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Background: Extended depth of focus (EDOF) and multifocal (Multi) intraocular lenses (IOL) can provide a fixed distance of near vision, which may result in some discomfort for patients who prefer different near distances. The aim of this study was to compare the vision, comfortable near distance (CND) and visual comfort in patients who underwent implantation of EDOF, Multi, and monofocal (Mono) IOLs. Methods: A total of 100 eyes were implanted with Tecnis ZXR00, ZMB00 or ZCB00 IOLs. Uncorrected distance, intermediate, and near visual acuity (UDVA, UIVA, and UNVA, respectively), corrected distance visual acuity (CDVA), the fluctuations of CND, the ability to see at comfortable or standard near distance and visual comfort were evaluated at 3-month postoperative. Results: At 3 months postoperative, the EDOF and Multi groups showed non-inferiority compared to the Mono group in the UDVA (P > 0.05) and CDVA (P > 0.05) but superiority in the UNVA (P < 0.001). The UIVA was better in the EDOF group, with comparable results for the Multi and Mono groups. There was no difference in preoperative and postoperative CND in the three groups. The CND visual acuity (CNDVA) was lower than the UNVA in the three groups, especially in the EDOF and Multi groups (P < 0.05). The CND effectively improved patients' near visual comfort and visual clarity, except for one patient in the Multi group who complained of severe fatigue and was unable to tolerate the experience at month 3. Conclusion: The EDOF and Multi IOLs achieved excellent visual quality and superior UNVA compared to the Mono IOL, but the CNDVA was significantly inferior to the UNVA. Patients' near visual experience can be effectively improved at their CND. [ABSTRACT FROM AUTHOR]

Abstract Background Extended depth of focus (EDOF) and multifocal (Multi) intraocular lenses (IOL) can provide a fixed distance of near vision, which may result in some discomfort for patients who prefer different near distances. The aim of this study was to compare the vision, comfortable near distance (CND) and visual comfort in patients who underwent implantation of EDOF, Multi, and monofocal (Mono) IOLs. Methods A total of 100 eyes were implanted with Tecnis ZXR00, ZMB00 or ZCB00 IOLs. Uncorrected distance, intermediate, and near visual acuity (UDVA, UIVA, and UNVA, respectively), corrected distance visual acuity (CDVA), the fluctuations of CND, the ability to see at comfortable or standard near distance and visual comfort were evaluated at 3-month postoperative. Results At 3 months postoperative, the EDOF and Multi groups showed non-inferiority compared to the Mono group in the UDVA (P > 0.05) and CDVA (P > 0.05) but superiority in the UNVA (P

K Ashley Tuan,1 Douglas P Benoit,1 Brett O’Connor2 1Visioneering Technologies, Incorporated, Medical Affairs, Alpharetta, GA, USA; 2MyEyeDr-Mandarin, Jacksonville, FL, USACorrespondence: Douglas P Benoit, Visioneering Technologies, Incorporated, Medical Affairs, Alpharetta, GA, USA, Email dbenoit@vtivision.comPurpose: Employing “relative plus” (Add) power to extend the functional vision range is a primary method to correct presbyopia with contact lenses. Simultaneous vision contact lenses are typically associated with visual disturbances at higher Add powers, often resulting in compromised vision and necessitating specialized fitting methods. Among mature individuals suffering from presbyopia, we evaluated the visual performance of a catenary curve-based extended depth of focus (EDOF) optical profile contact lens with a simplified fitting process.Methods: Mature individuals suffering from presbyopia with Add requirements of +2.00 D or more were recruited. Monocular and binocular visual acuities were obtained across optical vergences ranging from − 4.00 D to +2.00 D to generate defocus curves for best spectacle-corrected distance vision (baseline) and center-distance, catenary curve-based contact lenses (catenary). A subjective questionnaire evaluating the lenses was employed.Results: Twenty-four mature individuals suffering from presbyopia, average age 59.2 (range: 51– 68 years) and average Add requirement of +2.24 D (range +2.00 D to +2.50 D) were enrolled. Under high-contrast conditions, the catenary lens provided functional binocular vision (0.30 logMAR or better) at all optical vergences from distance to − 3.50 D (equivalent to 28 cm). Participants demonstrated a significant improvement (p < 0.05) in binocular visual acuity while wearing the catenary lens with an imposed defocus of − 1.50 D to − 4.00 D (equivalent to object distances from 66 cm to 25 cm). Subjective ratings with the catenary lens were equivalent to those documented at baseline.Conclusion: The catenary curve-based lenses provided a full range of functional vision while maintaining clear distance vision for individuals suffering from advanced presbyopia. Comparison with previous results involving this lens indicates that these findings are also generalizable to wearers with lower Add requirements. This EDOF design provides a universal Add which is sufficient for advanced presbyopia.Trial Registration: ClinicalTrials.gov. Identifier: NCT05495971.Keywords: presbyopia, multifocal contact lens designs, catenary optics, defocus curves, extended depth of focus

Depth of focus (DOF) is defined as the axial range in which the specimen stage moves without losing focus while the imaging apparatus remains stable. It may not be possible to capture an image that includes the entire specimen in focus due to the narrow DOF in microscopic systems. Extended depth of focus (EDOF) is used to overcome this limitation in microscopic systems. Although the researchers have developed so many EDOF microscope approaches, this research field still has some crucial shortcomings such as high computational costs, complexity and execution time, requiring additional equipment, low precise characterization of curves, and edges in images, varying performance depending on the specimen and microscope, using only gray levels of input images to acquire the pixel's focus values. In order to minimize these shortcomings and comprehensively analyze the performance of EDOF approaches, a novel multi-focus image data set is generated, and a deep learning-based EDOF microscope approach is proposed in this study. When compared with the state-of-art EDOF approaches, our study provides various crucial contributions such as the first EDOF approach based on unsupervised deep learning, providing more accurate and specimen-free EDOF, generating a novel multi-focus image data, not requiring any pre- or post-processing technique and acquiring the pixel's focus degrees using deep features. In order to evaluate the effectiveness of the suggested approach, 20 different EDOF approaches are applied to a multi-focus image data set containing 9 image collections (4 synthetic and 5 microscope image collections) in total. Performance analysis metrics with and without requiring a reference image are preferred to identify which EDOF microscope approach can extract more essential details from the multi-focus images for the synthetic and microscope image collections, which are Root Mean Square Error (RMSE), Peak Signal Noise Ratio (PSNR), Universal Quality Index (UQI), Correlation Coefficient (CC), Perception-based Image Quality Evaluator (PIQE), Blind/Referenceless Image Spatial Quality Evaluator (BRISQUE), Extension of Universal Quality Index for N Images (UQIN), and Naturalness Image Quality Evaluator (NIQE). Objective and subjective analysis of this study demonstrates that unsupervised deep learning model is more efficient to transmit crucial details from multi-focus images. Moreover, the suggested EDOF microscope approach with highest PSNR, UQI, CC, UQIN and lowest RMSE, PIQE, BRISQUE, NIQE produces higher performance than the state-of-art approaches. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical outcomes following bilateral implantation of the AcrySof™ IQ Vivity™ toric extended depth of focus (EDOF) intraocular lens (IOL). Design: Prospective interventional case series. Methods: Patients with bilateral significant cataracts and pre-existing corneal astigmatism underwent cataract surgery and implantation with the AcrySof™ IQ Vivity™ toric IOL. Dominant eyes were targeted at emmetropia and non-dominant eyes at -0.50D. Primary endpoints were binocular uncorrected distance (UDVA), intermediate (UIVA at 66 cm) and near (UNVA at 40 cm) acuities at 3 months. Secondary outcomes were corrected distance (CDVA), distance corrected intermediate (DCIVA) and distance corrected near (DCNVA), refractive predictability, rotational stability, binocular defocus curve, contrast sensitivity, Questionnaire for Visual Disturbances (QUVID) and Visual Function Index (VF-14) questionnaire scores. All visual acuities were converted to logarithm of minimum angle of resolution (logMAR) for analysis. Results: 30 patients underwent uneventful phacoemulsification. The mean binocular UDVA, UIVA and UNVA were 0.06 ± 0.12, 0.11 ± 0.10 and 0.26 ± 0.10 respectively. The mean refractive spherical equivalent (MRSE) for dominant and non-dominant eyes were − 0.07D ± 0.27 and − 0.12D ± 0.54 respectively. 92.4% of dominant eyes and 84.6% of non-dominant eyes within 0.50D of target. The mean IOL rotation was 3.85° ± 5.09 with 86.7% of eyes with less than 5° of rotation. 26.7%, 20% and 36.7% of patients reported starbursts, haloes and glare respectively. The mean VF-14 score was 91.77. Conclusion: Bilateral implantation of the AcrySof™ IQ Vivity™ Toric IOL resulted in very good unaided visual acuities for far and intermediate distance with functional near vision. Dysphotopsias were reported but despite this, a high level of visual function was achieved. [ABSTRACT FROM AUTHOR]

