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Hiroko Bissen-Miyajima,1 Yuka Ota,1 Saori Yaguchi,1 Kunihiko Nakamura,1 Noriyuki Sasaki2 1Department of Ophthalmology, Tokyo Dental College Suidobashi Hospital, Tokyo, Japan; 2Alcon Japan Ltd, Tokyo, JapanCorrespondence: Hiroko Bissen-Miyajima, Department of Ophthalmology, Tokyo Dental College, Suidobashi Hospital, Kandamisaki‑cho 2‑9‑18, Chiyoda‑ku, Tokyo, 101‑0061, Japan, Tel +81-3-5275-1856, Email bissen@tdc.ac.jpPurpose: To evaluate the effectiveness and safety of the AcrySof IQ PanOptix toric intraocular lens (IOL) with cylinder power of 1.0 D (TFNT20) in a Japanese population with low corneal astigmatism and compare with historical control data for nontoric IOLs.Setting: Tokyo Dental College Suidobashi Hospital, Tokyo, Japan.Design: Prospective, single-center study.Methods: Patients ≥ 20 years old received TFNT20 IOL in at least 1 eye based on Alcon Toric calculator (Holladay Total surgically induced astigmatism). Effectiveness endpoints included the percentage of eyes with refractive cylinder ≤ 0.25 D at 30– 60 days after surgery, which was compared with a historical control threshold rate of 29.2% for nontoric IOLs and refractive cylinder ≤ 0.50 D. Monocular uncorrected distance visual acuity (UDVA; 5 m), uncorrected intermediate visual acuity (UIVA; 60 cm), uncorrected near visual acuity (UNVA; 40 cm), and adverse events were evaluated.Results: Of 41 eyes implanted with TFNT20 IOLs, 37 eyes (90%) achieved refractive cylinder ≤ 0.25 D at 30– 60 days after surgery, demonstrating the superiority of TFNT20 compared with historical data (P< 0.0001). Refractive cylinder of ≤ 0.50 D was achieved by 41 eyes (100%). At 30– 60 days, mean ± SD monocular CDVA was − 0.15 ± 0.07 logMAR, UDVA was − 0.09 ± 0.09 logMAR, UIVA was − 0.00 ± 0.07 logMAR, and UNVA was 0.03 ± 0.07 logMAR. Six eyes (15%) had elevated postoperative intraocular pressure, which returned to normal and was not device-related.Conclusion: TFNT20 IOLs successfully reduced postoperative refractive cylinder and provided good distance, intermediate, and near uncorrected VAs in Japanese patients with low corneal astigmatism.Keywords: trifocal IOL, toric IOL, low corneal astigmatism, toric calculator, visual acuity

Thomas Kohnen,1 Ruth Lapid-Gortzak,2 Dandapani Ramamurthy,3 Hiroko Bissen-Miyajima,4 Andrew Maxwell,5 Tae-Im Kim,6 Satish Modi7 1Department of Ophthalmology, Goethe-University, Frankfurt, Germany; 2Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, Netherlands; 3The Eye Foundation, Coimbatore, Tamil Nadu, India; 4Department of Ophthalmology, Tokyo Dental College Suidobashi Hospital, Tokyo, Japan; 5The California Eye Institute, Fresno, CA, USA; 6Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea; 7Seeta Eye Centers, Poughkeepsie, NY, USACorrespondence: Thomas Kohnen, Department of Ophthalmology, Goethe University, Theodor‑Stern-Kai 7, Frankfurt, 60590, Germany, Tel +49 69 6301 6739/ 3945, Fax +49 69 6301 3893, Email thomas.Kohnen@kgu.dePurpose: To investigate visual and safety outcomes of AcrySof® IQ PanOptix® (model TFNT00), a trifocal, presbyopia-correcting intraocular lens (IOL), in patients of different ethnicities across multiple countries, based on a pooled analysis of six prospective multicenter studies.Patients and Methods: This pooled analysis included adult patients from six prospective clinical studies performed across 56 centers worldwide. After cataract removal by phacoemulsification, all patients were implanted with TFNT00; follow-up duration varied from 3 to 12 months according to the studies’ design. Binocular defocus curve; absolute manifest refraction spherical equivalent (MRSE); and binocular photopic uncorrected and corrected visual acuities at distance (UCDVA, BCDVA; 4– 5 m), intermediate (UCIVA, DCIVA; 60– 66 cm), and near (UCNVA, DCNVA; 40 cm) were measured.Results: The study included 557 patients, 547 of whom were implanted bilaterally with the TFNT00 IOL (n = 1094 eyes). Binocular visual data at 1 month and 3– 6 months after implantation were available for up to 546 and 542 bilaterally implanted patients, respectively. A continuous range of 0.1 logarithm of the minimum angle of resolution (logMAR) or better vision from distance (0.00 diopter [D], 4– 5 m) to near (– 3.00 D; optically equivalent to 33 cm) was observed 3– 6 months after TFNT00 implantation. At 3– 6 months, 88.2% of first eyes achieved an MRSE ≤ 0.50 D and 88.7% of second eyes achieved an MRSE ≤ 0.50 D. Overall, 99.3%, 92.3%, and 94.6% of patients bilaterally implanted with TFNT00 achieved binocular photopic BCDVA, DCIVA, and DCNVA of 0.14 logMAR or better, respectively. Ocular adverse device effects and secondary surgical interventions (SSIs) were infrequent.Conclusion: This global pooled analysis showed that TFNT00 provided a continuous range of 0.1 logMAR (~20/25 Snellen) or better vision from distance to 33 cm, with a low incidence of ocular adverse device effects and SSIs.Keywords: PanOptix, intraocular lens, presbyopia, trifocal lens, diffractive lens, pooled analysis

