Search Results (16)

Background: Spectacle independence is a key goal in refractive lens exchange (RLE), especially in younger, high-expectation patients. This study evaluates a novel extended monovision approach combining a monofocal aspheric intraocular lens (IOL) in the dominant eye with a rotationally asymmetric bifocal extended-depth-of-focus (EDOF) IOL in the non-dominant eye. The strategy aims to optimize full-range visual performance while minimizing photic phenomena. Methods: In this retrospective cohort study, presbyopic patients underwent bilateral RLE with a monofocal IOL (Hoya Vivinex XC1-SP; target: 0 diopters [D]) in the dominant eye and a rotationally asymmetric bifocal EDOF IOL (LENTIS LS-313 MF15; addition: +1.5 D; target: −1.25 D) in the non-dominant eye. Uncorrected distance visual acuity (UDVA, at 6 m), uncorrected intermediate visual acuity (UIVA, at 66 cm), and uncorrected near visual acuity (UNVA, at 36 cm) were assessed. Additional evaluations included binocular defocus curves, contrast sensitivity, stereoacuity, and photic phenomena. Spectacle independence and satisfaction were measured using the PRSIQ and NEI-RQL-42 questionnaires. Results: A total of 38 patients (76 eyes) were included. The mean postoperative binocular UDVA, UIVA, and UNVA were −0.03 ± 0.08, −0.08 ± 0.09, and 0.04 ± 0.08 logMAR, respectively. The defocus curve peaked at 0.0 D (6 m) with a mean visual acuity of −0.03 ± 0.08 logMAR. Functional vision better than 0.2 logMAR extended over defocus steps from +1.00 to −3.25 D. All patients were spectacle-independent for distance and intermediate vision, and 84% reported complete spectacle independence. Contrast sensitivity was within normal limits for age. Minimal photic phenomena were reported, and stereoacuity was preserved in 97% of patients (≤100 arcseconds). Conclusions: This innovative extended monovision approach, combining two different IOLs in a mini-monovision setup, provides excellent uncorrected visual acuity at all distances, high spectacle independence, and minimal side effects. It represents a compelling alternative to multifocal IOL implantation in presbyopic RLE candidates. Full article

Functional Optical Balance (FOB) is a novel personalized strategy for intraocular lens (IOL) selection in cataract surgery, designed to reconcile the trade-off between optical quality and spectacle independence. FOB is a core concept aiming to maximize visual performance by treating the two eyes as a synergistic pair. One eye (often the dominant eye) is optimized for pristine optical quality (typically distance vision with a high-contrast monofocal or low-add IOL). In contrast, the fellow eye is optimized for extended depth of focus and pseudoaccommodation (using an extended depth-of-focus or multifocal/trifocal IOL) to reduce dependence on glasses. This review introduces the rationale and theoretical basis for FOB, including the interplay of depth of focus and optical aberrations, binocular summation, ocular dominance, and neuroadaptation. We discuss the clinical implementation of FOB: how the first-eye results guide the second-eye IOL choice in a tailored “mix-and-match” approach, as well as practical workflow considerations such as patient selection, ocular measurements, and decision algorithms. We also review current evidence from the literature on asymmetric IOL combinations (e.g., monofocal plus multifocal, or EDOF plus trifocal), highlighting visual outcomes, patient satisfaction, and remaining evidence gaps. Overall, FOB represents a paradigm shift toward binocular, patient-customized refractive planning. Early clinical reports suggest it can deliver a continuous range of vision without significantly compromising visual quality, though careful patient counseling and case selection are essential. Future directions include the integration of advanced diagnostics, artificial intelligence-driven IOL planning tools, and adaptive optics simulations to refine this personalized approach further. The promise of FOB is to improve cataract surgery outcomes by achieving an optimal balance: one that provides each patient with excellent visual quality and functional vision across distances, tailored to their lifestyle and expectations. Full article