Abstract Aim To evaluate the objective visual outcomes following implantation of extended depth of focus intraocular lens (EDOF IOL) in individuals with varying axial lengths (AL) and targeted refraction. Methods This retrospective study comprised age-matched eyes that underwent implantation of the EDOF IOL. Eyes were categorized based on AL into groups: control group with AL 0.05). Additionally, in the high myopia group, the CS of the − 2.25 to -1.50 group was lower compared to that of the − 0.75 to 0.00 group (P = 0.017). Among high myopia patients, 90.00% with refraction ranging from − 1.50 to -0.75 reported achieving overall spectacle independence. Conclusions Implantation of extended depth of focus intraocular lenses (IOLs) yields satisfactory visual and refractive outcomes in eyes with axial myopia. Among high myopia patients, a refraction ranging from − 1.50 to -0.75 diopters achieves superior visual quality compared to other postoperative myopic diopters.

Digital holographic microscopy (DHM) is a well-known technique utilized by researchers to precisely examine the 3D topography of microscopic objects. Until now, DHM systems have offered researchers a trade-off between either achieving telecentricity or maintaining a limited depth of focus, presenting a challenge for comprehensive 3D imaging. Here, we propose a very stable DHM system that utilizes a customized microscope objective and electrically tunable lens to enable rapid axial scanning within the extended depth of focus range, continuous field of view, and telecentricity at each image plane. An extended depth of focus up to 5.5 mm axially is obtained with consistent magnification and resolution with a minimal magnification error of 2.2 % over the entire axial range. Additionally, a thorough investigation into the temporal stability of the system was conducted, with multiple holographic recordings taken over a period of 7 s. The minimal deviation in object height, measuring just 0.31 nm (without the use of vibration isolation), underscores the good temporal stability inherent in this proposed DHM system. • A customized MO + ETL module has been proposed for DHM system geometry. • It provides both telecentricity and extended depth of focus in DHM simultaneously. • The module provided constant magnification and resolution. • An extended depth of focus up to 5.5 mm axially is obtained. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the objective visual outcomes following implantation of extended depth of focus intraocular lens (EDOF IOL) in individuals with varying axial lengths (AL) and targeted refraction. Methods: This retrospective study comprised age-matched eyes that underwent implantation of the EDOF IOL. Eyes were categorized based on AL into groups: control group with AL < 26 mm; high myopia group with AL ≥ 26 mm. Each group was then subdivided based on postoperative spherical equivalent (SE). Follow-up at three months included assessment of uncorrected visual acuity at different distances, contrast sensitivity (CS), refractive outcomes, and spectacle independence. Results: Overall, this study included 100 eyes from 100 patients, comprising 50 males (50.00%) and 50 females (50.00%), with 20 eyes in each group. In the control group, the uncorrected distance visual acuity (UDVA) at 5 and 3 m (m) in the − 1.50 to -0.75 group was inferior to that of the − 0.75 to 0.00 group (P = 0.004). Conversely, the uncorrected near visual acuity (UNVA) at 33 cm in the − 1.50 to -0.75 group was superior to that of the − 0.75 to 0.00 group (P = 0.005). Within the high myopia group, the UDVA at 5 and 3 m in the − 2.25 to -1.50 group was worse than in the − 0.75 to 0.00 group (P = 0.009 and 0.008, respectively). However, the UNVA at 33 cm in the − 2.25 to -1.50 group was better than in the − 0.75 to 0.00 group (P = 0.020). No significant differences were observed among the groups for corrected distance visual acuity (CDVA) (P > 0.05). Additionally, in the high myopia group, the CS of the − 2.25 to -1.50 group was lower compared to that of the − 0.75 to 0.00 group (P = 0.017). Among high myopia patients, 90.00% with refraction ranging from − 1.50 to -0.75 reported achieving overall spectacle independence. Conclusions: Implantation of extended depth of focus intraocular lenses (IOLs) yields satisfactory visual and refractive outcomes in eyes with axial myopia. Among high myopia patients, a refraction ranging from − 1.50 to -0.75 diopters achieves superior visual quality compared to other postoperative myopic diopters. [ABSTRACT FROM AUTHOR]

Purpose: Limitations of existing diffractive multifocal designs for presbyopia correction include discrete foci and photic phenomena such as halos and glare. This study aimed to explore a methodology for developing refractive extended depth‐of‐focus (EDoF) lenses based on a periodic power profile. Methods: The proposed design technique employed an optical power profile that periodically alternated between far, intermediate and near distances across the pupil radius. To evaluate the lens designs, optical bench testing was conducted. The impact on visual performance was assessed using a spatial light modulator‐based adaptive optics vision simulator in human subjects. Additionally, the effects of pupil size change and lens decentration on retinal image quality were examined. A comparative performance analysis was carried out against a typical diffractive trifocal design and a monofocal lens. Results: The proposed design method was found to be effective in uniformly distributing light energy across all object distances within the desired depth of focus (DoF). While trade‐offs between overall image quality and DoF still exist, the EDoF lens design, when tested in human subjects, provided a continuous DoF spanning over 2.25 D. The results also revealed that the EDoF design had a slightly higher dependence on changes in pupil size and lens decentration than the diffractive trifocal design. Conclusion: The proposed design method showed significant potential as an approach for developing refractive EDoF ophthalmic lenses. These lenses offer a continuous DoF but are slightly more susceptible to variations in pupil size and decentration compared with the diffractive trifocal design. [ABSTRACT FROM AUTHOR]

Akshaya Lakshmi Thananjeyan,1 Anna Siu,2 Angela Jennings,2 Chandra Bala2 1Emergency Department, St. Vincent’s Hospital, Sydney, NSW, Australia; 2Personal-Eyes, Sydney, NSW, AustraliaCorrespondence: Chandra Bala, Personal-Eyes, 2/33 York St, Sydney, NSW, 2000, Australia, Tel +61-88337111, Email chandrabala.eye@gmail.comPurpose: To assess visual outcomes of the implantation of a non-diffractive extended depth of focus (EDOF) intraocular lens (IOL) in patients with age-related macular degeneration (AMD).Setting: Ophthalmology practice, Sydney, Australia.Design: Retrospective chart review.Methods: Patients with AMD undergoing cataract surgery and receiving non-diffractive EDOF AcrySof IQ Vivity IOL implantation over a 2-year period were identified. Corrected distance visual acuity (CDVA), distance-corrected near visual acuity (DCNVA; 50 cm), contrast sensitivity, central foveal thickness, VF-14 questionnaire results, and quality of life where available were analyzed.Results: A total of 28 sequential patients (51 eyes) were included in this pilot study (46% male, mean age 77.4 years). Of 27 eyes that had late AMD, 17 (63%) had wet AMD. Mean patient preoperative CDVA was logMAR 0.32± 0.29. Postoperative monocular CDVA and DCNVA were logMAR 0.20± 0.25 and N9± 5 (range N5–N36), respectively. Eyes achieving postoperative CDVA of Snellen 6/5– 6/12 (n=42, 82%), 6/15– 6/24 (n=7, 14%), and greater than 6/24 (n=2, 4%) achieved a mean DCNVA of N8 (range N5–N10), N13 (range N10–N18), and N27 (range N18–N36), respectively. Eyes achieving CDVA of Snellen 6/5– 6/12 showed contrast sensitivity within the normal range. On postoperative VF-14 questionnaire, patients with CDVA of Snellen 6/5– 6/12 reported minimal visual impairment, while patients with CDVA greater than 6/15 reported mild impairment. A majority of patients (96%, n=27) were satisfied with the improvement in quality of life postoperatively. No intraoperative complications were reported.Conclusion: The EDOF AcrySof IQ Vivity IOL provides improved near vision proportional to distance vision in patients with early AMD.Keywords: age-related macular degeneration, cataract, intraocular lens, extended depth of focus, non-diffractive