Purpose: To compare the quality of images of gratings placed in a model eye viewed through an extended depth of focus (EDoF) intraocular lens (IOL) to that of diffractive bifocal IOL or monofocal IOL., Design: Experimental laboratory investigation., Methods: Nondiffractive wavefront shaping EDoF (CNAET0, Alcon Laboratories), echelette-designed EDoF (ZXR00V, Johnson & Johnson Vision), diffractive bifocal IOL with low power addition (SV25T, Alcon Laboratories), or monofocal IOL (CNA0T0, Alcon Laboratories) was placed in a fluid-filled model eye. A United States Air Force Resolution Grating Target was glued to the posterior surface of the model eye and viewed through a flat or a wide-angle contact lens. The contrast of the gratings viewed through the EDoF or multifocal IOLs was compared to that through the monofocal IOL. A wavefront analyzer was used to measure the spherical power of the central 4.5 mm optics of the EDoF, multifocal, and monofocal IOLs. The distribution of the dioptric power and the dioptric power map were compared., Results: The gratings observed through the flat contact lens with CNAET0, ZXR00V, or SV25T were slightly blurred when viewed through the multifocal optics. The blurred area was in the circumferential area of CNAET0, the central area of SV25T, and the peripheral area of ZXR00V. The mean contrast was 0.258 ± 0.020 for CNAET0, 0.227 ± 0.025 for ZXR00V, and 0.221 ± 0.020 for SV25T for the 16.0 cyc/mm grating. The contrast was significantly lower for ZXR00V (P = .004) and SV25T (P = .004) than 0.303 ± 0.015 for CNA0T0 but the differences were not significant for CNAET0. For the wide-angle contact lens, the contrast for CNAET0 was 0.182 ± 0.009, for ZXR00V was 0.162 ± 0.011, and for SV25T was 0.163 ± 0.007 for the 16.0 cyc/mm grating, and none was significantly different from 0.188 ± 0.012 for CNA0T0. The dioptric variations of CNAET0 indicated a ring-shaped area of higher power corresponding to the circumferential blurred zone observed through the flat contact lens., Conclusions: The wavefront shaping and echelette-designed EDoF-IOLs reduce the contrast of the grating more than the monofocal IOL when viewed through the flat contact lens. The degree of reduction depended on the design of the extended-focus optics. The difference was less through the wide-angle contact lens., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: The aim of this prospective and comparative study was to investigate the association of perimetry parameters on visual acuity and contrast sensitivity in primary open-angle glaucoma (POAG) eyes with diffractive extended depth-of-focus (EDoF) and monofocal intraocular lenses (IOLs)., Methods: In cataract eyes with medicinally controlled POAG with no defects in the central visual field and mean deviation (MD) values of - 10 dB or better, EDoF and monofocal IOLs with the same platform except for echelette optics for EDoF were implanted in 22 and 24 eyes, respectively. Corrected distance visual acuity (CDVA), contrast sensitivity at 3 to 18 cycles per degree (cpd), and automated perimetry using 30-2 and 10-2 Swedish Interactive Threshold Algorithm programs were examined 3 months postoperatively. The influences of perimetry parameters including MD, foveal sensitivity (FS), and the means of the central four points (central MD and central FS) on CDVA and contrast sensitivity were evaluated using linear and multiple regression analyses., Results: In POAG eyes with EDoF IOLs, contrast sensitivities at 12 and 18 cpd were associated with 30-2 and 10-2 perimetry parameters. In POAG eyes with monofocal IOLs, associations of 30-2 parameters were found in CDVA and 3-cpd contrast sensitivity., Conclusions: The visual function of POAG eyes with EDoF IOLs was associated with perimetry parameters in high spatial frequency contrast sensitivity, which was different from that of POAG eyes with monofocal IOL., Trial Registration: Japan Registry for Clinical Research: jRCTs032200218., (© 2024. The Author(s).)

Introduction: The aim of this prospective study was to compare the visual functions of extended depth-of-focus intraocular lenses (EDOF IOLs) and monofocal IOLs in eyes with mild to moderate primary open-angle glaucoma (POAG)., Methods: Cataractous eyes with POAG controlled using medical treatments, no central visual field defects, and mean deviation (MD) values of -10 dB or better on the 30-2 test grid of the Swedish Interactive Threshold Algorithm standard program were included. Twenty-two eyes of 22 patients received EDOF IOLs (ZXR00V and ZXV150-375; J&J), whereas 24 eyes of 24 patients received monofocal IOLs (ZCB00V and ZCV150-375; J&J). MD values, corrected distance visual acuity (CDVA), and photopic contrast sensitivity were measured at 3 months after surgery. Noninferiority of CDVA and contrast sensitivity in eyes with EDOF IOLs to eyes with monofocal IOLs were examined., Results: The postoperative mean MDs of eyes with EDOF and monofocal IOLs were -2.76 dB and -4.21 dB with no significant difference. The CDVA of eyes with EDOF IOLs was noninferior to that of eyes with monofocal IOLs (P = 0.02). There were no inferiority in contrast sensitivity at any spatial frequency (P < 0.001)., Conclusions: The visual function of EDOF IOLs in eyes with mild-to-moderate POAG was not inferior to that of monofocal IOLs., Trial Registration: Registered in the Japan Registry for Clinical Research (identifier: jRCTs032200218)., (© 2023. The Author(s).)

Background: To prospectively evaluate visual functions and patient satisfaction after bilateral implantation of diffractive continuous depth-of-focus intraocular lens (CDF IOL) compared with trifocal IOLs., Methods: This investigator-initiated study was approved by a certified local review board (registered: jRCTs032210305). CDF IOL (Synergy, J&J, group S) and trifocal IOL (AcrySof PanOptix, Alcon, group P) were implanted bilaterally in 30 patients each. Three months postoperatively, binocular outcomes of uncorrected (BUCVA) and distance-corrected (BDCVA) visual acuities at distances of 0.3, 0.4, 0.5, 0.7, and 5 m were measured. Contrast sensitivities were binocularly measured using CSV-1000 (2.5 m) and Pelli-Robson charts at distances of 0.4 and 1 m. Symptoms of glare, halo, starburst, and waxy vision, and satisfaction for near, intermediate, and far visions were assessed with questionnaires. Differences between the two groups were examined., Results: Twenty-seven patients each completed the follow-up. The mean age of the group S was lower than that of the group P (P < 0.001). The BUCVA at 0.4 m was better in the S group, while the mean manifest refraction of the P group showed a significant hyperopic shift (P < 0.001). BDCVA was significantly better in the S group. The contrast sensitivity results at three distances showed no discernible differences. Although more patients in the S group reported significant glare and halo, their satisfaction with near vision was higher., Conclusions: The binocular visual function of patients with CDF IOLs was comparable to or better than that of patients with trifocal IOLs. The patients were satisfied with near vision, despite the enhanced glare and halo. Understanding the differences between the two types of presbyopia-correcting IOLs is important to ensure patient satisfaction., Trial Registration: This clinical trial was registered in the Japan Registry for Clinical Research (identifier: jRCTs032210305) on September 13, 2021., (© 2023. The Author(s).)