Objectives: To evaluate the safety and efficacy of the simultaneous implantation of a monofocal capsular bag-fixated and a trifocal supplementary sulcus-fixated intraocular lens (duet procedure) in eyes with co-existing pathologies undergoing cataract or refractive lens surgery. Methods: In total, 80 eyes of 40 consecutive patients, who underwent refractive lens exchange or cataract surgery and received the duet procedure due to minor co-pathologies, were included in this retrospective case series. Preoperative assessment comprised slit-lamp biomicroscopy, optical biometry, posterior-segment optical coherence tomography, corneal endothelial specular microscopy, corneal tomography, manifest refraction and distance and near visual acuity testing. Three months postoperatively, uncorrected distance (UDVA) and uncorrected near visual acuity (UNVA) were recorded. Results: The preoperative manifest refractive spherical equivalent (MRSE) was −0.31 ± 4.29 diopters (D), with a mean refractive astigmatism of −0.80 ± 0.60 D. At three months postoperatively, monocular UDVA and binocular UNVA significantly improved from 0.52 ± 0.42 logMAR and 0.32 ± 0.27 logMAR to 0.05 ± 0.09 logMAR and −0.03 ± 0.10 logMAR, respectively (both p < 0.0001). Conclusions: Reversible multifocality provided by the duet procedure appears to be a feasible option in eyes with mild co-existing pathologies, as it yields satisfactory visual and refractive outcomes with high safety. Full article

Background/Objectives: A new, purely refractive extended depth-of-focus (EDOF) intraocular lens (IOL) was designed with a continuous change in power to bridge the gap between monofocal and multifocal IOLs. This study aimed to evaluate the real-world clinical outcomes of the new EDOF IOL compared with those of the enhanced monofocal IOL. Methods: A retrospective analysis was conducted on 100 eyes from 50 patients undergoing bilateral cataract surgery with either the PureSee™ EDOF (ZEN00V) or Eyhance™ (ICB00) monofocal IOL at a single institution. Visual acuity, defocus curves, contrast sensitivity, and patient-reported outcomes were evaluated three months postoperatively. Results: The ZEN00V group demonstrated superior uncorrected intermediate (0.11 ± 0.08 vs. 0.17 ± 0.11 logMAR, p = 0.006) and near visual acuity (0.25 ± 0.08 vs. 0.31 ± 0.13 logMAR, p = 0.023) compared to the ICB00 group, with comparable distance visual acuity. Both groups exhibited comparable defocus curves and contrast sensitivity. While photic phenomena were more frequent in the ZEN00V group, spectacle dependence was significantly lower for near vision (36% vs. 80%, p = 0.002) and comparable for intermediate and far vision. Conclusions: The PureSee™ EDOF IOL demonstrated enhanced intermediate and near vision with minimal compromise to distance vision while maintaining high contrast sensitivity. It also offered significant spectacle independence and patient satisfaction, making it a promising option for presbyopia correction. Full article

Purpose: A novel enhanced monofocal intraocular lens (IOL) has been developed to improve functional intermediate vision, maintaining a distance vision comparable to a standard monofocal lens and avoiding the drawbacks of multifocal IOLs. The aim of this study is to perform optical bench analysis and to evaluate refractive and visual outcomes and patient satisfaction. Methods: This prospective comparative single-center study was conducted in Careggi Hospital, University of Florence (Italy). We included 100 eyes from 50 patients who underwent bilateral cataract surgery. One group received the standard monofocal Tecnis GCB00 IOL, while the other group received the novel enhanced monofocal Evolux IOL. We evaluated binocular visual and refractive outcomes at 6 months after surgery. Binocular defocus curves and contrast sensitivity (CS) were also assessed. Optical quality was also analyzed in terms of higher-order aberrations (HOAs), modulation transfer function (MTF), objective scatter index (OSI), Strehl ratio, effective lens position (ELP), and halo analysis. A Patient-Reported Spectacle Independence Questionnaire (PRSIQ) was performed to assess spectacle independence outcomes. Finally, we analyzed the optical bench of both lenses. Results: All eyes implanted with Evolux achieved excellent distance vision, comparable to that achieved with GCB00. Evolux showed better intermediate and near vision, without any loss of visual quality, contrast sensitivity, or the presence of halos and photic phenomena. The optical bench analysis confirmed the different optical properties of the two lenses and supported the behavior obtained with the clinical defocus curve. Conclusions: These preliminary results show good refractive accuracy and visual outcomes for the enhanced monofocal IOL Evolux after cataract surgery. Further studies are needed to confirm our findings in terms of the number of patients and the period of follow-up. Full article

