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Francisco Pastor-Pascual,1 Paz Orts-Vila,2 Pedro Tañá-Sanz,2 Santiago Tañá-Sanz,2 Pedro Tañá-Rivero2 1Cataract and Refractive Surgery Department, Oftalvist Valencia, Valencia, Spain; 2Cataract and Refractive Surgery Department, Oftalvist Alicante, Alicante, SpainCorrespondence: Pedro Tañá-Rivero, Oftalvist Alicante, Avda. Dénia 76, Alicante, 03013, Spain, Tel +34 965 14 15 00, Email rdi@oftalvist.esPurpose: To assess the refractive and visual outcomes at different distances following cataract surgery with implantation of an omnidirectional aberration-free diffractive trifocal toric intraocular lens (IOL).Methods: A total of 24 patients who underwent bilateral implantation with the TrivaT-aAY IOL were analyzed at 3– 4 months post-surgery. Refractive error, monocular and binocular uncorrected and corrected-distance visual acuity (UDVA, CDVA), uncorrected and corrected-distance intermediate visual acuity (UIVA, CDIVA) at 60 cm, uncorrected and corrected-distance near visual acuity (UNVA, CDNVA) at 40 cm, monocular and binocular defocus curve and rotational stability were measured. Patients also completed the Catquest-9SF questionnaire at the last postoperative visit.Results: The postoperative mean values of binocular logMAR CDVA, CDIVA and CDNVA were − 0.06± 0.06, 0.05± 0.07 and 0.07± 0.08, respectively. One hundred percent of patients showed a cumulative binocular CDVA ≥ 20/25, and 95.83% of patients showed a cumulative binocular CDIVA and CDNVA ≥ 20/32. The mean postoperative spherical equivalent was 0.07± 0.26D and 100% and 97.92% eyes were within ± 1.00D and ± 0.50D, respectively. The mean postoperative refractive cylinder was − 0.22± 0.29D and 100% and 89.58% eyes showed a value ≤ 1.00D and ≤ 0.50D, respectively. The defocus curves showed a wide range of useful vision, with visual acuity values > 0.2 logMAR. Mean absolute IOL rotation was 2.19± 2.17 degrees and all eyes had a rotation < 10 degrees. For the questionnaire, 95.83% of patients reported being quite satisfied to very satisfied with their vision and about 79.17% did not report any difficulty with their vision in their everyday life. Between 83.33% and 95.83% of patients reported no difficulty performing different tasks. No intra- and postoperative complications were reported during the follow-up.Conclusion: Our study shows that the TrivaT-aAY IOL provides good visual acuities at all distances and refractive outcomes with excellent rotational stability and with high satisfaction among our patients after its implantation.Keywords: astigmatism, toric, diffractive, trifocal, intraocular lens, cataract