During cataract surgery, the intraocular temperature changes when irrigating low-temperature fluid and ophthalmic viscosurgical devices (OVDs) are inserted in the anterior chamber, and such a temperature variation affects the unfolding of the intraocular lens (IOL). A porcine eye holder was developed for simulating temperature conditions in clinical surgery by maintaining the ocular temperature close to the body temperature. An aluminum holder was designed to fit porcine eyes and maintain the ocular temperature at approximately 36 °C, while surgery was performed at a room temperature of 20 °C. Intraocular temperature was monitored using a thermocouple sensor placed close to the posterior capsule in the vitreous cavity. Temperatures and microscopic image of the anterior chamber were simultaneously recorded. With the use of the eye holder system, the intraocular temperature unstable during surgery was observed, and there were significant reductions during hydrodissection, irrigation and aspiration, OVD insertion in the capsule, and OVD removal after IOL implantation., (© 2023. The Author(s).)

Purpose: The study aims to determine the effectiveness of bridging sutures in preventing iris capture and a subsequent reverse pupillary block after an intrascleral fixation of an implanted intraocular lens (IOL)., Methods: We studied 6 eyes that had an iris capture with reverse pupillary block due to a dislocated IOL after an intrascleral fixation. After the dislocated IOL was repositioned, 10-0 polypropylene sutures were inserted 1.5 mm posterior to the limbus and directed to run between the iris and the IOL. The sutures were placed orthogonal to the haptics of the IOL. Anterior segment optical coherence tomography (AS-OCT) was used in 4 eyes to evaluate the degree of iridodonesis before and after the bridging sutures. The heights of the temporal and nasal sectors of the middle iris from the iris plane (the line between anterior chamber angles) were compared for each 0.2-s AS-OCT image taken immediately after the eye moved from a lateral to a primary position., Results: None of the eyes had a recurrence of the iris capture after the bridging sutures. The refractive error, anterior chamber depth, and vision were not significantly altered after the bridging sutures were placed. The AS-OCT images showed that the height of the nasal iris was decreased more at 0 s postoperatively blocking the excessive downward movement of the nasal iris but not the iridodonesis., Conclusion: Bridging sutures were effective in preventing iris capture and subsequent reverse pupillary block after an intrascleral fixation of an IOL., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Implantation of presbyopia-correcting intraocular lenses (IOLs) has not been advised for glaucomatous eyes because of the risk of decreased contrast sensitivity with progress of glaucoma. Extended depth-of-focus (EDF) IOLs have been reported to provide comparable postoperative visual function and influence on the visual field to monofocal IOLs., Methods: This case series was a retrospective medical record review of 16 eyes of 10 patients who had normal tension glaucoma (NTG) with no central visual field defects and underwent cataract surgery with implantation of diffractive EDF IOLs. At 3 months postoperatively, distance-corrected visual acuities (DCVAs) at distances of 5, 1, and 0.5 m and photopic contrast sensitivity were examined. Automated perimetry using the 30-2 Swedish interactive threshold algorithm was also performed, and the mean variance (MD) values, mean deviation values at the central four points (central MD), and foveal threshold were recorded., Results: The mean age of the patients (5 men, 5 women) was 66.5 years. Over 80% of eyes obtained DCVAs of 20/20, 20/20, and 20/25 at 5 m, 1 m, and 0.5 m, respectively. Whereas 5 of 16 eyes were categorized as severe by the Hodapp-Parrish-Anderson classification, postoperative contrast sensitivity was within the normal range, except for 4 eyes at 18 cycles per degree., Conclusions and Importance: In this case series, the postoperative visual functions of NTG patients with EDF IOLs were almost comparable to those of normal eyes with the same IOLs, which demonstrated that the use of EDF IOLs for controlled NTG eyes would be permissible. While careful patient selection and follow-up for NTG progress are important, further investigations are necessary for confirming the safety and exploring the selection criteria., Competing Interests: Hiroko Bissen-Miyajima, Yuka Ota, Manabu Hirasawa, Kenya Yuki, and Keiichiro Minami declare that they have no conflict of interest., (© 2023 The Authors.)

Purpose: To evaluate differences in subjective and objective refractions in eyes with extended-depth-of-focus intraocular lenses (EDOF IOLs) using echelette optics, and the effect of the light wavelength used during examinations., Methods: In the prospective study, subjective and objective refractions of 128 eyes of 64 patients were examined 3 months after implantation of the EDOF IOLs (ZXR00V, Johnson & Johnson Surgival Vision). Objective refractions were measured using an autorefractor with a near-infrared (NIR) light source. Clinical differences in the spherical, cylindrical and spherical equivalent (SE) refractions between the subjective and objective refractions were evaluated. Then, lens powers of monofocal, EDOF and diffractive bifocal IOLs in the use of a 850-nm light source were measured experimentally for using a lensmeter, and the differences from the monofocal IOLs were calculated., Results: The mean objective refractions were more myopic (p < 0.001) than the subjective refractions; the differences in the spherical, cylindrical and SE refractions were -0.71, -0.26 and -0.84 dioptre, respectively. Experimental investigation resulted that there was the mean difference of 0.83 D with the EDOF from monofocal IOLs at 850 nm, while the difference was -0.20 D with bifocal IOLs., Conclusions: The diffractive EDOF IOLs using echelette gratings inherently induced constant differences in the subjective and objective refractions, which arose from the chromatic difference in IOL powers for the visible and NIR lights., (© 2020 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To compare the quality of images viewed through an extended depth of focus (EDF) intraocular lens (IOL) to that through multifocal or monofocal IOL., Study Design: Experimental study METHODS: EDF IOL (Symfony ® , ZXR00V, Johnson & Johnson Vision), diffractive multifocal (ZLB00, + 3.25D or ZMB00, + 4.0D), or monofocal (ZCB00V) IOL with a spherical power of + 20.0 diopter (D) was placed in a fluid-filled model eye with corneal aberrations similar to those of human eyes. A United States Air Force Resolution Grating Target was glued to the posterior surface of the model eye and viewed through a flat contact lens, a 60D or 128D wide-angle non-contact lens (Resight ® ) or wide-angle contact lens (MiniQuad ® ). The contrast of the grating images recorded with the EDF and multifocal IOLs were compared to those through the monofocal IOL., Results: The grating images viewed through the flat contact lens were slightly blurred when viewed through the EDF IOL but clearer than those through the multifocal IOLs with very blurred images in the periphery. The contrast of the images viewed through the EDF and multifocal IOLs through the flat contact lens was significantly lower than through the monofocal IOL (P < 0.02). The contrast of the images viewed through the EDF IOL with 60D or 128D wide-angle non-contact lens was significantly lower than through the monofocal IOL (P < 0.05) but not with wide-angle contact lens., Conclusion: Our results suggest that vitreous surgeons can accomplish a clearer view during vitrectomy in EDF IOL-implanted eyes with a wide-angle viewing contact lens and a flat contact lens than in multifocal IOL-implanted eyes.