Mikroskobik sistemlerde var olan odaklama derinliğinden dolayı numunenin tüm alanının odaklandığı görüntü elde etmek imkânsız olabilmektedir. Bu durum, mikroskobik sistemlerde görüntü işleme ve yapay zekâ algoritmaları kullanılarak gerçekleştirilen sınıflandırma, bölütleme, hizalama (registration), panoramik birleştirme (stitching) gibi uygulamalarının başarılarını olumsuz yönde etkilemektedir. Literatürde numunenin tüm alanının odaklandığı görüntü elde etmek için odaklama derinliğinin artırılması yaklaşımları geliştirilmektedir. Literatür çalışmaları, bu yaklaşımların, görüntülerdeki eğrilerin ve kenarların düşük kesinlikte karakterizasyonu, daha yüksek koşma süresi ve incelenen numuneye ve kullanılan mikroskoba göre performans değişimi gibi çeşitli kısıtlamalara sahip olduklarını ortaya koymaktadır. Ek olarak, bu yaklaşımlar odaklama bilgilerini genelde görüntülerin gri seviye değerlerini kullanarak hesaplamaktadırlar. Bu çalışmada bu kısıtlamaları minimize etmek için yeni bir odaklama derinliğinin artırılması yaklaşımı geliştirilmekte ve odaklama derinliğinin artırılmasında derin özelliklerin odaklama değerlerinin çıkarılmasındaki etkileri incelenmektedir. Çalışmada elde edilen sonuçlar derin özelliklerin piksellerin odaklama değerlerini hesaplamada gri seviye değerlerine göre daha etkin olduğunu göstermektedir.

Purpose: Evaluate postoperative visual performance in patients with bilaterally implanted AT LARA or AT LARA/AT LISA tri (Carl Zeiss AG, Jena, Germany) intraocular lenses. Methods: Multicentered, comparative, open-label, retrospective/prospective study. Post-IOL implantation, patients were prospectively enrolled into this study; preoperative patient data were collected retrospectively. Follow-up was at 2–4 and 5–8 months post-surgery. The primary endpoint was binocular best corrected distance visual acuity (CDVA). The study was retrospectively registered on clinicaltrials.gov (#NCT05462067). Results: Seventy-one patients (142 eyes) were enrolled; 67 patients (134 eyes) have 5–8 months data. The mean binocular CDVA at 2–4 months was -0.10 ± 0.06 logMAR in the bilateral AT LARA group (“bilateral”) and -0.11 ± 0.09 logMAR in the combined implantation AT LARA/ AT LISA tri group (“combined implantation”); (P = 0.4856). At 5–8 months, mean binocular CDVA was -0.13 ± 0.06 logMAR in the bilateral group and -0.11 ± 0.09 in the combined implantation group (P = 0.4003). At 5–8 months, more eyes in the bilateral group attained 0.2 logMAR or better binocular uncorrected intermediate VA (UIVA; 67 cm) than those in the combined implantation group (100% vs. 94%, respectively). The bilateral group achieved a mean of 0.24 ± 0.11 logMAR in uncorrected near VA (UCNVA), compared to a mean of 0.16 ± 0.12 logMAR in the combined implantation group at 5–8 months (P = 0.0041). Conclusions: A combined implantation approach (AT LARA in the distance dominant eye/AT LISA tri in the non-dominant eye) produced similar CDVA outcomes but better UCNVA as bilateral implantation with the AT LARA. UIVA was comparable between groups. No new safety concerns were reported. [ABSTRACT FROM AUTHOR]

Thomas Kohnen,1 John P Berdahl,2 Xin Hong,3 Chandra Bala4 1Department of Ophthalmology, Goethe University Frankfurt, Frankfurt am Main, Germany; 2Vance Thompson Vision, Sioux Falls, SD, USA; 3Alcon Vision LLC, Fort Worth, TX, USA; 4PersonalEYES, Sydney, NSW, AustraliaCorrespondence: Thomas Kohnen, Department of Ophthalmology, Goethe University, Theodor-Stern-Kai 7, Frankfurt, 60590, Germany, Email thomas.kohnen@kgu.dePurpose: To evaluate the clinical rationale of wavefront-shaping technology, describe how intraocular lenses (IOLs) using wavefront-shaping technology are differentiated from refractive or diffractive optical presbyopia-correcting designs, and describe the mode of action of this technology.Methods: Extended depth of focus (EDoF) IOLs are the latest class of presbyopia-correcting IOLs addressing the growing demand of patients for reduced spectacle dependence. These use various optical technologies, including diffractive designs (eg, TECNIS Symfony ZXR00 and AT LARA 29 MP) and non-diffractive designs such as small aperture (eg, IC-8 IOL and XtraFocus Pinhole Implant), spherical aberration (eg, MINI WELL Ready and LuxSmart), and wavefront shaping (eg, AcrySof IQ Vivity DFT015 and Clareon Vivity CNWET0). Despite some improvement in visual acuity at intermediate and near distances, these technologies can still be associated with increased rate of visual disturbances or poorer distance vision compared with monofocal IOLs. One way to overcome such limitations is using a wavefront-shaping optical principle.Results: Clinical data show that wavefront-shaping technology results in a continuous EDoF compared with a monofocal IOL while exhibiting a minimal halo, similar to an aspheric monofocal IOL. Clinically, this translates to a lens that has proven to exceed the American National Standards Institute/American Academy of Ophthalmology criteria for an EDoF IOL.Conclusion: The novel wavefront-shaping optic technology allows patients to achieve a continuous range of vision from distance to functional near with low levels of visual disturbances comparable with aspheric monofocal IOLs.Keywords: cataract surgery, visual disturbances, extended depth of focus, wavefront-shaping technology

Abstract Introduction Patients implanted with a range-of-vision intraocular lens (IOL) (multifocal or extended depth of focus, EDOF) may be more susceptible to visual disturbances from poor tear film quality, and prophylactic treatment of meibomian gland dysfunction (MGD) has been recommended. The purpose was to evaluate whether vectored thermal pulsation (LipiFlow™) treatment prior to cataract surgery with a range-of-vision IOL safely improves postoperative outcomes. Methods This is a prospective, randomized, open-label, crossover, multicenter study of patients with mild-to-moderate MGD and cataract. The test group underwent LipiFlow treatment prior to cataract surgery and implantation of an EDOF IOL, while the control group did not. Both groups were evaluated 3 months postoperatively, after which the control group received LipiFlow treatment (crossover). The control group was re-evaluated 4 months postoperatively. Results A total of 121 subjects were randomized, with 117 eyes in the test group and 115 eyes in the control group. At 3 months after surgery, the test group had a significantly greater improvement from baseline in total meibomian gland score compared with the control group (P = 0.046). At 1 month after surgery, the test group had a significant decrease in corneal (P = 0.04) and conjunctival (P = 0.002) staining compared to the control group. At 3 months after surgery, the test group had significantly lower incidence of being bothered by halos compared with the control group (P = 0.019). The control group had a significantly lower incidence of being bothered by multiple or double vision compared with the test group (P = 0.016). After crossover, patients had significant improvement in vision (P = 0.03) and total meibomian gland score (P