Hakan Kaymak,1,2 Richard Potvin,3 Kai Neller,1,2 Karsten Klabe,1 Robert Donald Anello4 On behalf of the NINO Study Group1Internationale Innovative Ophthalmochirurgie GbR, Duesseldorf, Germany; 2Institute of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany; 3Science in Vision, Frisco, TX, USA; 4Global Clinical and Medical Affairs, Hoya Surgical Optics, Irvine, CA, USACorrespondence: Robert Donald Anello, HOYA Surgical Optics, 110 Progress, Suite 175, Irvine, CA, 92618, USA, Tel +1 909-224-6149, Email bob.anello@hoya.comPurpose: To evaluate clinical outcomes after bilateral or contralateral implantation of the Gemetric™ (G) and Gemetric™ Plus (GPlus) diffractive trifocal intraocular lenses (IOLs).Methods: This was a prospective, randomized, multi-center open-label study comparing clinical results and subjective patient responses around 6 months after implantation of the study lenses (toric and non-toric) in three different groups (bilateral G, bilateral GPlus and contralateral G/GPlus implantation). Results included the manifest refraction, uncorrected and distance corrected monocular and binocular visual acuity (VA) at distance, intermediate and near; the defocus curve; contrast sensitivity; and patient reported outcomes regarding spectacle independence, satisfaction and visual disturbances.Results: There was no statistically significant difference in the mean refraction spherical equivalent between the two lens models (p = 0.33) or between the toric and non-toric lenses (p = 0.06). Monocular VA was better at distance with the G lens and better at near with the GPlus lens (p < 0.01). Mean binocular VA was better than 0.1 logMAR at all distances for all groups, both uncorrected and distance corrected. The mean binocular distance corrected VA was better than 0.15 logMAR from 0.0 D to − 3.50 D for all groups. All VA data for the contralateral group was as good or better than for the bilateral GPlus group. Questionnaire results showed no difference between groups for the frequency, severity, or degree of bother of visual disturbances (p > 0.24).Conclusion: The two diffractive trifocal IOLs studied here may be used either bilaterally or contralaterally for the correction of presbyopia in cataract patients, providing excellent visual acuity with low levels of visual disturbances and high rates of overall spectacle independence. Bilateral Gemetric implantation resulted in slightly better distance and intermediate vision while contralateral implantation provided slightly better near vision. There was no apparent advantage to implanting the GPlus IOL bilaterally.Keywords: Gemetric™, Gemetric™ Plus, trifocal, presbyopia-correcting, diffractive, trifocal, Vivinex&#x2122

Santiago Tañá-Sanz, Pedro Tañá-Sanz, Maria Dolores Rodríguez-Carrillo, María Ruiz-Santos, Clara Álvarez de Toledo, Pedro Tañá-Rivero Cataract and Surgery Department, Oftalvist Alicante, Alicante, SpainCorrespondence: Pedro Tañá-Rivero, Oftalvist Alicante, C/ Angel Lozano 11, Alicante, 03001, Spain, Tel + 34 965 141 500, Email rdi@oftalvist.esPurpose: To assess refractive and visual outcomes post-cataract surgery with bilateral implantation of a bi-aspheric diffractive trifocal intraocular lens (IOL).Methods: A total of 24 patients who underwent bilateral implantation with the Asqelio Trifocal IOL TFLIO130C were evaluated at the 6 months postoperative mark. Key outcome measures included refractive error, photopic monocular and binocular uncorrected and corrected distance visual acuity (UDVA, CDVA), uncorrected and corrected intermediate visual acuity (UIVA, CDIVA) at 60 cm, and uncorrected and corrected near visual acuity (UNVA, CDNVA) at 40 cm. Additionally, monocular and binocular CDNVA were assessed under mesopic conditions. Monocular and binocular defocus curves, and binocular contrast sensitivity under photopic and mesopic conditions, with and without glare, were measured. Catquest-9SF and visual symptoms questionnaires were also administered.Results: Postoperative average values of binocular logMAR photopic CDVA, photopic CDIVA, photopic CDNVA and mesopic CDNVA were − 0.01± 0.06, 0.03± 0.09, 0.02± 0.05 and 0.19± 0.13, respectively. About 100% of patients showed cumulative CDVA and CDNVA ≥ 20/25, and CDIVA ≥ 20/32. The average absolute depth-of-focus was about 4.50D. The average postoperative spherical equivalent was 0.05± 0.30D and 100% and 93.75% eyes were within ± 1.00D and ± 0.50D, respectively. Contrast sensitivity was either within or above normal levels under both photopic and mesopic conditions, both with and without glare, except for 12 cpd under mesopic conditions with glare where the mean falls just below the normal range. Questionnaires revealed that 87.5% of patients were either satisfied or very satisfied with their vision after the surgery, and higher percentages for no difficulty in performing different activities, ranging from 70.83% to 95.83%, were reported.Conclusion: This study demonstrates that the bi-aspheric diffractive trifocal IOL yields very good visual performance across distances, fostering high satisfaction levels and minimal difficulties in daily activities.Keywords: trifocal, diffractive, intraocular lens, phacoemulsification, cataract

