September 2018

REFRACTIVE

Presentation spotlight
Two trifocals tested and compared


by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer


Implanted AT LISA tri
Source: Breyer Kaymak Klabe Augenchirurgie



European cataract surgeons
have had great outcomes using trifocal IOLs, and some of the first comparative studies are out, allowing physicians to gauge the differences in these IOLs and choose the right technology for patients.

The trifocal AcrySof IQ PanOptix IOL matched the AT LISA diffractive IOL for intermediate and far visual acuity and showed an advantage for near vision in study

Trifocal IOLs may be a patient’s best bet for achieving a full range of vision. Spectacle-free intermediate vision is arguably the most sought after visual correction among patients opting for premium lenses, allowing them to carry out the majority of their daily activities without the use of glasses. However, surgeons have found that striving to attain spectacle independence using MFIOLs usually comes at the price of diminished far or near visual performance. European cataract surgeons have had great outcomes using trifocal IOLs, and some of the first comparative studies are out, allowing physicians to gauge the differences in these IOLs and choose the right technology for patients.
Data from a study that compared a newer model diffractive IOL with an older model that were first presented as an e-poster at the 22nd ESCRS Winter Meeting demonstrated good outcomes in near, intermediate, and far visual acuity, and underlined how a thorough understanding of MFIOL capacity is essential in meeting each patient’s visual needs.
Detlev Breyer, MD, Breyer, Kaymak & Klabe Eye Surgery and Premium Eyes, Düsseldorf, Germany, the first author of the e-poster, said that both trifocal IOLs offered a broad range of good binocular vision.

Study data

The study involved the implantation of the AcrySof IQ PanOptix (Alcon, Fort Worth, Texas) in 20 eyes and the AT LISA tri (Carl Zeiss Meditec, Jena, Germany) in 372 eyes. The male to female ratio in the AcrySof IQ study group was 34:66, and the patients had a mean age of 59.2 ± 10.7 years. In the AT LISA group, the male to female ratio was 50:50 with a mean patient age of 64.4 ± 7.2 years.
The mean spherical equivalent (SE) in the AcrySof IQ group was –0.4 ± 3.9 D, and the mean cylinder was –1.1 ± 1.0 D. Preoperatively, the corrected distance visual acuity (CDVA) was logMAR 0.20 ± 0.18 and the uncorrected distance visual acuity (UDVA) was logMAR 0.62 ± 0.40. The mean IOL power used in the group was 20.6 ± 5.2 D and the target SE was –0.13 ± 0.20 D.
AT LISA patients had a mean SE of 0.4 ± 3.8 D and a mean cylinder of –0.4 ± 0.3 D. The group had a mean CDVA of logMAR 0.15 ± 0.20 and a mean UDVA of logMAR 0.71 ± 0.32. The mean IOL power was 22.2 ± 3.9 D, and the target SE was –0.13 ± 0.25 D.

Predictable visual outcomes

According to Dr. Breyer, the predictability of an intraocular device can be calculated by subtracting the target SE from the actual postoperative SE. In the 20 PanOptix patients, the difference in SE was –0.19 ± 0.54 D, while in 269 AT LISA patients, the difference between target and postoperative SE was 0.08 ± 0.62. The difference in SE was less than or equal to 0.5 D in 70.0% of PanOptix patients and 66.2% of AT LISA patients; it was less than or equal to 1.0 D in 90% of PanOptix patients and in 93.3% of AT LISA patients. The study showed a comparable deviation from target refraction after 3 months, with slight but significant undercorrection in the PanOptix group (p<.05). Dr. Breyer thinks that more data is needed.
The outcomes from binocular defocus curves revealed that the PanOptix eyes (n=10) achieved significantly better near vision (p<.05) than AT LISA eyes did. The AT LISA eyes (n=36) achieved slightly better outcomes for far visual acuity. Both lenses demonstrated similar MFIOL capacities and showed vast improvements for intermediate and near vision when compared to monofocal IOLs.

Halo and glare simulation

Glare and halo have proven to be the most common grounds for MFIOL explantation. Knowing an IOL’s capacity to induce these bothersome side effects, therefore, has enormous practical value. Using simulation software, Dr. Breyer and his colleagues investigated halo and glare effects in 126 phakic, 52 AT LISA, and 12 PanOptix eyes. The simulation software subjectively matched patient photopsias (binocular, uncorrected eyes) via a graphic user interface. The intensity of visual effects was categorized as none, mild, moderate, or severe.
According to the simulation, approximately 25% of phakic eyes had no glare or halo. Mild glare and halo effects were observed in roughly 60% of the phakic eyes, 25% of the PanOptix eyes, and just below 25% of the AT LISA eyes. Moderate glare and halo were observed in roughly 10% of the phakic eyes, and in more than 60% of both the AT LISA and PanOptix eyes. Severe glare and halo were reported in less than 10% of the AT LISA eyes only.

Comparison

The AT LISA tri diffractive trifocal IOL achieved a UDVA of logMAR –0.03 ± 0.10, an uncorrected intermediate visual acuity (UIVA) of logMAR 0.08 ± 0.08, and a UNDA of logMAR 0.10 ± 0.10. The MFIOL capacity was 83%, when tested monocularly and with correction, and it was 88% when tested binocularly without correction. Halo and glare strength were 57% ± 11%.
The PanOptix diffractive trifocal IOL had a UDVA of logMAR 0.01 ± 0.06, a UIVA of logMAR 0.02 ± 0.02, and a UNVA of logMAR 0.05 ± 0.10. The MFIOL capacity was 80% when tested monocularly and with correction, and 94% when tested binocularly without correction. The halo and glare strength were 54 ± 11%.
“Both lenses provided a broad range of good binocular vision,” Dr. Breyer said. “The AT LISA tri proved slightly better for far vision, while the PanOptix was better at near and intermediate ranges, which was in agreement with tested optical bench measurements.1 Halo and glare were comparable for both diffractive IOLs but significantly stronger than for phakic eyes (30% ± 16%). It is important to be aware that a postoperative period of several months may be needed for satisfying neuroadaptation, as one study has shown.2
According to the outcomes of an unrelated comparative study that investigated the optical performance of three trifocal IOLs, the AcrySof IQ PanOptix, the AT LISA tri, and the FineVision Micro (PhysIOL, Liege, Belgium), the AcrySof IQ PanOptix showed equivalent or better performance in image quality, resolution, and photic phenomena compared with the other two trifocal IOLs. The study’s investigators predicted the PanOptix to provide better intermediate vision at 60 cm, compared to the 80 cm distance offered by the other two lenses.

References

1. Carson D, et al. Optical bench performance of 3 trifocal intraocular lenses. J Cataract Refract Surg. 2016;42:1361–1367.
2. Rosa AM, et al. Functional magnetic resonance imaging to assess neuroadaptation to multifocal intraocular lenses. J Cataract Refract Surg. 2017;43:1287–1296.

Editors’ note: Dr. Breyer has no financial interests related to his comments.

Contact information

Breyer: premiumeyes@augenchirurgie.clinic

Two trifocals tested and compared Two trifocals tested and compared
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