Purpose: The purpose of this study was to evaluate experimentally the efficacy of femtosecond laser (FL)-assisted capsulotomy using an eye model with different degrees of zonular dehiscence (ZD)., Methods: An eye model with ZD was created by removing the total iris and including the planned range of the ZD in porcine and human cadaver eyes. FL-assisted capsulotomies (laser group) and manual capsulotomies (manual group) were created for the eye model with 0, 45, 135, 180, and 270 degrees of ZD. The continuity, mean diameter, ellipticity, and decentration of the capsulotomy were evaluated using the captured images. The same evaluation of FL-assisted capsulotomies was done for five human cadaver eyes with 180 degrees of ZD., Results: In the laser group, no differences were seen in the mean diameter, ellipticity, and decentration, although the manual group resulted in significantly larger, ovalized, and decentered capsulotomies with different degrees of ZD ( P < 0.001, P  < 0.001, and P  = 0.0317, respectively). Continuous capsulotomies or capsulotomies with microadhesions were obtained up to 180 degrees of ZD, and incomplete treatment areas were seen in eyes with 270 degrees of ZD. Capsulotomy of the human cadaver eyes with 180 degrees of ZD showed similar results to those of porcine eyes., Conclusions: In this experimental study, FL-assisted capsulotomy showed favorable results in eyes with between 0 and 180 degrees of ZD compared to conventional manual capsulotomy., Translational Relevance: Our experimental model can simulate the capsulotomy in cases with ZD, the results are useful when determining the indication for FL-assisted capsulotomies., Competing Interests: Disclosure: S. Yaguchi, Alcon Vision, LLC (F); H. Bissen-Miyajima, Alcon Vision, LLC (F, R); Y. Ota, Alcon Vision, LLC (F); S. Oki, None; K. Minami, Alcon Vision, LLC (F), (Copyright 2020 The Authors.)

The prospective comparative case series aimed to evaluate the binocular uncorrected visual acuities (BUCVAs) after staged implantations of extended-depth-of-focus intraocular lenses (EDOF IOLs) targeting emmetropia and -0.5 diopter (D). Diffractive EDOF IOLs with an add power of +1.75 D were implanted in the first eyes targeting emmetropia or -0.5 D according to the patients' preferences, then the targets for the second eyes were determined 1 week or longer after the implantation. IOL powers were determined with the SRK/T formula. Consequently, the subjects were divided into 3 groups: those with emmetropia targeted bilaterally (group EE, 22 patients), those with -0.5 D targeted bilaterally (group MM, 21 patients), and those with monovision of emmetropia and -0.5 D (group EM, 21 patients). Manifest refraction spherical equivalent (MRSE), BUCVA from 0.3 to 5 meters, spectacle use, and questionnaire regarding photic symptoms and patient satisfaction were assessed 3 months postoperatively. No significant differences were seen in the mean BUCVAs at any distance (P > 0.23), spectacle use (P = 0.13), or photic symptoms and patient satisfaction (P>0.65). When the EE and MM groups were assigned based on the MRSE, the EE group was better at 5 m (P = 0.005) while the MM group at 0.5 m (P = 0.031). The effect of different targeted refractions was not identified due to insufficient accuracy in the use of the SRK/T power calculation., Competing Interests: The authors have read the journal policies and the authors have the following competing interests to declare: The study was supported by Johnson & Johnson Surgical Vision. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Purpose: To evaluate the effectiveness and safety of a new trifocal intraocular lens (IOL) after cataract removal in patients living in Japan., Study Design: Prospective multicenter clinical study., Methods: One hundred and thirty-five eyes of 68 patients (19 men, 49 women; mean age, 66.3 ± 7.4 years) were followed for 6 months. Trifocal IOLs with focal points at near, intermediate, and distance were implanted bilaterally in eyes with less than 1 diopter of corneal astigmatism. The visual acuity (VA) at distance, 60 and 40 centimeters (cm), and contrast sensitivities were measured. Patients completed quality-of-life questionnaires preoperatively and postoperatively., Results: The mean bilateral logarithm of the minimum angle of resolution VA at 5 meters (m), 60 cm, and 40 cm were, respectively: uncorrected, - 0.104 ± 0.095, - 0.065 ± 0.111, and - 0.042 ± 0.105; and distance-corrected, - 0.197 ± 0.076, - 0.112 ± 0.111, and - 0.073 ± 0.111. The contrast sensitivities at distance and near were within the normal range at all spatial frequencies under photopic conditions. Patients reported complete spectacle independence in 75.0% of cases. Total use of spectacles was reported by 1.5% and partial by 20.6%; the purpose of spectacle use was primarily for near visual tasks. Mild-to-moderate glare was reported by 65.7% of patients and halos by 70.1%; only 1.5% of subjects reported severe glare and halos., Conclusions: This new trifocal IOL provides equally good uncorrected VAs at distance, intermediate, and near, and decreases spectacle dependence in daily life. Patients frequently report mild-to-moderate glare and halos, and patients should be informed about these before implantation.