Francisco Pastor-Pascual,1 Paz Orts-Vila,2 Pedro Tañá-Sanz,2 Santiago Tañá-Sanz,2 Pedro Tañá-Rivero2 1Cataract and Refractive Surgery Department, Oftalvist Valencia, Valencia, Spain; 2Cataract and Refractive Surgery Department, Oftalvist Alicante, Alicante, SpainCorrespondence: Pedro Tañá-Rivero, Oftalvist Alicante, Avda. Dénia 76, Alicante, 03013, Spain, Tel/Fax +34 965 14 15 00, Email rdi@oftalvist.esPurpose: To evaluate the refractive and visual outcomes following cataract surgery and implantation of a diffractive trifocal intraocular lens (IOL) with a 7.0 mm optical zone.Methods: A total of 23 patients who underwent bilateral implantation with the Triva-aXAY IOL were analyzed at 6 months post-surgery. The main outcome measures were refractive error, monocular and binocular uncorrected and corrected-distance visual acuity (UDVA, CDVA), uncorrected and corrected-distance intermediate visual acuity (UIVA, CDIVA) at 60 cm, uncorrected and corrected-distance near visual acuity (UNVA, CDNVA) at 40 cm, and binocular defocus curve. Patients also completed the Catquest-9SF questionnaire.Results: All eyes were within ± 1.00D, and 91.30% of eyes within ± 0.50D, with a mean postoperative spherical equivalent of – 0.14± 0.29D. Similarly, 95.65% of patients showed a binocular UDVA ≥ 20/25, compared to 100% for CDVA, and the mean binocular UDVA and CDVA were 0.02± 0.06 and 0.00± 0.05 logMAR, respectively. At intermediate vision, 65.22% of patients showed a binocular UIVA ≥ 20/25, compared to 86.96% for CDIVA, and the mean binocular UIVA and CDIVA were 0.07± 0.06 and 0.06± 0.06 logMAR, respectively. At near, 95.65% of patients showed a binocular UNVA and CDNVA ≥ 20/25, with a mean binocular UDNVA and CDNVA of 0.04± 0.07 and 0.02± 0.05 logMAR, respectively. Finally, 95.65% of patients reported being quite satisfied to very satisfied with their vision and about 74% did not report any difficulty with their vision in their everyday life. Between 65.22% and 100% of patients reported no difficulty performing different tasks.Conclusion: Our study shows good visual and refractive outcomes with high satisfaction in patients implanted with the Triva-aXAY IOL with a 7.0 mm optical zone.Keywords: large optic, diffractive, trifocal, intraocular lens, cataract

Joaquin O De Rojas,1 Helga P Sandoval,2 Richard Potvin,3 Kerry D Solomon2 1Center for Sight/US Eye, Sarasota, FL, USA; 2Carolina Eyecare Physicians/US Eye, Mt. Pleasant, SC, USA; 3Science in Vision, Bend, OR, USACorrespondence: Joaquin O De Rojas, Center for Sight, PL, 2601 S. Tamiami Trail, Sarasota, FL, 34239, USA, Email jderojas@centerforsight.netPurpose: To evaluate vision, visual quality, patient satisfaction and spectacle independence after bilateral implantation of the TECNIS Synergy™ intraocular lens.Setting: Two clinical practices in the USA.Design: Ambispective unmasked non-randomized clinical trial.Methods: Patients with a history of uneventful bilateral femtosecond laser assisted cataract surgery with the study IOL implanted, targeted for emmetropia, at least 3 months prior to the study visit were enrolled. Monocular and binocular visual acuity (VA) were measured at distance, intermediate and near, along with binocular mesopic VA. Low contrast binocular VA and reading speed in mesopic and photopic conditions were also measured. Patient satisfaction, spectacle independence, visual symptoms, and functional vision questionnaires were completed.Results: Results from 52 subjects were available for analysis. Mean binocular unaided visual acuity was ~0.1 logMAR (20/20) from distance to 33 cm, with 81% of subjects having 0.2 logMAR (20/25) vision or better at all test distances and 92% reporting never needing glasses at any distance. Average reading speed at 40 cm was only 10 words/minute slower in dim light (p = 0.03). Mesopic and low contrast acuity appeared good. Halos were the most frequent and bothersome visual disturbances, with the greatest effect on driving at night. Eighty-eight percent of subjects reported being “completely” or “mostly” satisfied with their overall unaided vision.Conclusion: This hybrid technology IOL provided a range of binocular visual acuity from distance to 33 cm and good functional vision, even in dim light. Patients should be advised of the likelihood of visual disturbances, particularly halos.Keywords: synergy, multifocal IOL, diffractive, hybrid technology