The aim of this study is to evaluate the results obtained on the optical bench and clinically with an isofocal lens (ISOPure, BVI medical, Belgium) to compare them to a standard monofocal one (MicroPure, BVI medical, Belgium). To do so, we have combined laboratory investigation and a prospective, comparative, and randomized clinical study. First, we have measured the wavefront of the two models studied using a NIMO TR1504 (Lambda-X, Belgium) deflectometer for three nominal powers: +10.00, +20.00 and +30.00 D. In the randomized study with 48 patients, half of them implanted with ISOPure and the other with MicroPure, we have measured visual acuities and contrast sensitivity under photopic and mesopic conditions. The optical bench results show that the isofocal lens presented higher power than the monofocal one, at the lens center, due to the spherical aberration (coefficients Z(4,0), Z(6,0) and Z(8,0)) induced by the greater asphericity of its design. The addition obtained depended on the nominal power, from +1.00 to +1.50 D. The results of the clinical study showed that the ISOPure lens presented better visual outcomes, which were statistically significant, at intermediate distance compared to the MicroPure lens (p-values of 0.014 and 0.022 for 80 and 60 cm, respectively) without decreasing the contrast sensitivity. Clinical outcomes were not affected by pupillary size. In conclusion, due to the increase in power at the lens center due to its highly aspherical design, the isofocal lens evaluated showed better intermediate vision than the monofocal one. [ABSTRACT FROM AUTHOR]

Introduction: Patients implanted with a range-of-vision intraocular lens (IOL) (multifocal or extended depth of focus, EDOF) may be more susceptible to visual disturbances from poor tear film quality, and prophylactic treatment of meibomian gland dysfunction (MGD) has been recommended. The purpose was to evaluate whether vectored thermal pulsation (LipiFlow™) treatment prior to cataract surgery with a range-of-vision IOL safely improves postoperative outcomes. Methods: This is a prospective, randomized, open-label, crossover, multicenter study of patients with mild-to-moderate MGD and cataract. The test group underwent LipiFlow treatment prior to cataract surgery and implantation of an EDOF IOL, while the control group did not. Both groups were evaluated 3 months postoperatively, after which the control group received LipiFlow treatment (crossover). The control group was re-evaluated 4 months postoperatively. Results: A total of 121 subjects were randomized, with 117 eyes in the test group and 115 eyes in the control group. At 3 months after surgery, the test group had a significantly greater improvement from baseline in total meibomian gland score compared with the control group (P = 0.046). At 1 month after surgery, the test group had a significant decrease in corneal (P = 0.04) and conjunctival (P = 0.002) staining compared to the control group. At 3 months after surgery, the test group had significantly lower incidence of being bothered by halos compared with the control group (P = 0.019). The control group had a significantly lower incidence of being bothered by multiple or double vision compared with the test group (P = 0.016). After crossover, patients had significant improvement in vision (P = 0.03) and total meibomian gland score (P < 0.0001). No safety concerns or relevant safety findings were uncovered. Conclusion: Presurgical LipiFlow treatment of patients implanted with range-of-vision IOLs improved meibomian gland function and postoperative ocular surface health. This supports guidelines recommending proactive diagnosis and management of MGD in patients with cataracts to improve patient experience. Trial Registration: The study was registered on www.clinicaltrials.gov (NCT03708367). [ABSTRACT FROM AUTHOR]

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Evaluating chromatic aberration for a multifocal intraocular lens (MIOL) in vitro is essential for studying its performance because it helps determine the most appropriate lens for each patient, enhancing surgical outcomes. While refractive MIOLs with angular power variation have shown positive clinical outcomes, studies of these MIOLs on optical benches primarily employed monochromatic green light, neglecting the impact of longitudinal chromatic aberration (LCA) on MIOL performance. To address this gap, we evaluated the through-focus modulation transfer function (TF-MTF) and the point spread function (PSF) of two refractive segmented extended depth of focus intraocular lenses (IOLs) (Femtis Comfort and Precizon Presbyopic), comparing the results with those obtained with two widely known diffractive multifocal intraocular lenses (AcrySof IQ ReSTOR and FineVision Pod F). Measurements of the TF-MTF were conducted using both monochromatic and polychromatic light in a customized optical bench. The refractive designs exhibited distinct haloes in the PSFs. When comparing the refractive and diffractive designs, opposite signs of LCA were observed at near foci. These findings emphasize the influence of the optical design of IOLs on their performance under polychromatic light, providing valuable information for vision care professionals when selecting the most suitable lens for each patient. [ABSTRACT FROM AUTHOR]

Two-photon excitation in light-sheet microscopy advances applications to live imaging of multicellular organisms. In a previous study, we developed a two-photon Bessel beam light-sheet microscope with a nearly 1-mm field of view and less than 4-μm axial resolution, using a low magnification (10×), middle numerical aperture (NA 0.5) detection objective. In this study, we aimed to construct a light-sheet microscope with higher resolution imaging while maintaining the large field of view, using low magnification (16×) with a high NA 0.8 objective. To address potential illumination and detection mismatch, we investigated the use of a depth of focus (DOF) extension method. Specifically, we used a stair-step device composed of five-layer annular zones that extended DOF two-fold, enough to cover the light-sheet thickness. Resolution measurements using fluorescent beads showed that the reduction in resolutions was small. We then applied this system to in vivo imaging of medaka fish and found that image quality degradation at the distal site of the beam injection could be compensated. This demonstrates that the extended DOF system combined with wide-field two-photon light-sheet microscopy offers a simple and easy setup for live imaging application of large multicellular organism specimens with sub-cellular resolution. [ABSTRACT FROM AUTHOR]

Mohammed Abd Elghaffar Shehata, Mohamed Hassan Hosny, Doaa Ahmed Tolba, Mohamed Attya Department of Ophthalmology, Cairo University, Cairo, EgyptCorrespondence: Mohamed Attya, Department of Ophthalmology, Cairo University, 15th Zahret Alsokar, Alsheikh Othman, Alhawamedia, Giza, Egypt, Tel +201113332892, Email Mohamed.attya86@cu.edu.egPurpose: To evaluate postoperative visual performance and total ocular aberration in cataract patients after implantation of the TECNIS Eyhance™ intraocular lens (IOL).Methods: Our study is a prospective interventional non-comparative study that was conducted on 34 eyes of 17 patients who underwent phacoemulsification and Eyhance IOL implantation. Postoperative corrected and uncorrected near and far visual acuity and total ocular aberration were assessed 3 months after surgery.Results: Our study included 34 eyes of 17 patients. At the third postoperative month, the mean spherical equivalent (SE) was − 0.32 diopters (D) (SD ± 0.62), and the mean distance-corrected near visual acuity (DCNVA) was 0.33 (SD ± 0.15) and 0.42 (SD ± 0.17) decimal notation (DN) monocular and binocular, respectively. The mean near distance with maximum visual acuity was 79.47 cm (SD ± 7.70) and 74.76 cm (SD ± 7.90) monocular and binocular, respectively. The mean postoperative minimum reading addition (add) was 1.6 D (SD ± 0.47). The mean spherical aberration (SA) was 0.13 μm (SD ± 0.09). The correlation of amount of spherical aberration with power of minimum reading add at 40 cm was not statistically significant (p=0.324).Conclusion: The TECNIS Eyhance IOL provides good intermediate visual acuity and decreases the power of the reading add needed after phacoemulsification.Keywords: high-order aberration, presbyopia, extended depth of focus, aspheric IOLs, Eyhance

Brian M Shafer,1 Cathleen McCabe,2 Harvey Reiser,3 T Hunter Newsom,4 John Berdahl5 1Department of Ophthalmology, Chester County Eye Care Associates, Malvern, PA, USA; 2Department of Ophthalmology, The Eye Associates, Sarasota, FL, USA; 3Department of Ophthalmology, Eye Care Specialists, Kingston, PA, USA; 4Department of Ophthalmology, NewsomEye, Sebring, FL, USA; 5Department of Ophthalmology, Vance Thompson Vision, Sioux Falls, SD, USACorrespondence: Brian M Shafer, Chester County Eye Care Associates, 325 Central Ave, Suite 101, Malvern, PA, 19355, USA, Email Brian.M.Shafer@gmail.comPurpose: To evaluate the long-term (> 1 yr) outcomes a non-diffractive extended vision intraocular lens (AcrySof IQ Vivity) compared to monofocal control.Setting: This was a multicenter trial that took place in 4 separate private ophthalmology practices throughout the United States.Design: This was a prospective, non-interventional, controlled, multicenter trial. All subjects were enrolled from participants in the Food and Drug Administration (FDA) clinical trial that led to the approval of the AcrySof IQ Vivity.Methods: Binocular uncorrected distance visual acuity (UCDVA), distance corrected visual acuity (DCVA), uncorrected intermediate visual acuity (UIVA) at 66cm, distance corrected intermediate visual acuity (DCIVA) at 66cm, uncorrected near visual acuity (UNVA) at 40cm, and distance corrected near visual acuity (DCNVA) at 40cm were measured. The binocular defocus curve was measured. A 23-question survey on visual performance including questions on spectacle independence, satisfaction, dysphotopsias, and likelihood of recommending their lens to another person was used administered.Results: A total of 64 eyes of 32 subjects were enrolled. Seventeen subjects had bilateral implantation of the AcrySof IQ Vivity lens, and 15 subjects had bilateral implantation of the AcrySof IQ Monofocal (SN60WF). Mean follow up time was 1078 days for the study group compared to 1067 days for the control group (p = 0.92). There were no differences in UCVA or DCVA between the two groups. Compared to control, the AcrySof IQ Vivity group had better mean binocular UIVA (logMAR 0.29 vs 0.18; p = 0.09), DCIVA (logMAR 0.33 vs 0.11; p = 0.003), UNVA (logMAR 0.49 vs 0.30, p = 0.01), and DCNVA (logMAR 0.54 vs 0.29; p = 0.001).Conclusion: The AcrySof IQ Vivity is a novel, non-diffractive extended range of vision intraocular lens that provides long-term, enhanced visual acuity at intermediate and near ranges with high levels of patient satisfaction and minimal dysphotopsias.Keywords: Vivity, extended depth of focus, defocus curve, cataract surgery