Purpose: To conduct a nationwide prospective cohort study of multifocal intraocular lens (mfIOL) implantation to determine clinical outcomes and patient satisfaction and assess factors affecting patient satisfaction., Design: Prospective, multicenter cohort study., Methods: Setting: institutional; patient population: a total of 1051 consecutive patients (1631 eyes) who underwent cataract surgery with mfIOL implantation at 65 Japanese institutions from January 2017 to June 2018. The inclusion criteria were patient age of 20 years and older and cataract surgery with mfIOL implantation. The exclusion criteria were the absence of informed consent, completed postoperative questionnaires, and no record of the IOL models implanted., Observation Procedures: the uncorrected and corrected distance visual acuities (UDVAs and CDVAs) at 5 m; uncorrected VAs at 50, 40, and 30 cm; and questionnaires regarding subjective visual symptoms, spectacle independence, and surgical satisfaction were assessed 3 months postoperatively., Main Outcome Measure: odds ratios for the overall surgical satisfaction were computed for the preoperative/postoperative factors., Results: We analyzed data from 1384 eyes of 871 patients. The UDVAs and CDVAs, respectively, improved significantly at 3 months postoperatively. The intermediate and near VAs varied with the IOL models; 68.4% of patients were almost or totally spectacle-independent; 3.9% of patients reported surgical dissatisfaction. In patients implanted bilaterally with the same mfIOLs, postoperative blurred vision and/or decreased contrast was the most important factor in the overall surgical satisfaction., Conclusions: MfIOLs provided good visual outcomes and high satisfaction rates in this large patient cohort. The difference in the outcomes with the extended depth-of-focus IOLs did not differ significantly from the bifocal IOLs. The postoperative blurred vision is important to the overall surgical satisfaction., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: We evaluate the efficacy of capsular tension rings (CTRs), iris retractors (IRs), and capsule expanders (CEs) in stabilizing the lens capsule under different degrees of zonular dehiscence using a porcine model., Methods: We developed an experimental model that can be used to observe the dynamics of lens capsules with different degrees of zonular dehiscence during phacoemulsification and aspiration (PEA). PEA was performed without any aid (control) and with devices. A CTR was used for a dehiscence of 30°, 45°, 60°, 90°, 120°, 150°, and 180° and one to four IRs or one to three CEs were used for a dehiscence of 90°, 120°, and 180°. The retention rate, calculated as the area of the capsular bag during PEA divided by the area before zonular dissection, and the number of lens fragments dropped into the vitreous cavity during PEA were examined and compared among the control and experimental groups., Results: The retention rate increased significantly with the use of devices compared to the control (P < 0.05). The number of dropped lens fragments decreased by one or less with the use of CTR, one IR, or one CE for 90°, two IRs, or one or two CEs for 120°, and three or four IRs, or two or three CEs for 180° of zonular dehiscence., Conclusions: The experimental porcine eye model with zonular dehiscence makes it possible to observe the entire configuration of the lens capsule, and demonstrates differences in the efficacy of capsular bag retention with CTR, IR, and CE.

Purpose: To evaluate the binocular visual function and depth of focus after staged implantation of diffractive multifocal intraocular lenses (MIOLs) with 3 different add powers following cataract removal., Design: Prospective comparative case series., Methods: Setting: Institutional., Study Population: Both eyes of 56 patients that underwent staged implantation of bifocal IOLs., Intervention: In the first eye, MIOLs with a +4.0-diopter (D) add power were implanted. Based on outcomes at 1 week postoperatively and patient preference for near vision, 1 of 3 near add powers-+4.0 D (group MM), +3.25 D (group ML), or +2.75 D (group MK)-was implanted in the fellow eye., Main Outcome Measure(s): Three months postoperatively, the binocular uncorrected and distance-corrected visual acuities (BUCVA and BDCVA, respectively) at 5.0, 1.0, 0.5, 0.4, and 0.3 meters; binocular defocus curves; contrast sensitivity; and near stereopsis were measured., Results: The MM, ML, and MK groups included 21, 18, and 17 patients, respectively. The mean BUCVA in the MM group was significantly (P = .003) worse than that in the MK group at 0.5 meter. The BDCVAs at 0.5 meter in the ML and MK groups were significantly (P < .02) better than that in the MM group. The defocus curves with the -2.0 D refraction differed significantly (P < .001) between the MM and MK groups. The binocular contrast sensitivity and stereopsis values did not differ significantly., Conclusions: Staged implantation of different add powers obtained better binocular intermediate visual acuity without degradation of visual function., (Copyright © 2018 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the safety and efficacy of femtosecond laser-assisted cataract surgery (FLACS) in Japanese eyes., Study Design: Retrospective case series., Methods: The clinical records of 529 consecutive eyes of 312 Japanese patients who underwent FLACS from 2013 to 2016 were reviewed. The completion rates of anterior capsulotomy and corneal incisions using the femtosecond laser (LenSx, Alcon) and the number of attempts to achieve secure docking between the cornea and laser system were recorded. The uncorrected and corrected distance visual acuities (VAs) and uncorrected and distance-corrected near VAs 1 week postoperatively were evaluated., Results: Anterior capsulotomies were completed in 98.7% of eyes. The corneal incisions were incomplete in 8.3%, which included eyes with arcus senilis and neovascularization. The mean corneal endothelial cell reduction rate was 5.5%. Multiple docking attempts were required in 22.9% of eyes, while canthotomy was performed in two eyes. The postoperative VAs were favorable., Conclusion: FLACS was safe and reliable in Japanese eyes. Further improvements in docking are required to accommodate small corneas and narrow palpebral spaces.