Background/Objectives: Phacoemulsification and intraocular lens (IOL) implantation comprise a standard procedure for cataract treatment. However, minimal refractive error remains a determinant of postoperative results. Our study aimed to evaluate the refractive outcomes and the impact of the surgeon’s experience and the IOL model on Kosovan and Hungarian patients after cataract surgery. Methods: This study included the preoperative and postoperative data of 1417 patients scheduled to undergo cataract surgery with IOL implantation at two centers: the Ophthalmology Department of Semmelweis University, Budapest, Hungary, and the Ophthalmology Department of the University Clinical Center of Kosovo, Prishtina, Kosovo. STATA and SPSS were used for statistical analysis. Results: The data of 1001 Hungarian and 416 Kosovan patients were included in this study. There was a statistically significant difference between the groups in the 1-month postoperative best-corrected distance visual acuity (BCDVA) (p = 0.001); in the Hungarian patients, the 1-month BCDVA was 85.2%, while in the Kosovan patients, it was 49.6%. Of the 14 different IOLs implanted in the Hungarian patients, the AcrySof IQ toric SN6AT, FineVision HP (POD F GF), and 677MTY IOLs resulted in a statistically significant positive impact on the 1-month postoperative visual acuity (p < 0.05). The AcrySof SA60AT and Akreos ADAPT AO, implanted in the Kosovan patients, had a statistically significant positive impact on the 1-month postoperative visual acuity (p < 0.05). More extensive surgeon experience had a statistically significant positive impact on postoperative outcomes (p < 0.00). Conclusions: Multifocal and toric IOLs showed superiority in terms of postoperative outcomes in our study; therefore, we conclude that greater surgeon experience, the availability of premium IOLs, and appropriate IOL selection have a considerable impact on refractive outcomes after cataract surgery. Full article

This study compares a standard monofocal intraocular lens (IOL) with two rotationally asymmetric refractive multifocal IOLs, analyzing power profiles and wavefront data across three nominal powers. Tested IOLs included monofocal Acunex AN6 and multifocal AN6V (addition +1.50 D) and AN6VM (addition +3.00 D) by Teleon Surgical, at powers +10.00 D, +20.00 D, and +30.00 D. Using NIMO TR1504, power profiles, spherical aberration, and coma were analyzed. Multifocal lenses displayed an asymmetrical design, with zones for far and near vision and a central notch for far power. The multifocal AN6V and AN6VM showed neutral spherical aberration in the center, increasing to positive values, and finally achieving negative values towards the periphery. The vertical coma coefficient [Z(3:−1)] remains almost stable for the monofocal IOLs. The lower-addition multifocal IOLs induce primary vertical coma of +0.11 microns at 3 mm away from the lens center compared to +0.21 microns obtained with the high-addition lens. We can conclude that the multifocal AN6V and AN6VM lenses display an asymmetrical design. The final addition provided by these lenses depends on its nominal power. The variation of SA with optic size is more pronounced for the monofocal model, and it is dependent on the nominal power. Full article

To demonstrate the results of ray tracing higher- and lower-order aberrations in pseudophakic eyes with rotationally asymmetrical segment multifocal lenses, total high- and low-order aberrations, measured by root mean square value (RMS), refraction, uncorrected distance and uncorrected near visual acuity (UCDVA and UCNVA), and tear break-up time, were measured at scotopic size in 42 eyes of patients implanted with bifocal refractive Mplus15/Mplus30 IOL with +1.5 dpt near addition (42 eyes of patients implanted with Mplus15)/+3.0 dpt near addition (91 eyes of patients implanted with Mplus30), and 107 eyes of control group. No significant differences were noticed between the examined groups concerning UCDVA, UCNVA, and tear break-up time (p < 0.001). Coma and total high-order aberrations were significantly higher for the Mplus30 lens in comparison to the Mplus15 lens and the control group (Coma, Trefoil p < 0.001, Secondary Astigmatism p = 0.002). The spherical aberrations were significantly higher in the lower-addition lens (p = 0.016) in comparison to the control group and to the higher-addition lens group (p < 0.001). Both intraocular lens models were successful at reaching refractive aim, good distance, and near function with the lower higher-order aberrations for the low-addition lens. Full article

Background: Corneal refractive surgery induces high-order aberrations, specifically spherical aberration (SA). These aberrations can have implications when patients later develop cataracts and require the implantation of multifocal intraocular lenses (MIOLs). MIOLs with asymmetric designs pose challenges in predicting outcomes, particularly in these cases. The aim of this study was to evaluate how different values of SA, resulting from various types of refractive surgeries, affect the optical performance of the FEMTIS Comfort intraocular lens. Methods: The through-focus modulation transfer function (TF-MTF) curve and high-contrast images of tumbling E were used as parameters to assess the optical performance of the MIOL. These parameters were measured using an adaptive optics visual simulator. Results: Increasingly negative values of SA make the MIOL more bifocal, moderating its extended-depth-of-focus characteristic. Conversely, higher positive SA values cause the TF-MTF curve to shift towards positive vergences, leading to worsened distance vision in the +1.00 to +2.00 D range, but improved vision in the +0.50 D to +1.00 D range. Conclusions: Assessing SA in patients prior to implanting MIOLs with asymmetric designs is necessary for predicting outcomes and making informed decisions based on the visual requirements of patients. Full article