Abstract Background Recently, a new presbyopia-correcting intraocular lens (IOL) that combines extended depth-of-focus and bifocal profiles (ZFR00: Tecnis® Synergy®, Johnson & Johnson Vision, Santa Ana, CA, USA) has been established and several studies have been reported. We attempted to compare the performance with a standard IOL (ZCB00: Tecnis® monofocal, Johnson & Johnson Vision, Santa Ana, CA, USA) manufactured using the same material from the same company, which has been extensively used worldwide. Methods The medical records of patients undergoing cataract surgery with ZCB00 or ZFR00 implantation between March 2021 and September 2021 and with available 3-month visit data were reviewed. Uncorrected near, intermediate, and distance visual acuity (VA), corrected distance VA, and optical quality were the main outcome measures. Results This study included forty-six patients (64 eyes), with twenty-one patients (32 eyes) implanted with ZCB00 and twenty-five patients (32 eyes) implanted with ZFR00. The average age of the patients was 66.0 ± 10.1 (range: 40 to 82) and 65.1 ± 4.7 (range: 59 to 77) years in the ZCB00 and ZFR00 groups, respectively. The preoperative characteristics did not differ significantly between the two groups. Compared to the ZCB00 group, the ZFR00 group demonstrated significantly superior intermediate and near VA (p

Kjell Gunnar Gundersen,1 Richard Potvin2 1IFocus Øyeklinikk AS, Haugesund, Norway; 2Science in Vision, Bend, OR, USACorrespondence: Kjell Gunnar Gundersen, IFocus Øyeklinikk AS, Sørhauggata 111, Haugesund, 5527, Norway, Tel +47 808900, Email kg@ifocus.noPurpose: To evaluate the range of vision, visual function, and quality of vision after implantation of a secondary extended depth of focus intraocular lens (EDOF IOL) implanted in the sulcus.Setting: One clinical practice in Haugesund, Norway.Design: Prospective single arm non-interventional study.Methods: Eligible subjects presenting for surgery, or who had previous successful primary cataract or refractive lens exchange surgery in both eyes were subsequently implanted with the AddOn® secondary EDOF IOL in the sulcus. Manifest refraction and visual acuity at distance, intermediate and near were measured 3 months after surgery, along with the monocular defocus curve. Subjects also completed a visual function and a quality of vision questionnaire.Results: The study included 32 eyes of 16 subjects. At 3 months postoperative, the mean refraction spherical equivalent (MRSE) was − 0.16 ± 0.30 D, with a residual cylinder of 0.29 ± 0.27 D. The mean monocular uncorrected VA was 0.1 logMAR (20/25) or better at all test distances. The monocular defocus curves showed a depth of focus of 2.0 D. For every category except reading fine print, all but one subject (94%) had no difficulty or little difficulty with near tasks. Glare and halos were the most common visual disturbances, with no reports of starbursts. There was no evidence of any intralenticular opacification in any of the eyes, and no evidence of iris chafing/depigmentation.Conclusion: This secondary EDOF IOL provided excellent distance and intermediate vision, and very good near vision to subjects. Subject reported near visual function was also very good and visual disturbances were limited. This lens appears to be a good option for patients who would like to improve their range of vision. Results appear as good or better than those reported for primary EDOF lenses.Keywords: sulcus, secondary IOL, AddOn EDOF, EDOF, extended depth of focus

Purpose: To evaluate postoperative visual performance and total ocular aberration in cataract patients after implantation of the TECNIS Eyhance™ intraocular lens (IOL). Methods: Our study is a prospective interventional non-comparative study that was conducted on 34 eyes of 17 patients who underwent phacoemulsification and Eyhance IOL implantation. Postoperative corrected and uncorrected near and far visual acuity and total ocular aberration were assessed 3 months after surgery. Results: Our study included 34 eyes of 17 patients. At the third postoperative month, the mean spherical equivalent (SE) was − 0.32 diopters (D) (SD ± 0.62), and the mean distance-corrected near visual acuity (DCNVA) was 0.33 (SD ± 0.15) and 0.42 (SD ± 0.17) decimal notation (DN) monocular and binocular, respectively. The mean near distance with maximum visual acuity was 79.47 cm (SD ± 7.70) and 74.76 cm (SD ± 7.90) monocular and binocular, respectively. The mean postoperative minimum reading addition (add) was 1.6 D (SD ± 0.47). The mean spherical aberration (SA) was 0.13 μm (SD ± 0.09). The correlation of amount of spherical aberration with power of minimum reading add at 40 cm was not statistically significant (p=0.324). Conclusion: The TECNIS Eyhance IOL provides good intermediate visual acuity and decreases the power of the reading add needed after phacoemulsification. [ABSTRACT FROM AUTHOR]

Katarzyna Ewa Nowik,1 Kamil Nowik,1 Piotr Kanclerz,2,3 Jacek Pawe&lstrok; Szaflik1 1Department of Ophthalmology, Public Ophthalmic Clinical Hospital (SPKSO), Medical University of Warsaw, Warsaw, Poland; 2Department of Ophthalmology, Hygeia Clinic, Gda&nacute;sk, Poland; 3Helsinki Retina Research Group, University of Helsinki, Helsinki, FinlandCorrespondence: Katarzyna Ewa Nowik, Tel +48 509 873 680, Email lek.katarzynaolejnik@onet.euPurpose: Extended depth of focus intraocular (EDOF) IOLs form a bridge between single- and multifocal IOL design. This study aimed to compare clinical outcomes obtained after implanting two different optical designs of EDOF IOLs: the Mini Well Ready (SIFI Medtech, Catania, Italy) and Tecnis Symfony (Abbott Laboratories, Illinois, USA).Methods: The retrospective observational study included 61 patients (122 eyes) who underwent bilateral implantation of the Mini Well Ready IOL (32 patients) or the Tecnis Symfony IOL (29 patients). The following preoperative and postoperative parameters were evaluated: spherical equivalent, anterior astigmatism, pupil size, monocular and binocular uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), monocular and binocular uncorrected intermediate visual acuity (UIVA) and distance-corrected intermediate visual acuity (DCIVA), monocular and binocular uncorrected near visual acuity (UNVA) and distance-corrected near visual acuity (DCNVA). In the 6 months postoperative period, defocus curve, contrast sensitivity, photopic phenomena, and posterior capsule opacification were assessed.Results: The patients receiving the Tecnis Symfony had slightly better monocular and binocular UDVA and CDVA than with the Mini Well Ready IOL, the differences were not statistically significant. Whereas the UIVA, DCIVA, UNVA, DCNVA, UNVA and DCNVA values were higher in the Mini Well Ready group, the differences were not significant. There were no significant between-group differences regarding the defocus curve for the vast majority of tested vergences. Dysphotopsias postoperatively were assessed at 6 months.Conclusion: Patients receiving both the Mini Well Ready and Symfony IOLs had excellent visual acuity outcomes and spectacle independence.Keywords: cataract, extended depth of focus, defocus curve, intraocular lens