Purpose: To retrospectively evaluate the current practice, trends, and outcomes of refractive surgery in Japan., Methods: This multicenter survey comprised 78,248 eyes of 39,727 consecutive patients who underwent refractive surgery at 45 major institutions in Japan. The corresponding ophthalmologists responded to a selfadministered questionnaire. The authors especially evaluated the safety, efficacy, predictability, stability, and adverse events of LASIK and phakic intraocular lens (IOL) implantation 3 months postoperatively., Results: The most common refractive surgery was LASIK (90.9%), followed by corneal inlay (5.0%), posterior chamber phakic IOL implantation (1.3%), laser-assisted subepithelial keratomileusis (1.0%), refractive lens exchange (0.9%), photorefractive keratectomy (0.3%), and refractive lenticule extraction (0.2%). For subgroup analysis, 69,987 eyes (99.5%) and 67,512 eyes (95.9%) achieved corrected and uncorrected distance visual acuity of 20/20 or better, respectively, after LASIK, and 935 eyes (98.8%) and 890 eyes (94.1%), respectively, after phakic IOL implantation. There were 69,176 eyes (98.3%) and 908 eyes (96.0%) within ±1.00 diopter (D) of the attempted correction after LASIK and phakic IOL implantation, respectively. There were 1,926 eyes (2.7%) and 1 eye (0.1%) with changes in refraction of 1.00 D or less from 1 week to 3 months after LASIK and phakic IOL implantation, respectively. No vision-threatening complications occurred in any case., Conclusions: According to this survey, LASIK remains the most prevalent surgical technique in Japan. Both LASIK and phakic IOL implantation offered good safety and efficacy outcomes, yielding predictable and stable results. [J Refract Surg. 2017;33(9):598-602.]., (Copyright 2017, SLACK Incorporated.)

Purpose: To quantify zonular weakness based on lens movement at the start of continuous curvilinear capsulorhexis (CCC) and establish a classification system for it., Setting: Kozawa Eye Hospital and Diabetes Center, Mito, Japan., Design: Retrospective interventional case series., Methods: We examined 402 consecutive eyes of 316 patients who underwent CCC, phacoemulsification and aspiration (PEA), and intraocular lens (IOL) implantation. The movement of the lens capsule was measured using images from video recordings of the CCC procedure. Zonular weakness was classified based on the shifted distance: Grade I, less than 0.20 mm; Grade II, 0.20-0.39 mm; and Grade III, greater than 0.40 mm. For each of these grades, we examined the use of the capsule stabilization device during PEA, the surgical procedure for lens removal, and IOL fixation., Results: We classified 276 eyes (68.6%) as Grade I, 102 eyes (25.4%) as Grade II, and 24 eyes (6.0%) as Grade III. As the grade increased, the use of the capsule stabilization device in PEA and scleral suture fixation of IOL increased., Conclusions: Zonular weakness was quantified by measuring the movement of the lens capsule. An objective classification of zonular weakness based on lens movement may be useful for selecting the appropriate device and procedure during cataract surgery.

Purpose: To assess the clinical outcomes of currently used refractive surgery procedures performed in 2015., Design: Prospective, multicenter cohort study., Methods: This prospective study included 15 011 eyes of 7622 consecutive patients who underwent laser in situ keratomileusis (LASIK), surface ablation, refractive lenticule extraction (ReLEx), or phakic intraocular lens (IOL) implantation at 42 major institutions. We determined the safety, efficacy, predictability, stability, and adverse events of these surgeries preoperatively and at 1 week and 1 and 3 months postoperatively., Results: Mean logMAR corrected distance visual acuity 3 months after LASIK, surface ablation, ReLEx, posterior chamber phakic IOL, or iris-supported phakic IOL implantation was -0.18 ± 0.07, -0.16 ± 0.08, -0.17 ± 0.09, -0.21 ± 0.08, and -0.10 ± 0.12, respectively; the corresponding values for logMAR uncorrected distance visual acuity were -0.15 ± 0.11, -0.12 ± 0.12, -0.12 ± 0.13, -0.15 ± 0.12, and 0.01 ± 0.21, respectively. The percentages within ±1.0 diopter (D) of the attempted correction were 96%, 93%, 97%, 99%, and 84% after LASIK, surface ablation, ReLEx, posterior chamber phakic IOL, and iris-supported phakic IOL implantation, respectively. Refractive change from 1 week to 3 months was -0.08 ± 0.07, 0.21 ± 0.63, -0.04 ± 0.41, 0.01 ± 0.31, and 0.01 ± 0.46 D, respectively. No vision-threatening complications occurred during the observation period., Conclusions: Although more prolonged follow-up is still necessary, currently used refractive surgery procedures have good safety and efficacy outcomes, yielding predictable and stable results. Contemporary LASIK, surface ablation, ReLEx, and phakic IOL implantation appear to be feasible options for the treatment of refractive errors., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: To evaluate visual performance after contralateral implantation of AcrySof ReSTOR aspheric intraocular lenses (IOLs) with +3.0 and +4.0 diopter near additions., Design: This was a retrospective case study conducted at Tokyo Dental College Suidobashi Hospital in Tokyo, Japan., Methods: Eleven patients who were implanted with the SN6AD1 IOL and the SN6AD3 IOL contralaterally were included in this study. The distance, intermediate (1 m, 50 cm), and near (40 and 30 cm) uncorrected and corrected binocular visual acuity (VA), contrast sensitivity, depth of focus, and patient satisfaction were assessed more than 1 month postoperatively., Results: Postoperatively, the mean uncorrected (corrected) binocular logarithm of the minimum angle of resolution VA levels were as follows: distance, -0.120 (-0.163); intermediate, 1 m, 0.226 (0.012) and 50 cm, 0.037 (0.006); and near, 40 cm, 0.067 (-0.040) and 30 cm, 0.091 (-0.053). The depth of focus had a smooth curve with double peaks. The mean contrast sensitivity was normal at all spatial frequencies. All patients were spectacle independent and expressed high satisfaction., Conclusions: Contralateral implantation of multifocal IOLs with +3.0 and +4.0 D additions takes advantage of the good uncorrected near VA provided by both IOLs and may be an option for patients who require a broader range of good uncorrected near VA.

Purpose: To evaluate the visual performance in eyes with diffractive intraocular lenses (IOLs) after laser in situ keratomileusis (LASIK)., Methods: This single-center retrospective study evaluated eyes that had diffractive multifocal IOL implantation after previous LASIK or not treated with LASIK (controls). The outcomes' measures were the visual acuities (VAs) at distance and near, spherical equivalent (SE) and contrast sensitivity at one month postoperatively., Results: The study evaluated 40 eyes of 33 patients. The mean uncorrected logMAR VAs were -0.05 ± 0.13/0.00 ± 0.14 (LASIK group/control group) at distance and 0.10 ± 0.13/0.16 ± 0.18 at near. There was no statistically significant difference between the 2 groups at the VAs. The SE of the LASIK group was -0.06 ± 0.39 D, significantly lower than the control group (0.22 ± 0.45 D) (p < 0.05). The contrast sensitivity of the LASIK group at high spatial frequency was lower than the control group (p < 0.05)., Conclusion: After LASIK, the diffractive multifocal IOL provided good uncorrected distance and near VAs. However, decrease in contrast sensitivity should be considered.