Evaluating chromatic aberration for a multifocal intraocular lens (MIOL) in vitro is essential for studying its performance because it helps determine the most appropriate lens for each patient, enhancing surgical outcomes. While refractive MIOLs with angular power variation have shown positive clinical outcomes, studies of these MIOLs on optical benches primarily employed monochromatic green light, neglecting the impact of longitudinal chromatic aberration (LCA) on MIOL performance. To address this gap, we evaluated the through-focus modulation transfer function (TF-MTF) and the point spread function (PSF) of two refractive segmented extended depth of focus intraocular lenses (IOLs) (Femtis Comfort and Precizon Presbyopic), comparing the results with those obtained with two widely known diffractive multifocal intraocular lenses (AcrySof IQ ReSTOR and FineVision Pod F). Measurements of the TF-MTF were conducted using both monochromatic and polychromatic light in a customized optical bench. The refractive designs exhibited distinct haloes in the PSFs. When comparing the refractive and diffractive designs, opposite signs of LCA were observed at near foci. These findings emphasize the influence of the optical design of IOLs on their performance under polychromatic light, providing valuable information for vision care professionals when selecting the most suitable lens for each patient. Full article

Cataract or refractive lens surgery, along with the implantation of multifocal intraocular lenses (MF-IOL), enables a complete range of functional far, near and intermediate vision. Refractive, diffractive and extended depth of focus (EDoF) or combination of these principles represent the technology used to obtain this multifocality. Aberrometry makes it possible to study the aberrations induced by MF-IOLs. Among the different optical principles available to measure ocular aberrations, pyramidal wavefront-based sensor (PWS) aberrometry shows the highest resolution with MF-IOLs. Retinal image quality measured by a PWS aberrometer differed significantly according to the technology of the implanted lens. Monofocal and diffractive lenses showed the highest values of far-distance retinal image quality, followed by refractive and EDoF lenses; however, retinal image quality analysed in diffractive lenses appears to be more dependent on residual refractive error. Considering this limitation, PWS-aberrometry could be used to compare diffractive lenses. Nevertheless, further studies are needed to provide additional information about the clinical retinal image quality of MF-IOLs and to help surgeons in the important preoperative selection of IOLs. Full article

This study compares the visual and refractive performance of the TECNIS Synergy (DFR00V-DFW150-225-300-375) multifocal intraocular lens (IOL) and the AcrySof IQ PanOptix (TFAT00-30-40-50-60) multifocal IOL. Patients who underwent phacoemulsification and cataract extraction and received either a multifocal Synergy or PanOptix IOL were included. Monocular uncorrected distance (UDVA), intermediate (UIVA), near (UNVA), and corrected distance (CDVA) visual acuities were assessed at three and six months postoperatively. Secondary outcome measures of photic phenomena were also assessed. A total of 140 patients (224 eyes) were included in this study, with 69 patients (105 eyes) in the Synergy group and 71 patients (119 eyes) in the PanOptix group. There were no statistically significant differences in UIVA or CDVA measurements across all time points. When assessing UDVA, at three months postoperatively, there were more eyes in the PanOptix group with vision better than 20/40 (p = 0.04). At three and six months postoperatively, the average UNVA was superior in the Synergy group (p = 0.01, 0.002). While the Synergy group reported more night vision disturbances at one and three months (p = 0.01, 0.03), the PanOptix group had more night vision disturbances at six months (p = 0.02). Although not statistically significant, the AcrySof IQ PanOptix multifocal IOL demonstrated better UDVA and UIVA sooner postoperatively than the TECNIS Synergy multifocal IOL. The Synergy IOL provided statistically better UNVA compared to the PanOptix IOL at three and six months postoperatively. Synergy patients reported more early photic phenomena than PanOptix patients, which later diminished. Full article