The aim of this study is to evaluate the results obtained on the optical bench and clinically with an isofocal lens (ISOPure, BVI medical, Belgium) to compare them to a standard monofocal one (MicroPure, BVI medical, Belgium). To do so, we have combined laboratory investigation and a prospective, comparative, and randomized clinical study. First, we have measured the wavefront of the two models studied using a NIMO TR1504 (Lambda-X, Belgium) deflectometer for three nominal powers: +10.00, +20.00 and +30.00 D. In the randomized study with 48 patients, half of them implanted with ISOPure and the other with MicroPure, we have measured visual acuities and contrast sensitivity under photopic and mesopic conditions. The optical bench results show that the isofocal lens presented higher power than the monofocal one, at the lens center, due to the spherical aberration (coefficients Z(4,0), Z(6,0) and Z(8,0)) induced by the greater asphericity of its design. The addition obtained depended on the nominal power, from +1.00 to +1.50 D. The results of the clinical study showed that the ISOPure lens presented better visual outcomes, which were statistically significant, at intermediate distance compared to the MicroPure lens (p-values of 0.014 and 0.022 for 80 and 60 cm, respectively) without decreasing the contrast sensitivity. Clinical outcomes were not affected by pupillary size. In conclusion, due to the increase in power at the lens center due to its highly aspherical design, the isofocal lens evaluated showed better intermediate vision than the monofocal one.

T Hunter Newsom,1 Richard Potvin2 1Newsom Eye & Laser Center, Sebring, FL, USA; 2Science in vision, Bend, OR, USACorrespondence: T Hunter Newsom, Email hunter@newsomeye.netPurpose: To assess the visual outcomes and quality of vision of patients receiving the AcrySof® IQ Vivity™ non-diffractive extended vision intraocular lens (NDEV IOL) after uneventful cataract surgery when the non-dominant eye is targeted for slight myopia.Design: Single site, prospective, single-arm study.Methods: Eligible subjects interested in reducing their dependence on spectacles over a range of working distances were enrolled and followed for 3 months after the second eye surgery. Subjects were bilaterally implanted with this NDEV IOL, with a target of emmetropia in the dominant eye and a myopic refraction of − 0.75D in the non-dominant eye. At 3 months postoperative, the uncorrected and distance-corrected (with monovision) visual acuity at 40 cm, 66 cm and 4 m were recorded, along with the manifest refraction. Questionnaires related to spectacle independence, patient satisfaction and quality of vision were also administered.Results: Data from 33 subjects were analyzed. The mean difference between eyes by subject was 0.80 ± 0.37 D. Twenty-nine of 33 (88%) subjects had a binocular uncorrected near VA of 0.2 logMAR or better. Twenty-five of 33 eyes (76%) had a binocular distance-corrected (− 0.75 D in the non-dominant eye) VA of 0.2 logMAR or better at all three test distances. Satisfaction with vision at all distances was high. The reported level of spectacle independence was higher than for the same lens without monovision. Visual disturbances were higher than has been previously reported for this lens but were not correlated to the level of monovision.Conclusion: A target of − 0.75 D of myopia in the non-dominant eye of patients bilaterally implanted with this NDEV IOL improved near vision, increasing the rate of spectacle independence in patients relative to those targeted for bilateral emmetropia, with no correlated increases in visual disturbances.Keywords: wavefront shaping, spectacle independence, presbyopia correction, EDOF, extended depth of focus, extended depth of vision, non-diffractive, monovision

Kjell Gunnar Gundersen,1 Richard Potvin2 1IFocus Øyeklinikk AS, Haugesund, Norway; 2Science in Vision, Bend, OR, USACorrespondence: Kjell Gunnar GundersenIFocus Øyeklinikk AS, Sørhauggata 111, Haugesund, 5527, NorwayTel +47 808900Email kg@ifocus.noPurpose: To provide normative visual acuity and quality of vision data related to bilateral implantation of a wavefront shaping presbyopia correcting intraocular lens (IOL).Patients and Methods: This was a non-interventional research study of the refraction, visual acuity (VA) and quality of vision achieved after bilateral implantation of a wavefront shaping presbyopia correcting intraocular lens between 3 months and 12 months post-surgery. The manifest refraction, and uncorrected and distance corrected VA at near, intermediate and distance (40 cm, 50 cm, 66cm, 4 m) were tested. Binocular mesopic VA at 4m and uncorrected photopic low contrast (25%) VA at 4 m were also tested, the latter with and without a glare source. A patient reported outcome questionnaire was administered. Defocus curve testing with and without simulated myopia in the non-dominant eye was also tested (reported elsewhere).Results: Forty subjects completed the study. There was no statistically significant difference between the uncorrected and distance corrected VA at any distance. Mean logMAR binocular VAs were (− 0.07 ± 0.07) at 4 m, (0.00 ± 0.07) at 66 cm and (0.07 ± 0.11) at 40 cm. Uncorrected photopic low contrast VA was statistically significantly better without glare (0.09 ± 0.10) compared to with glare (0.44 ± 0.21, p < 0.01). Reported glare, halos and starbursts were “not at all” Or “a little” bothersome for more than 95% of subjects. Hazy vision and blurred vision were reported most often.Conclusion: The Vivity IOL provided patients with good distance and intermediate vision, and functional near vision with low reported bother from glare, halos, or starbursts.Keywords: non-diffractive, extended depth of focus, extended vision, cataract, presbyopia, quality of vision, wavefront shaping

Purpose: To determine the efficacy of two myopia control contact lenses (CL) compared with a single‐vision (SV) CL. Methods: Ninety‐five Chinese children with myopia, aged 7–13 years in a 1‐year prospective, randomised, contralateral, cross‐over clinical trial with 3 groups; bilateral SVCL (Group I); randomised, contralateral wear of an extended depth of focus (EDOF) CL and SVCL (Group II) and MiSight® CL and SVCL (Group III). In Groups II and III, CL were crossed over at the 6‐month point (Stage 1) and worn for a further 6 months (Stage 2). Group I wore SVCL during both stages. At baseline and the end of each stage, cycloplegic spherical equivalent refractive error (SE) and axial length (AL) were measured. Six‐monthly ΔSE/ΔAL across groups was analysed using a linear mixed model (CL type, stage, eye and eye* stage included as factors). Intra‐group paired differences between eyes were determined. Results: In Group I, mean (SD) ΔSE/ΔAL with SVCL was −0.41 (0.28) D/0.13 (0.09) mm and −0.25 (0.27) D/0.16 (0.09) mm for stages 1 and 2, with a mean paired difference between eyes of 0.01 D/0.01 mm and 0.05 D/−0.01 mm, respectively. ΔSE/ΔAL with SVCL was similar across Groups I to III (Stage 1: p = 0.89/0.44, Stage 2: p = 0.70/ 0.64). In Groups II and III, ΔSE/ΔAL was lower with the EDOF and MiSight® CL than the contralateral SVCL in 68% to 94% of participants, and adjusted 6‐month ΔSE/ΔAL with EDOF was similar to MiSight® (p = 0.49/0.56 for ΔSE/ΔAL, respectively). Discontinuations across the three groups were high, but not different between the groups (33.3%, 48.4% and 50% for Groups I to III, respectively [p = 0.19]) and most discontinuations occurred immediately after baseline. Conclusions: Extended depth of focus and MiSight® CL demonstrated similar efficacy in slowing myopia. When switched from a myopia control CL to SVCL, myopia progression was similar to that observed with age‐matched wearers in SVCL and not suggestive of rebound. [ABSTRACT FROM AUTHOR]

