos, and satisfaction with near vision in patients implanted withenVista Full Range of Vision (FRoV) IOL.
Methods
The data from 2 prospective, multicenter, double-masked, controlled clinical trials that evaluatedthe outcomes in patients undergoing implantation of a full range of vision (FRoV) enVista EnvyIOL (Bausch + Lomb) was pooled (N=443) and analyzed. Patients were divided into two groupsbased on MRSE: (1) within �0.25 D of emmetropia (plano), (2) outside �0.25 D of emmetropia (non-plano). The relationship between postoperative MRSE and DCNVA was assessed using ageneralized estimating effect (GEE) model. In addition, the relationships of postoperative MRSEwith patient-reported frequency, severity, and bothersomeness of dysphotopsia and satisfactionwith near vision were assessed.
Results
Postoperatively, the mean MRSE was -0.09 � 0.42 D. No statistically significant relationship wasobserved between postoperative MRSE and DCNVA (p=0.1390). The frequency, severity, andbothersomeness of halos or glare were comparable between the plano and non-plano groups(all p>0.05). The risk of poor satisfaction with near vision was higher in the non-plano groupthan the plano group (odds ratio =2.518); however, the p-value was not statistically significant(p=0.2717).
Conclusion
FRoV IOLs have low tolerance to residual MRSE; however, the present study showed that residual MRSE in patients implanted with the enVista Envy FRoV IOL had a negligible effect on the DCNVA outcomes, patient-reported frequency, severity, and bothersomeness of halo and glare, and patient satisfaction with near-vision outcomes.
Presenting Author
Lizaveta Chychko, MD
Co-Authors
Tadas Naujokaitis MD, Isabella Baur MD, Oliver Hassel MD, Nikola Henningsen MD, Emanuel Reitemeyer MD, Grzegorz Labuz BEng, PhD, Gerd Auffarth MD, PhD, Ramin Khoramnia MD
Purpose
To evaluate the near and intermediate reading performance after binocular refractive lens exchange and implantation of the new Clareon PanOptix IOL (Alcon, Fort Worth, TX, USA) using the Salzburg Reading Desk (SRD Vision). The studied IOL is made of a glistening-free hydrophobic acrylic material and is the successor of the AcrySof IQ PanOptix IOL.
Methods
In this prospective, interventional study, bilateral delayed sequential femtosecond laser assisted refractive lens exchange procedure with implantation of the Clareon PanOptix IOL was performed in 54 eyes of 27 patients. Reading performance was evaluated preoperatively and at 6 months postoperatively. Monocular and binocular uncorrected and distance corrected reading acuity and reading speed were assessed at 40 cm and 60 cm distance and at the subjectively preferred near and intermediate distances.
Results
The mean (�SD) patient age was 55 � 5 years. Before the surgery, the mean binocular uncorrected reading acuity was 0.53 � 0.22 logMAR at near (40 cm) and 0.53 � 0.22 logMAR at intermediate (60 cm) distances. Postoperatively, the mean binocular uncorrected reading acuity was 0.05 � 0.08 logMAR at the set near distance (40 cm) and 0.05 � 0.09 logMAR at the subjectively preferred near distance (38.8 � 2.5 cm). At the set intermediate distance (60cm), the postoperative mean uncorrected reading acuity was 0.09 � 0.10 logMAR. The preferred intermediate distance was 57.6 � 4.1 cm with a mean uncorrected reading acuity of 0.07 � 0.10 logMAR.
Conclusion
Uncorrected intermediate and near reading function considerably improved after bilateral diffractive trifocal IOL implantation. Reading function was comparable for the set and subjectively preferred distances.
Presenting Author
Steven J. Dell, MD, ABO
Co-Authors
Christopher Engelman MD, George Waring MD, Ashvin Agarwal MD
Purpose
To evaluate the long-term refractive stability and visual acuity outcomes following first-in-human implantation of a modular shape-changing IOL for simultaneous treatment of presbyopia and cataract.
Methods
The prospective, multicenter, open-label, first-in-human clinical trial evaluated outcomes of 29 eyes of 19 patients implanted with a modular shape-changing IOL during routine cataract surgery. Of the 19 patients, 63% were Caucasian and 37% were Asian. The mean age was 67 �11 years (range, 49�87 years). The study followed standard exclusion criteria for presbyopia-correcting IOLs. Patients were assessed at 1, 3, 6, 12, and 24 months postoperatively. Post-op evaluation included uncorrected (U) and distance-corrected (DC) visual acuities (VA), refraction and defocus curve. At 24 months, data for 19 eyes of 15 patients was available. Additional follow-up is underway.
Results
Patients achieved and maintained a mean refractive spherical equivalent within �0.50 D of plano at 1 month through 24 months. Refractive cylinder remained constant out to 24 months. At all distances, mean binocular UCVA improved over time and DCVA remained constant. For binocular UCVA at 24 months, 100% were 20/16 at distance and 20/25 at intermediate and near. For mean binocular DCVA, 100% were 20/16 at distance, 20/25 at intermediate, & 20/32 at near at 24 months. Eyes maintained 20/32 or better over approximately 4.5 D of continuous binocular defocus. No unexpected adverse events related to the IOL were reported at any point during follow-up.
Conclusion
A novel modular shape-changing IOL showed excellent refractive stability and visual acuity outcomes maintained over 24 months of follow-up, supporting its potential as a viable option for presbyopia-correction for cataract surgery patients.