Aim: To evaluate the effect of temperature on the restoration of the optical properties of hydrophobic acrylic intraocular lenses (IOLs) after ejection through a cartridge into a temperature-controlled water chamber., Methods: Acrylic IOLs (SA60AT; iSert 251; W-60; X-70; and VA-70AD) were loaded into a cartridge with viscoelastic material and ejected into a water chamber at 24°C or 34°C. A wavefront analyser was used to measure the spherical and cylindrical powers, and the higher-order aberrations of the optics of the IOLs. The time to restore the cylindrical power to within 0.1 dioptres of the baseline power was determined., Results: Surface irregularities of the IOLs after ejection were detected in the dioptric power maps but not in the higher-order aberration maps. The cylindrical power and the astigmatic and coma aberrations recovered immediately at 34°C but were delayed at 24°C. The restoration time of all IOLs at 24°C was significantly longer than that at 34°C (p<0.05)., Conclusions: The dioptric power maps determined by the wavefront analyser can detect and follow the restoration of the optical properties of hydrophobic acrylic IOLs immediately after ejection. The restoration time was dependent on the temperature of the water chamber., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Purpose: To evaluate the efficacy and safety of a newly developed diffractive multifocal intraocular lens (IOL) with +2.5 diopter near add power (SN6AD2, Alcon), whose theoretical distance for near focus is 50 cm., Methods: This study included 128 eyes of 64 patients (23 men and 41 women, average age: 66.7 ± 7.2 years) following cataract removal at Tokyo Dental College Suidobashi Hospital and Hayashi Eye Hospital. Visual acuities (VAs) at distance, 1 m, 50 cm and 40 cm, and questionnaires were evaluated until 1 year postoperatively., Results: At 1 year postoperatively, mean bilateral logMAR VAs were uncorrected -0.09 (5 m), 0.01 (1 m), 0.07 (50 cm), 0.18 (40 cm), distance corrected 0.01 (1 m), 0.08 (50 cm), 0.19 (40 cm), best corrected -0.17 (5 m), 0.00 (50 cm). From the patient's questionnaires, light or moderate glare was noticed in 17.5%, 4.8%, light or moderate halo was notice in 19.0%, 4.8% of the total patients., Conclusion: This IOL provides good distance to intermediate VAs and better near VA compared to monofocal IOL.

Purpose: To evaluate the efficacy and safety of a new acrylic one-piece toric intraocular lens (IOL)., Methods: This prospective multicenter clinical trial included 93 eyes of 61 patients that were implanted with a hydrophobic acrylic toric IOL from 2010 to 2012 and followed for 1 year. This IOL uses the platform of a microincision one-piece aspheric IOL, the NY-60 IOL (HOYA, Tokyo, Japan), with three increments in cylindrical power (NHT15, 1.5 diopters [D]; NHT23, 2.25 D; and NHT30, 3.0 D). The inclusion criterion was preoperative corneal astigmatism from 0.75 to 3.00 D. The primary endpoint was uncorrected distance visual acuity (UDVA) of 0.0 logMAR (20/20 Snellen) or better 6 months postoperatively. In addition to UDVA, corrected distance visual acuity (CDVA), residual astigmatism, stability of the IOL alignment, need of realignment, and the rate of Nd:YAG laser capsulotomy were evaluated up to 1 year postoperatively. Errors in astigmatic correction were assessed using Alpin's vector analysis., Results: The primary endpoint was achieved in 54.8% of eyes. One year postoperatively, the logMAR UDVAs were 0.02 ± 0.13, 0.05 ± 0.17, and 0.09 ± 0.14 with models NHT15, NHT23, and NHT30, which corresponds to 0.96 (19/20 Snellen), 0.89 (18/20 Snellen), and 0.82 (16/20 Snellen), respectively. One year postoperatively, the residual astigmatism was 0.66 ± 0.58 D. In each evaluation, the mean absolute change in the position of the axis mark was between 1.93° and 2.32°. Three eyes required repositioning of the IOL axis and 2 eyes received Nd:YAG laser capsulotomy. The correction error showed an undercorrection with against-the-rule astigmatism and overcorrection with with-the-rule astigmatism., Conclusions: The new one-piece toric IOL provided desirable clinical outcomes and stability in eyes with corneal astigmatism., (Copyright 2015, SLACK Incorporated.)

Purpose: The efficacy and safety of tinted aspheric multifocal toric intraocular lens (IOL) (SND1T3, SND1T4, SND1T5, SND1T6 : Alcon) were evaluated in 130 eyes of 65 patients following cataract removal., Methods: Visual acuities (VAs) at distance, near (40 cm) and intermediate (50 cm, 1 m), IOL rotation, contrast sensitivity, spectacle usage and glare/halo were examined up to 1 year postoperatively., Results: The mean bilateral uncorrected distance VA was -0.04 ± 0.10 logMAR, near VA was 0.00 ± 0.11 logMAR, intermediate VA at 50 cm was -0.00 ± 0.11 logMAR, intermediate VA at 1 m was 0.11 ± 0.15 logMAR. IOL rotation was 5.73 ± 4.36 degrees, photopic contrast sensitivities were within normal range, and 76.9% of the patients did not require any spectacles. None of the patients complained of either serious glare or halo., Conclusion: The multifocal toric IOL provides better VA from distance to near at 40 cm.