The purpose of this retrospective study is to investigate clinical outcomes of bilateral implantation of diffractive trifocal intraocular lenses (IOLs) and extended depth of focus IOLs in Koreans. The clinical outcomes of cataract surgery with bilateral implantation of PanOptix, FineVision, Symfony, and MiniWell were evaluated. Uncorrected distant, intermediate (80 cm, 60 cm), near (40 cm) visual acuity, defocus curve, manifest refraction, contrast sensitivity, and higher-order aberrations, quality of vision, spectacle independence, and subjective satisfaction at postoperative 3 months were assessed. A total of 136 eyes in 68 patients were included in the analyses. PanOptix and FineVision performed better visual acuity compared to Symfony and MiniWell at 40 cm distance. Defocus curve showed broad range of vision in PanOptix and FineVision with visual acuity of more than 0.1 logarithm of the minimum angle of resolution at −2.5 diopter (D) of defocus power, while Symfony and MiniWell presented excellent intermediate vision without a dip at defocus power of −0.5 D to −1.0 D. Glare, halo, and starburst were significantly less in MiniWell compared to others. In conclusion, all four IOLs presented satisfactory clinical outcomes. PanOptix and FineVision provided good near and intermediate vision, while Symfony and MiniWell provided good intermediate vision. MiniWell induced little dysphotopsia. [ABSTRACT FROM AUTHOR]

Purpose: To review the published literature assessing the efficacy of multifocal soft contact lenses for the treatment of myopia progression in children 18 years of age and younger., Methods: A literature search of the PubMed database was conducted last in March 2024 and was limited to articles published in English without date restrictions. The search yielded 76 articles, which were reviewed by the primary author in abstract form, and 28 articles were selected for full-text review. Twelve articles were deemed to have met the inclusion criteria and were assigned a level of evidence rating by the panel methodologist. Eleven studies were rated level I and 1 study was rated level II., Results: All studies showed less myopic progression, with changes in spherical equivalent (SE) ranging from 0.22 to 0.81 diopters (D) for multifocal soft contact lenses compared with 0.50 to 1.45 D in control groups who used single-vision spectacles or single-vision contact lenses over the course of at least 1 year. Additionally, axial elongation was less in the multifocal soft contact lens group compared with control groups, with a change in axial length (AL) of 0.05 to 0.39 mm in treatment groups compared with 0.17 to 0.67 mm in control groups with at least 1 year of follow-up. The difference in change between the groups was clinically modest and statistically significant in 11 studies for SE and in all 12 studies for AL. No serious adverse events were reported in any of the studies., Conclusions: Level 1 evidence supports slower myopia progression and AL elongation in children who used multifocal soft contact lenses compared with spectacles or single-vision contact lenses over at least 1 year of follow-up. However, few data are available on optimal treatment duration, the progression over longer periods, or progression after discontinuation of the multifocal contact lenses., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2024. Published by Elsevier Inc.)

Abstract Background To study and compare the clinical optical image quality following implantation with different premium IOLs by analysing the point spread function (PSF) Strehl ratio using a pyramidal wavefront sensor (PWS)-based aberrometer. Methods This study included 194 eyes implanted with: (a) 19 AcrySof SA60AT (control group); (b) 19 Miniwell; (c) 24 LENTIS Mplus LS-313 MF30; d) 33 LENTIS Mplus LS-313 MF15; (e) 17 AkkoLens Lumina; (f) 31 AT LISA Tri 839MP; (g) 20 Precizon Presbyopic; (h) 20 AcrySof IQ PanOptix; (i) 11 Tecnis Eyhance. Main outcome measures were PSF Strehl ratio, PSF Strehl ratio excluding second-order aberrations (PSFw2), total root mean square (RMS), low-order aberration (LOA) and high-order aberration (HOA) RMS measured by PWS aberrometer. Results AT LISA Tri had the highest PSFw2 Strehl ratio at both 3.0- and 4.0-mm pupil size (0.52 ± 0.14 and 0.31 ± 0.10; P

Sri Ganesh, Sheetal Brar, Nikhil RP, Dishitha Rathod Department of Phaco-Refractive Surgery, Nethradhama Super Speciality Eye Hospital, Bangalore, Karnataka, IndiaCorrespondence: Sheetal BrarNethradhama Superspeciality Eye Hospital, 256/14, Kanakapura Main Road, 7th Block, Jayanagar, Bengaluru, Karnataka, 560070, IndiaTel +919591002092Email brar_sheetal@yahoo.co.inPurpose: To evaluate the visual outcomes, contrast sensitivity, reading performance and patient satisfaction after bilateral implantation of AT LARA extended depth of focus (EDoF) intraocular lenses (IOLs).Methods: Patients undergoing phacoemulsification for age-related cataract and satisfying the eligibility criteria underwent bilateral implantation with AT LARA EDoF IOLs (Carl Zeiss Meditec, Jena, Germany). At follow-up visits of 1, 3, 6 and 12 months, binocular uncorrected and corrected distance, intermediate and near visual acuity, reading performance, defocus curve, contrast sensitivity and patient satisfaction for dysphotopsia and spectacle independence were evaluated.Results: A total of 60 eyes from 30 patients with a mean age of 65.40± 7.71 years were included in the study. At 12 months, 83% of patients (n=25) had binocular cumulative uncorrected distance visual acuity (UDVA) of 20/20 or better. Postoperative spherical equivalent refraction accuracy was within ± 0.50 D for 95% of eyes (n=57) and refractive cylinder accuracy was within ≤ 0.50 D in 95% of eyes (n=57). The mean binocular uncorrected near visual acuity (UNVA) was 0.16± 0.09 logMAR, and the mean uncorrected intermediate visual acuity (UIVA) at 60 and 80 cm was 0.01± 0.09 and 0.03± 0.08 logMAR, respectively, at 12 months. Reading speeds at 40, 60 and 80 cm showed improvement over time. No patient had complaints of severe dysphotopsia and none of the patients required glasses for any activity. No eye underwent YAG-laser capsulotomy for significant posterior capsule opacification at the end of mean follow-up.Conclusion: In our limited experience of 30 patients at 12 months, AT LARA EDoF IOLs resulted in excellent visual outcomes for uncorrected distance, intermediate and near visual acuity. The incidence of dysphotopsia and spectacle dependence was low, resulting in good patient satisfaction.Trial Registry: CTRI/2020/08/027105 (www.ctri.nic.in).Keywords: AT LARA, extended depth of focus, EDoF IOL, spectacle independence

Two-photon excitation in light-sheet microscopy advances applications to live imaging of multicellular organisms. In a previous study, we developed a two-photon Bessel beam light-sheet microscope with a nearly 1-mm field of view and less than 4-μm axial resolution, using a low magnification (10×), middle numerical aperture (NA 0.5) detection objective. In this study, we aimed to construct a light-sheet microscope with higher resolution imaging while maintaining the large field of view, using low magnification (16×) with a high NA 0.8 objective. To address potential illumination and detection mismatch, we investigated the use of a depth of focus (DOF) extension method. Specifically, we used a stair-step device composed of five-layer annular zones that extended DOF two-fold, enough to cover the light-sheet thickness. Resolution measurements using fluorescent beads showed that the reduction in resolutions was small. We then applied this system to in vivo imaging of medaka fish and found that image quality degradation at the distal site of the beam injection could be compensated. This demonstrates that the extended DOF system combined with wide-field two-photon light-sheet microscopy offers a simple and easy setup for live imaging application of large multicellular organism specimens with sub-cellular resolution.

