April 2018


Presentation spotlight
Novel EDOF trifocal IOL may meet demands for improved intermediate vision

by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer


Monocular and binocular defocus curves of the AT LISA 829 show a wide range of vision from distance to near intermediate
(60 cm).

McAlinden questionnaire results for dysphotopsia questions show a low degree of subjective disturbances.
Source: Florian Kretz, MD

IOL study shows high patient satisfaction and spectacle independence for distance and intermediate visual ranges in presbyopic patients

Reducing spectacle dependency in presbyopic patients is a major focus of cataract surgery. Presbyopic patients are more active than ever, making low compromise, full range of vision artificial lenses highly sought after. The reliance on computers, dashboards, and smartphones in everyday life has rendered spectacle-free intermediate vision more important for patient satisfaction. As the demands for better intermediate vision continue to rise, new IOL technologies promise to help meet these expectations.

Seventeen eyes

A new study that evaluated the postoperative functional results and patient satisfaction after implantation of a novel extended depth of focus (EDOF) trifocal IOL, the AT LARA 829 (Carl Zeiss, Meditec, Jena, Germany), demonstrated enhanced intermediate range visual acuity with less optical phenomena than other multifocal IOL models. According to Florian Kretz, MD, Augenärzte Gerl, Kretz & Kollegen, Rheine-Ahaus, Germany, who conducted the study and was the lead author of an e-poster presented at the XXXV Congress of the ESCRS, patients who chose intermediate and distance vision over near were best suited for this lens.
“Patients with a high demand for distance and up to 60 cm intermediate vision who are accepting of reading glasses but still want the best possible option for high optical quality are ideal candidates for this novel EDOF IOL,” Dr. Kretz said.
Dr. Kretz’ study included 17 eyes of 10 patients (four female and six male) with a median age of 69 years (age range: 51–78 years). He evaluated post-refractive results and functional results including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) at 4 meters, uncorrected near visual acuity (UNVA), distance corrected near visual acuity (DCNVA) at 40 cm, distance corrected intermediate visual acuity (DCIVA) at 90 cm, 80 cm, and 60 cm, defocus curve, HD Analyzer (Visiometrics, Costa Mesa, California), halo and glare simulator, and subjective questions.
The preoperative median sphere was +1.5 D, ranging from –1.0 to +4.0 D, the median cylinder was –0.75 D, ranging from –4.0 to –0.25 D, and the median spherical equivalent was 0.875 D, ranging from –1.5 to +0.875 D.


The AT LARA 829 IOL is a next generation EDOF IOL. It promises a wider range of focus within the EDOF segment with less visual side effects and dysphotopsias than multifocal IOLs (MFIOLs). The reason for this lies in the optic design of the AT LARA that includes smooth microphase technology to minimize light scatter and therefore halos and glare. The device has an aberration neutral aspheric design and advanced chromatic correction for optimized contrast sensitivity.
Outcomes with the AT LARA 829 revealed that in all 17 eyes the cumulative spherical equivalent was within –0.75 D to +0.75 D. In 88%, the spherical equivalent was between –0.5 D and +0.5 D, and in 82% it was within –0.25 D to +0.25 D. Just over half of the study eyes (53%) has a spherical equivalent within –0.125 D to +0.125 D, indicating high overall stability and demonstrating a high grade of optimization of the IOL calculation formulas.
Visual acuity (monocular, n=17) outcomes revealed logMAR 0.00 for both corrected and uncorrected distance vision. Intermediate visual acuity (distance corrected) was logMAR 0.05 at 90 cm, logMAR 0.10 at 80 cm, and logMAR 0.12 at 60 cm. Near (40 cm) visual outcomes (distance corrected) were logMAR 0.40, and uncorrected near visual acuity was logMAR 0.49. The binocular (n=7) outcomes largely mirrored those achieved monocularly for distance and near visual acuities. The greatest differences were seen in intermediate visual acuity; binocular distance corrected intermediate vision was logMAR –0.05 at 90 cm and logMAR 0.03 at 60 cm distances.
“The defocus curve shows the range of focus that patients can see with this IOL,” Dr. Kretz said. “As diopter values can be calculated in meters, it gives you a precise view of the distances the patients can see. With the AT LARA patients had a high level of visual acuity ranging from distance to 60 cm.”

Patient satisfaction

Patient satisfaction and subjective observations are a big part of what makes for successful surgery with MFIOLs. Dr. Kretz employed the McAlinden questionnaire to gauge patient satisfaction. According to the questionnaire, 100% of the patients (n=10) were spectacle free for both distance and intermediate vision. When it came to reading glasses, 71% needed spectacles and 29% were spectacle free. When asked how often they wore glasses for distance or intermediate distances, 86% responded “never” and 14% said “seldom.” For near visual activities, 43% of the patients said that they “never” used glasses, 29% said “seldom,” and 28% said “most of the time.” When asked if they would pick a multifocal again if they could choose, 100% responded “yes.”
Multifocals have been known to cause unwanted optical phenomena, including halo, glare, and starbursts. While the AT LARA is optimized to reduce these effects, patient sensitivity can still play a substantial role in how optical phenomena are perceived. When asked how often they experienced glare, 71% of patients said “occasionally,” and 29% said “never.” Halo was experienced “occasionally” in 29% of patients, “never” in 57%, and “quite often” in 14% of the study patients. Starburst was noted “occasionally” in 29% and “never” in 71%. Glare was considered “sometimes” severe in 71% of patients and “never” severe in 29%. Halo was considered “occasionally” severe in 43% and “never” severe in 57%. Starburst was “never” severe in 72% of the study patients, “occasionally” severe in 14%, and “quite often” severe in 14%. When asked how bothersome they considered these optical phenomena, 57% said the glare they experienced was “occasionally” bothersome, and 43% said it was “never” bothersome. Halo was “occasionally” bothersome in 43% and “never” in 57%. Starburst was “never” bothersome according to 71% of the patients and “occasionally” bothersome in 29%.
“The new AT LARA EDOF IOL offers us an additional option for individualized patient care thanks to the enhancement of intermediate visual acuity,” Dr. Kretz said. “This novel IOL design is associated with reduced optical phenomena, according to the McAlinden questionnaire results, with increased optical performance for distance and intermediate ranges. It causes less halo and glare perception in my experience than the Tecnis Symfony EDOF IOL [Johnson & Johnson Vision, Santa Ana, California]. A mix and match approach may be a good option for further enhancement of the range of focus, which we did not opt for in this small sample size.”

Editors’ note: Dr. Kretz has financial interests with Alimera Sciences (Alpharetta, Georgia), Carl Zeiss Meditec, Glaukos (San Clemente, California), Oculentis (Berlin, Germany), and Polytech Domilens (Rossdorf, Germany).

Contact information

Kretz: f.kretz@augenklinik.de

Novel EDOF trifocal IOL may meet demands for improved intermediate vision Novel EDOF trifocal IOL may meet demands for improved intermediate vision
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