Presenting Author
Thomas Kohnen, MD, PhD
Co-Authors
Eva Hemkeppler MSc, Klemens Kaiser MD, Petra Davidova MD, Annika Klinkenbusch MD
Purpose
To evaluate the one-year efficacy and safety of the one-piece multifocal intraocular lens (IOL) Clareon PanOptix CNWT (Alcon, Fort Worth, TX, USA).
Methods
This is a prospective, single-centre, single-arm, interventional study conducted at the Department of Ophthalmology, Goethe-University Frankfurt, Germany. Cataract patients underwent bilateral implantation of a multifocal IOL following phacoemulsification. Examinations included manifest refraction, uncorrected visual acuity (UCVA) and distance-corrected visual acuity (DCVA) at 4m, 80cm, 60cm and 40cm, defocus test, contrast sensitivity (CS) under photopic and mesopic conditions and a questionnaire on subjective quality of vision, optical phenomena, and spectacle independence. The primary outcome was the presence of IOL glistenings. Primary endpoints were assessed at a follow-up of 12 months.
Results
The binocular UCVA was -0.04 � 0.08 logMAR and at intermediate (80 cm and 60 cm) and near (40 cm) -0.03 � 0.05, -0.04 � 0.11 and 0.05 � 0.11 logMAR, respectively. The binocular distance-corrected defocus curve showed a peak at 0.0 D and -2.0 D with -0.07 and -0.02 logMAR, and between +0.5 and -3.0 D within 0.10 logMAR. At 12 months, there was no evidence of glistenings in any eye. Twenty-four (89%) participants would choose the IOL again and 23/27 (85%) would recommend the IOL to others.
Conclusion
The trifocal Clareon PanOptix IOL provides patients with high visual performance and spectacle independence at all distances without evidence of IOL glistenings.
Presenting Author
Thomas Kohnen, MD, PhD
Co-Authors
Myriam B�hm MSc, MD, Eva Hemkeppler MSc, Klemens Kaiser MD, Petra Davidova MD, Annika Klinkenbusch MD
Purpose
To evaluate outcomes on visual acuity at different distances, range of vision, patient satisfaction, spectacle independence, visual quality and refractive outcomes in cataract patients implanted with the multifocal Acunex VarioMax IOL.
Methods
In this prospective, single-site, clinical trial patients after bilateral implantation of the Acunex Variomax IOL were included. After 12-months follow-up, binocular uncorrected and corrected visual acuities at distance (UCDVA, BCDVA), intermediate (UCIVA, DCIVA) and near (UCNVA, DCNVA) will be measured. Spectacle independence, defocus curve ranging from -5.0 D to +2.0 D in 0.5D steps, patient satisfaction and visual disturbances will be also evaluated.
Results
Monocular UCVA was 0.02 � 0.09 logMAR at 4 m, 0.15 � 0.2 logMAR at 80 cm and 0.24 � 0.10 logMAR at 40 cm. Defocus curve testing showed a binocular VA range from 0.00 to -2.00 D (-0.06 logMAR to 0.09 logMAR). Median CS under photopic and mesopic conditions was 1.48 � 0.18 logCS and 1.25 � 0.29 logCS respectively.
Conclusion
This segmental multifocal IOL provides good VA at all distances (<0.25 logMAR), particularly providing good intermediate visual acuity and depth of focus (DoF). It showed good CS and high spectacle independence with a high degree of patient satisfaction.
Presenting Author
Molly Snider, MD
Co-Authors
James Randleman MD, Bianca Susanna MD
Purpose
This study aimed to evaluate the objective and subjective outcomes of presbyopia-correcting lenses (PCL) in patients who had previously undergone laser vision correction (LVC) surgery.
Methods
We conducted a retrospective analysis of patients with a history of LVC who underwent implantation of presbyopia-correcting lenses between January 2017 and December 2022. Key outcomes included post-operative refraction, corrected and uncorrected distance and near visual acuity, spectacle independence, subjective quality of vision, and presence of glare, halos, or starbursts. We also evaluated the need for additional procedures such as IOL exchange, additional LVC, or YAG capsulotomy. Exclusion criteria included insufficient follow-up, unilateral presbyopia-correcting lens implantation, or presence of other ocular pathologies.
Results
The study analyzed 27 patients (46 eyes) who had phacoemulsification with PC-IOLs after prior LVC. Nearly half (46.4%) were intolerant, and 7.1% had IOL exchange. Only 18% were fully satisfied. The mean age was 62.5�6.4 years, with 21.4�10.8 months of follow-up. Refractive EDOF IOLs were most common (70%). Intolerant patients had worse MRSE (-0.57�0.48 vs. -0.28�0.76, p=0.009) and fewer within 0.5 D of MRSE (33.3% vs. 66.7%, p=0.03). Photic symptoms were reported by 44.4%, more in the PCI group (66.7% vs. 33.3%, p=0.085). LVC enhancement had the highest symptom improvement rate (75%), followed by IOL exchange (100%).
Conclusion
Half of patients with prior LVC experienced PCI, often due to residual refractive error and photic symptoms. Intolerant patients had worse MRSE and were less likely to achieve target refraction. LVC enhancement had the highest success in symptom relief. Careful patient selection and precise refractive targeting are key to optimizing outcomes.
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