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Takeshi Teshigawara,1– 3 Akira Meguro,3 Nobuhisa Mizuki3 1Department of Ophthalmology, Yokosuka Chuoh Eye Clinic, Yokosuka, Kanagawa, 238-0008, Japan; 2Tsurumi Chuoh Eye Clinic, Yokohama, Kanagawa, 230-0051, Japan; 3Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa, 236-0004, JapanCorrespondence: Takeshi TeshigawaraDepartment of Ophthalmology, Yokosuka Chuoh Eye Clinic, 2-6 Odaki-cho, Yokosuka, Kanagawa, 238-0008, JapanTel +81 46 827 4001Fax +81 46 827 4141Email teshitake@gmail.comPurpose: Halos are a chief source of patient dissatisfaction after multifocal intraocular lens (IOL) implantation. The primary purpose of this study was to investigate the influence of age, postoperative refraction, and pre- and postoperative pupil size on postoperative halo size with a trifocal diffractive IOL (AcrySof IQ PanOptix) and extended depth-of-focus (EDOF) IOL (TECNIS Symfony) to determine whether these factors could predict postoperative halo size.Patients and Methods: This single-center, open-label study conducted between October 2018 and April 2020 in Yokosuka, Japan included 160 patients: 80 with PanOptix and 80 with Symfony IOLs. Size and intensity of the halos were examined binocularly using a computer-based simulator (Eyeland Design Network GmbH) and scored from 0 (minimum) to 10 (maximum) at 1, 3, and 6 months postoperatively, along with the change in each variable for both IOLs. The respective correlations of halo size with age, postoperative refraction, pre- and postoperative pupil size, and discomfort level due to the halo were also investigated 6 months postoperatively.Results: Halo size and intensity were significantly mitigated between 1, 3, and 6 months postoperatively. Throughout the observation period, halo size was significantly larger with PanOptix than with Symphony (P < 0.05), and halo intensity was significantly higher with Symphony than with PanOptix (P < 0.05). The pre- and postoperative pupil size correlated positively with halo size, while age and postoperative refraction were negatively correlated, for both IOLs.Conclusion: Understanding the features and predictive preoperative factors of halos in different types of multifocal IOLs may be useful in improving patient satisfaction.Keywords: halo size, multifocal intraocular lens, biometric predictable factors, trifocal intraocular lens, extended depth-of-focus intraocular lens, photic phenomena, halo

Purpose: To evaluate the visual quality and performance of TECNIS Symfony intraocular lenses (IOLs) implanted with or without micro-monovision approach. Setting: Chongqing Aier Mega Eye Hospital, Chongqing, China; Daping Hospital of Army Medical University, Chongqing, China. Design: Prospective study. Methods: The study comprised 70 cataract patients who had bilateral implantation of TECNIS Symfony extended range of vision IOLs, either with intended micro-monovision (monovision group: 35 patients) or with intended emmetropia (control group: 35 patients). Visual acuity, modulation transfer function (MTF), defocus curve, spectacle independence, and photic phenomena were analyzed 3 months postoperatively. Results: There was no significant difference between the two groups in binocular uncorrected visual acuity at distance. Mean binocular uncorrected visual acuity at intermediate (monovision: 0.81 dec; control: 0.58 dec) and near (monovision: 0.59 dec; control: 0.30 dec) were significantly better in the monovision group. In the monovision group, the difference of MTF values between the dominant and the non-dominant eyes was not statistically significant and MTF values were within the normal range for both eyes. Spectacle independence at intermediate and near was statistically significantly higher in the monovision group compared to the control group. The incidence of photic phenomena was similar in both groups. Conclusion: Micro-monovision implantation of TECNIS Symfony IOLs provided a superior range of visual acuity from far to near and higher spectacle independence compared to a control group targeted for emmetropia., Competing Interests: Dr Tan reports grants from Aier Eye Group Co. Ltd, during the conduct of the study outside the submitted work. The authors report no other conflicts of interest in this work.

Purpose: The purpose of this study was to evaluate the visual, refractive, and aberrometric outcomes as well as the level of patient satisfaction and photic phenomena after myopic laser in situ keratomileusis (LASIK) surgery using wavefront-guided (WFG) ablations based on measurements obtained with a high-resolution aberrometer., Patients and Methods: This study was a prospective analysis including 253 eyes of 127 patients (aged between 19 years and 54 years) undergoing WFG LASIK using the STAR S4 IR Excimer Laser System combined with the iDesign System and iFS Femtosecond Laser. Visual, refractive, and aberrometric outcomes during a 2-month follow-up as well as patient satisfaction and photic phenomena were evaluated by means of a questionnaire., Results: A total of 85% (215/253) and 99% (251/253) of eyes achieved a postoperative (Postop) uncorrected distance visual acuity of 20/16 and 20/20, respectively, and all eyes achieved an uncorrected distance visual acuity of 20/25. Postop spherical equivalent values were within ±0.25 D and ±0.50 D in 97% and 100% of eyes, respectively. Likewise, manifest cylinder was <0.25 D in 97% (245/253) of eyes. A statistically significant reduction was found in the total root mean square ( P <0.001) and in the level of primary spherical aberration ( P =0.001). Postop difficulties related to vision were graded as minimal, with low levels of photic phenomena and high levels of patient satisfaction. The level of difficulty to perform daily activities and the level of glare perceived by patients while driving car were significantly decreased ( P <0.001)., Conclusion: WFG LASIK surgery using the technology evaluated is predictable and effective for the correction of myopia and leads to high levels of patient satisfaction., Competing Interests: The authors report no conflicts of interest in this work.