AIM: To evaluate the retinal image of two types of aspheric diffractive multifocal intraocular lens(IOL).METHODS: Retrospective cohort study. Totally 155 cases of simple cataract who received phacoemulsification combined with IOLs implantation from October 2017 to October 2019. They were divided into three groups according to the types of IOL: Aspheric Bifocal Diffractive Group: 54 patients(54 eyes); Aspheric Trifocal Diffractive Group: 54 patients(54 eyes); Aspheric Monofocal Group: 47 patients(47 eyes). All patients were evaluated postoperatively at 6mo. Double-pass visual quality analysis system was used to evaluate OSI, MTF cutoff, Strehl Ratio, OV 100%, OV 20% and OV 9% respectively. Uncorrected distance visual acuity(5m), uncorrected intermediate visual acuity(80cm), uncorrected near visual acuity(40cm), corrected distance visual acuity, distance-corrected intermediate visual acuity, distance-corrected near visual acuity were measured and compared among three groups. Visual function-14 was also assessed.RESULTS:Both of bifocal and trifocal groups had similar MTF cutoff(P=0.445), OV 100%, OV 20% and OV 9%(OV 100%: P=0.974; OV20%: P=0.713; OV 9%: P=0.947). Monofocal group had better MTF cutoff(P=0.007), OV 100%(P=0.001), OV 20%(P=0.002)and OV 9%(P=0.011)than bifocal. Besides, monofocal group had better MTF cutoff(P=0.043), OV 100%(P=0.012), OV 20%(P=0.043)and OV 9%(P=0.029)than trifocal group. There was no difference among all groups in uncorrected distance visual acuity and corrected distance visual acuity(P=0.054, 0.180). There was difference in distance-corrected intermediate(H=91.292, P

Sunny B Patel,1 Michael E Snyder,1,2 Christopher D Riemann,1,2 Robert E Foster,1,2 Robert A Sisk1,2 1Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA; 2Cincinnati Eye Institute, Cincinnati, OH, USA Purpose: The purpose of this study was to evaluate the functional and anatomical outcomes of combined phacovitrectomy with multifocal intraocular lens (mfIOL) implantation.Methods: Retrospective, interventional, non-comparative case series of six eyes that received a combined phacoemulsification surgery with apodized, diffractive mfIOL implantation for cataract and pars plana vitrectomy (PPV) with membrane peeling for epiretinal membrane (ERM). Outcome measures included distance and near visual acuities (DVA and NVA), central macular thickness (CMT), intraocular pressure (IOP), and disruption of external limiting membrane (ELM) or inner-segment outer-segment (IS/OS) junction.Results: Mean logMAR glare DVA improved from 0.40 (Snellen 20/50) preoperatively to a mean uncorrected DVA of 0.038 (Snellen 20/22) (P=0.004) at 6 months after surgery. All eyes achieved NVA of J2 or better by 12 months postoperatively. Median CMT improved by 10 µm and mean IOP increased by 1 mmHg at 12 months postoperatively. Percentage of patients with ELM or IS/OS disruptions decreased from 66.7% to 33.3%. Two eyes demonstrated residual metamorphopsia on Amsler grid testing postoperatively. Postoperatively, four eyes required laser capsulotomy and one required LASEK for refractive correction.Conclusion: Combined phacovitrectomy, membrane peeling, and mfIOL implantation improved VA in patients with idiopathic ERM. Multifocality was achieved, but final visual outcome was delayed due to posterior capsular opacification and macular healing. Keywords: cataract, combined, epiretinal membrane, multifocal intraocular lens, phacoemulsification, phacovitrectomy