Objective: To assess the visual complaints, reasons, and patient satisfaction for multifocal intraocular lens (IOL) explantation., Design: Retrospective observational case series., Methods: This study evaluated 50 eyes of 37 patients who underwent multifocal IOL explantation followed by IOL implantation. Before and 3 months after IOL exchange surgery, we investigated the symptoms, reasons, patient demographics, clinical results, and patient satisfaction in eyes undergoing multifocal IOL explantation. Data collected included preoperative subjective and objective findings, reasons, IOL type, postoperative course, and patient satisfaction., Results: The most common complaints for IOL explantation were waxy vision, followed by glare and halos, blurred vision at far, dysphotopsia, blurred vision at near, and blurred vision at intermediate. The most common reasons for IOL explantation were decreased contrast sensitivity, followed by photic phenomenon, unknown origin including neuroadaptation failure, incorrect IOL power, preoperative excessive expectation, IOL dislocation/decentration, and anisometropia. The axial length was 25.13±1.83 mm. Of the explanted multifocal IOLs, 84% were diffractive and 16% were refractive. Monofocal IOLs accounted for 90% of the exchanged IOLs. Patient satisfaction was significantly improved from 1.22±0.55 preoperatively to 3.78±0.97 postoperatively, which was graded on a scale of 1 (very dissatisfied) to 5 (very satisfied) (Wilcoxon signed-rank test, P<.001)., Conclusions: Multifocal IOL explantation was required in some patients undergoing multifocal IOL implantation. IOL exchange surgery appears to be a feasible surgical option for dissatisfied patients with persistent visual symptoms after multifocal IOL implantation., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: To evaluate the quality of the image of a grating target placed in a model eye and viewed through a small-aperture corneal inlay., Setting: Kyorin Eye Center, Tokyo, Japan., Design: Experimental study., Methods: A Kamra corneal inlay was placed on the anterior surface of a fluid-filled model eye, and a United States Air Force target and a calibrated scale were placed on the inner surface of the model eye. With a flat contact lens or a contact or noncontact wide-angle viewing system, the contrast of the grating images and the field of view through the inlay were compared with those without the inlay., Results: A blurred dark ring was observed with the flat contact lens and MiniQuad wide-viewing contact lens in the model eye with the inlay. The contrast of the gratings was significantly decreased at 16 cycles/mm (P=.028), 32 cycles/mm (P=.046), and 64 cycles/mm (P=.015). With the Resight noncontact wide-angle viewing system, the field of view was reduced from 62 degrees to 32 degrees when the front lens was at 7.0 mm and slightly reduced from 75 degrees to 62 degrees at 5.0 mm with the inlay., Conclusions: The contrast of grating images observed through the inlay was significantly reduced when viewed with the flat contact lens. The field of view through the wide-angle viewing system was also altered. However, the noncontact wide-angle viewing system may be recommended for vitreous surgeries in eyes with the inlay by adjusting the distance of the front lens from the cornea., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the surface light scattering associated with diffractive multifocal intraocular lenses (IOLs) and visual function 6 years after implantation., Setting: Private practice., Design: Retrospective comparative case series., Methods: Patients received a hydrophobic acrylic IOL and were followed for more than 6 years. Six years postoperatively, the intensity of the surface light scattering was measured using a Scheimpflug camera-based anterior segment analyzer. The corrected distance (CDVA) and near (CNVA) visual acuities and contrast sensitivity were assessed., Results: Twenty eyes of 10 patients received a diffractive multifocal IOL (Acrysof Restor SA60D3, study group), and 16 eyes of 8 patients received a monofocal IOL (Acrysof SA60AT, control group). Six years postoperatively, the anterior surface light scattering was more than 100 computer compatible tape units in both groups, with no significant difference between groups (P=.417). The mean CDVA and CNVA in the study group were -0.06 logMAR ± 0.04 (SD) and -0.04 ± 0.05 logMAR, respectively; however, the CNVA in both groups decreased compared with that at 1 year, as did the CDVA in the control group. Contrast sensitivity was within normal range at all spatial frequencies in both groups. There were no significant correlations between surface light scattering and the changes in corrected visual acuities (distance or near) between 1 year and 6 years postoperatively in either group., Conclusion: Although there was significantly increased surface light scattering 6 years postoperatively, the visual function with a diffractive multifocal IOL was comparable to that with a monofocal IOL., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess whether corrected visual acuity after implantation of diffractive multifocal intraocular lenses (IOLs) varies with patient age., Setting: Tokyo Dental College, Suidobashi Hospital, Tokyo, Japan., Design: Cross-sectional study., Methods: Eyes receiving a diffractive multifocal IOL after cataract extraction were divided into 5 age decades: 30s (30 to 39 years), 40s, 50s, 60s, and 70s. Corrected distance (CDVA), distance-corrected near (DCNVA), and corrected near (CNVA) visual acuities 1 month postoperatively were compared between the age decades. Contrast sensitivity was evaluated at 3 months. Eyes with a monofocal IOL served as controls., Results: The mean CDVA was significantly better in the 30s and 50s than in the 60s and 70s (P<.033). There was significant decline in DCNVA in the 60s and 70s compared with the 30s (P<.03). The CNVA was better in the 30s than in the 50s, 60s, and 70s (P<.003), better in the 40s than in the 60s and 70s (P<.008), and better in the 50s than in the 70s (P=.001). No change in CDVA was found with the monofocal IOL. Contrast sensitivity was significantly higher in the 30s than in the 60s and 70s at 6 cycles per degree (cpd) (P<.025) and in the 50s to 70s at 18 cpd (P<.027)., Conclusion: Corrected visual acuities and contrast sensitivity were worse in older patients than in younger patients. Visual acuities with the monofocal IOL were not associated with patient age., Financial Disclosure: Dr. Bissen-Miyajima has received lecture fees from Abbott Medical Optics, Inc. Neither of the other authors has a financial or proprietary interest in any material or method mentioned., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the long-term postoperative visual performance of an apodized diffractive multifocal intraocular lens (IOL)., Methods: Twenty-one patients (42 eyes) underwent cataract surgery with bilateral implantation of an apodized diffractive multifocal IOL. The monocular uncorrected and corrected distance visual acuities, uncorrected, distance-corrected and corrected near visual acuities, and manifest refractive spherical equivalent were measured 1 and 5 years postoperatively. The contrast sensitivity, incidence of glare or halos, and rate of neodynium:YAG (Nd:YAG) posterior capsulotomy were evaluated 5 years postoperatively., Results: No significant differences were found between the distance and near visual acuities at 1 and 5 years postoperatively. The contrast sensitivity was within the normal range for all spatial frequencies. No patients reported severe glare or halos. Six (14.3 %) eyes required Nd:YAG posterior capsulotomy., Conclusions: The apodized diffractive multifocal IOL provides good, stable distance and near visual acuity levels over a 5-year follow-up period.