Diffractive multifocal intraocular lenses (IOLs) modulate chromatic aberration and reduce it at certain distances due to interactions between the refractive and diffractive chromatic components. However, the extent to which computer modeling and on bench measurements of IOL chromatic aberration translate to chromatic aberration in patients implanted with these multifocal IOLs (MIOLs) is not yet fully understood. In this study, we compare the chromatic difference of focus and longitudinal chromatic aberrations in pseudophakic patients implanted with different IOL designs (monofocal and trifocal IOLs) and materials (hydrophobic and hydrophilic), and compared them with predictions from computer eye models and on bench measurements with the same IOLs. Patient data consisted of results from 63 pseudophakic eyes reported in four different studies and obtained psychophysically in the visual testing channel of a custom-developed polychromatic adaptive optics system. Computational predictions were obtained using ray tracing on computer eye models, and modulation transfer function (MTF) on bench measurements on physical eye models. We found that LCA (in vivo/simulated) for far vision was 1.37 ± 0.08 D/1.19 D for monofocal hydrophobic, 1.21 ± 0.08 D/0.88 D for monofocal hydrophilic, 0.99 ± 0.06 D/1.19 D for MIOL hydrophobic, and 0.82 ± 0.05 D/0.88 D for MIOL hydrophilic. For intermediate and near vision, LCA (in vivo/simulated) was 0.67 ± 0.10 D/0.75 D and 0.23 ± 0.08 D/0.19 D for MIOL hydrophobic and 0.27 ± 0.15 D/0.38 D and 0.15 ± 0.15 D/−0.13 D for MIOL hydrophilic, respectively. In conclusion, computational ray tracing and on bench measurements allowed for evaluating in vivo chromatic aberration with different materials and designs for multifocal diffractive intraocular lenses. Full article

(1) Background: This study aimed to evaluate and compare the clinical optical image quality following implantation with different premium IOLs by the analysis of the point spread function (PSF) Strehl ratio using a Pyramidal WaveFront-based sensor (PWS) aberrometer at two different pupil sizes. (2) Methods: This study included 96 eyes of 70 patients implanted with: (1) 19 AcrySof SA60AT (control group); (2) 24 LENTIS Mplus LS-313 MF30; (3) 33 LENTIS Mplus LS-313 MF15; and (4) 20 Precizon Presbyopic. Main outcome measures were PSF Strehl ratio, PSF Strehl ratio excluding second-order aberrations (PSFw2), total root-mean-square (RMS), and low- and high-order aberrations’ RMS measured by PWS aberrometer. Results: SA60AT had the highest significant PSFw2 Strehl ratio at both 3- and 4-mm pupil size (0.41 ± 0.11 and 0.28 ± 0.07) followed by LENTIS Mplus 15 (group C, 0.35 ± 0.1 and 0.21 ± 0.06) and a near tie between LENTIS MPLUS 30 (group B, 0.27 ± 0.08 and 0.18 ± 0.06) and Precizon Presbyopic (group D, 0.27 ± 0.07 and 0.17 ± 0.04). MPlus MF15 was found to be significantly better than MPlus MF30 at both 3.00 mm (p < 0.0001) and 4.00 mm (p = 0.002). (4) Conclusions: The PSFw2 represents a new tool to objectively evaluate the far distance retinal image quality of multifocal IOLs, and the far distance clinical image quality parameters measured by PWS aberrometer differed significantly according to the technology of the implanted lens. Full article

Background: Presbyopia treatment in pseudophakic patients with a monofocal IOL is challenging. This study investigates the refractive results of femto-PresbyLASIK and analyzes presbyopia treatment in pseudophakic eyes. Methods: 14 patients with 28 pseudophakic eyes were treated with femto-PresbyLASIK. The dominant eye was targeted at a distance and the non-dominant eye at −0.5 D. The presbyopic algorithm creates a steepness in the cornea center by using an excimer laser that leads to corneal multifocality. Results: 6 months after surgery a refraction of −0.11 ± 0.13 D (p = 0.001), an uncorrected distance visual acuity of 0.05 ± 1.0 logMAR (p < 0.001) and an uncorrected near visual acuity of 0.15 ± 0.89 logMAR (p = 0.001) were achieved in the dominant eye. For the non-dominant eye, the refraction was −0.28 ± 0.22 D (p = 0.002), the uncorrected distance of visual acuity was 0.1 ± 1.49 logMAR, and the uncorrected near visual acuity was 0.11 ± 0.80 logMAR (p < 0.001). Spherical aberrations (Z400) were reduced by 0.21–0.3 µm in 32% of eyes, and by 0.31–0.4 µm in 26% of eyes. Conclusion: By steepening the central cornea while maintaining spherical aberrations within acceptable limits, PresbyLASIK created a corneal multifocality that safely improved near vision in both eyes. Thus, femto-PresbyLASIK can be used to treat presbyopia in pseudophakic eyes without performing intraocular surgery. Full article