AIM: To evaluate clinical outcomes after implantation of a new diffractive aspheric multifocal intraocular lens (IOL) with +3.00 addition power. METHODS: This is a retrospective, consecutive case series of cataract patients who underwent bilateral implantation of the Optiflex MO/HF D012 (Moss Vision Inc. Ltd, London, UK) multifocal IOL. Patients followed for 6mo were included in the study. Data on distance, intermediate and near visual acuity, refractive error [manifest spherical equivalent (MSE)], contrast sensitivity, adverse events, subjective symptoms, spectacle independence and patient satisfaction [visual function questionnaire (VFQ)-25 questionnaire] were retrieved from electronic medical records and analyzed. RESULTS: Forty eyes of 20 patients with a mean age of 66.7±8.5y (range: 53-82) were included in the study. Mean uncorrected distance, near and intermediate visual acuity remained stable through postoperative visits and was 0.19±0.19 logMAR, Jaeger 4 and Jaeger 3 respectively at the 6mo visit. At the end of postoperative 6mo, MSE was -0.14±0.42 diopters (D) and 98% of the eyes were within 1.00 D of target refraction. Postoperative low contrast (10%) visual acuity remained stable (P=0.54) through follow up visits with a mean of 0.35±0.17 logMAR at the 6mo visit. There were no reported adverse events. None of the patients reported subjective symptoms of halo or glare. Spectacle independence rate was 90%. Mean VFQ-25 questionnaire score was 93.5±6.12. CONCLUSION: The Optiflex MO/HF-DO12 IOL was safely implanted and successfully restored distance, intermediate and near visual acuity without impairing contrast sensitivity. High levels of spectacle independence were achieved at all distances including intermediate distance.

AIM:To research the efficacy and safety of diffractive aspheric multifocal intraocular lens(MIOL)in the Uighur in phacoemulsification to provide guidance for the clinical treatment of cataracts patients in Xinjiang region. METHODS:Two hundred and twenty-eight Uygur patients(280 eyes)received phacoemulsification from April 2012 to March 2013 were randomly divided into multifocal group(106 cases with 146 eyes)and monofocal group(122 cases with 134 eyes). Patients were followed up for 3mo. The intraocular pressure(IOP), uncorrected distance visual acuity, uncorrected near vision, best-corrected distance visual acuity and best corrected near vision were measured. The delensed rate, visual quality, and satisfaction for lenses in the form of questionnaires were compared. RESULTS:Multifocal group was better on the uncorrected near vision than monofocal group(PP>0.05). The contrast sensitivity of multifocal group under scotopia at spatial frequency 3c/d was lower than that of monofocal group(PP>0.05). Delensed rate of multifocal group was higher than that of monofocal group(PP>0.05).CONCLUSION:MIOL with phacoemulsification can provide patient good full range vision, especially on good near vision. The patients with MIOL implanted have a higher delensed rate, less postoperative adverse symptoms, quicker recovery and satisfaction.

The continued development of new intraocular lens (IOL) material and design has provided cataract surgeons more lens-based options than ever before. Surgeons must carefully evaluate, which IOLs may be the best for their patients and their practices. The roles of refractive index, water content, optic coloration (blue- or violet-light-blocking), and design of acrylic IOLs are widely debatable among surgeons. Ease of use, availability, cost, and surgeon preference are also important factors that influence surgeons′ IOL selection.