Purpose: To evaluate a novel hydrophobic, non-diffractive, extended depth of focus (EDOF) intraocular lens (IOL) design in comparison to two monofocal aspheric lenses. Methods: Inclusion criteria for this prospective, monocentric cohort study were opacification of the crystalline lens and patients' wishes for surgery. In the case of the EDOF IOL, patients asked for a presbyopia correction. All patients received surgery on both eyes. Corrected and uncorrected distance visual acuity (CDVA, UCDVA), uncorrected and distance corrected intermediate visual acuity (UIVA, DCIVA) and defocus curves (all monocular and binocular) were compared three months postoperatively. Results: Fifty-six eyes were implanted with an EDOF IOL (LuxSmart™, Bausch & Lomb GmbH, Berlin, Germany), 50 eyes with a monofocal aspheric IOL: 32 eyes with a clear IOL (PolylensVR AS 61, Polytech Domilens, Roßdorf, Germany), 16 eyes with a yellow IOL (iSert® 251, Hoya Surgical Optics GmbH, Frankfurt, Germany). Three months postoperatively, UCDVA was comparable with the EDOF IOL, versus the monofocal IOL (P>0.9). Binocular DCIVA in the EDOF IOL was significantly higher than in the monofocal IOL (P = 0.001). Monocular DCIVA better than 20/23 Snellen was achieved in 10% with the monofocal IOL and in 68% (P<0.0001) with the EDOF IOL. Defocus curves showed a depth of focus at 20/23 Snellen of 1.6 vs. 0.83 diopters (D) in the EDOF IOL, vs. the monofocal IOL. No patient reported halos or starbursts in non-standardized questioning. Conclusion: This non-diffractive EDOF IOL provided comparably high UCDVA and significantly higher DCIVA than the mono-focal lenses, causing only mild optical phenomena. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to assess the safety and efficacy of a novel extended-depth-of-focus (EDOF) soft contact lens for myopia control in children. Methods: A prospective, multicenter, randomized, double-masked, placebo-controlled, contralateral-eye comparison clinical trial was conducted in 72 children (40 male and 32 female) aged 9 to 14 years, with each eye randomly selected to wear either an experimental EDOF contact lens or a single-vision control lens at least 8 h per day, 5 days a week, for 52 weeks. Each contact lens was worn and then replaced daily. Measurements including best-corrected visual acuity, spherical equivalent refractive error (SER), axial length (AXL), and keratometry were performed at weeks 1, 4, and 13, and every 13 weeks thereafter for 52 weeks. The primary outcome measure was the change in SER, measured using cycloplegic auto-refraction. The secondary outcome measure was the change in AXL. Results: At week 52, the mean change in SER was significantly lower with the experimental lens (−0.70 ± 0.49 D) than with the control lens (−0.88 ± 0.51 D; P <.001). The mean AXL elongation was significantly lower with the experimental lens (0.34 ± 0.19 mm) than with the control lens (0.38 ± 0.19 mm; P <.001). The EDOF lens reduced AXL and myopia progression by 10.5% and 20.5%, respectively. The change in SER, but no AXL, was significantly associated with EDOF lens wear in adjusted multivariate regression analysis. Reported adverse events did not differ significantly between the two lens types. Conclusions: The results of this 1-year clinical trial demonstrate that the experimental EDOF soft contact lens slows myopia progression and reduces AXL elongation in children compared with a single-vision contact lens. (This study was retrospectively registered with ClinicalTrials.gov; identifier: NCT04238897; date of registration: January 23, 2020.) [ABSTRACT FROM AUTHOR]

The objective of this prospective, randomized, double-masked study was to compare the contrast sensitivity and quality of vision of patients bilaterally implanted with the following six different presbyopia correcting intraocular lenses (IOLs): SV25T0 (n = 19), ATLISA 809M (n = 18), ATLISA TRI 839MP (n = 19), ZKB00 (n = 20), ZLB00 (n = 20) and Symfony ZXR00 (n = 20). For comparison purposes, 36 patients were implanted with a monofocal lens (ZA9003). Contrast sensitivity was assessed binocularly at distance under photopic, mesopic and mesopic plus glare conditions, and at near under photopic conditions. Quality of vision was explored in terms of photic phenomena and spectacle independence. Overall, the monofocal lens offered better contrast sensitivity, under all illumination conditions, and less occurrence and intensity of photic phenomena. Amongst the multifocal IOL (MIOL) designs, the extended depth of focus Symfony ZXR00 provided better contrast sensitivity than the other MIOLs, particularly at intermediate and high spatial frequencies. Up to 40% and 50% of patients implanted with MIOLs reported glare and halos, respectively. The SV25T0 resulted in less occurrence and intensity of halos. The evaluation of photic phenomena and contrast sensitivity under different illumination conditions may reflect real-life, visually challenging situations, and thus provide insightful information to assist ophthalmic surgeons when selecting the best intraocular lens for their patients. [ABSTRACT FROM AUTHOR]

Background: Recently, a new presbyopia-correcting intraocular lens (IOL) that combines extended depth-of-focus and bifocal profiles (ZFR00: Tecnis® Synergy®, Johnson & Johnson Vision, Santa Ana, CA, USA) has been established and several studies have been reported. We attempted to compare the performance with a standard IOL (ZCB00: Tecnis® monofocal, Johnson & Johnson Vision, Santa Ana, CA, USA) manufactured using the same material from the same company, which has been extensively used worldwide.Methods: The medical records of patients undergoing cataract surgery with ZCB00 or ZFR00 implantation between March 2021 and September 2021 and with available 3-month visit data were reviewed. Uncorrected near, intermediate, and distance visual acuity (VA), corrected distance VA, and optical quality were the main outcome measures.Results: This study included forty-six patients (64 eyes), with twenty-one patients (32 eyes) implanted with ZCB00 and twenty-five patients (32 eyes) implanted with ZFR00. The average age of the patients was 66.0 ± 10.1 (range: 40 to 82) and 65.1 ± 4.7 (range: 59 to 77) years in the ZCB00 and ZFR00 groups, respectively. The preoperative characteristics did not differ significantly between the two groups. Compared to the ZCB00 group, the ZFR00 group demonstrated significantly superior intermediate and near VA (p < 0.001) at 3 months postoperatively. The ZFR00 group showed significantly lower objective measured optical quality than that in the ZCB00 group.Conclusions: The ZFR00 exhibited a continuous range of vision and a smooth defocus curve, while the ZCB00 provided superior objective optical quality. [ABSTRACT FROM AUTHOR]

Small aperture optics work by blocking unfocused peripheral light rays while allowing central light rays to focus on the retina. This pinhole effect creates an extended depth of focus and has been used in presbyopia correction, improving intermediate and near vision without markedly affecting distance vision. Another beneficial effect of small aperture optics is reducing aberrations caused by irregular corneas or irregular pupils. The first small aperture surgical device was the Kamra corneal inlay used on the nondominant eyes of presbyopic emmetropes. The pinhole concept was also adapted into the IC-8 intraocular lens (IOL) for presbyopia correction during cataract surgery and by the XtraFocus piggyback device to lessen unwanted aberrations in eyes with irregular corneas or pupils. The IC-8 IOL can be placed monocularly or binocularly with mini-monovision for further near vision improvement. The XtraFocus piggyback device can be placed either in the sulcus or capsular bag. The aim of this literature review is to synthesize evidence on the efficacy, safety, and patient-reported outcomes on surgical devices utilizing small aperture optics. A comprehensive search on PubMed was conducted with the keywords "small aperture optics," "small aperture corneal inlay," "small aperture IOL," "Kamra corneal inlay," "IC-8 IOL," and "XtraFocus." In this review, we describe the progression of small aperture surgical devices, patient criteria, visual outcomes, complications, satisfaction, and recommendations for surgical success. [ABSTRACT FROM AUTHOR]

We aimed to compare the postoperative quality of vision among patients who received extended depth of focus (EDOF), bifocal, and monofocal intraocular lens (IOL) implantation. A retrospective study was conducted, and 87 patients who underwent cataract surgery were enrolled. Patients were categorized into different groups according to IOL design, with 24, 29, and 34 individuals constituting bifocal, EDOF, and monofocal groups. Preoperative and postoperative visual acuity (VA), biometry data, refractive status, contrast sensitivity (CS), higher-order aberrations (HOAs), and a quality of vision questionnaire that consisted of 11 questions were obtained 1 month postoperatively. The Kruskal–Wallis test and Pearson's chi-square test were applied for statistical analyses. The postoperative CDVA was better in the EDOF group than in the bifocal group (p = 0.043), and the residual cylinder was lower in the EDOF groups than in the other two groups (both p < 0.05). The CS was worse in the EDOF group than in the other two groups (all p < 0.05), while the spherical aberration and trefoil were lower in the EDOF group than in the bifocal group (both p < 0.05). In terms of the quality of vision, the scores were better in the monofocal group than in the EDOF group in seven items (all p < 0.05), and the quality of vision in the bifocal group was better than in the EDOF group in small print reading (p = 0.042). In addition, the incidence of glare was lower in the monofocal group than in the other two groups (p < 0.001), while the spectacle dependence ratio was significantly higher in the monofocal group compared to the other two groups (p < 0.001). In conclusion, the general quality of vision was better in the monofocal group compared to the bifocal and EDOF groups, while the spectacle dependence ratio was significantly higher in the monofocal group than in the other two groups. [ABSTRACT FROM AUTHOR]

Kjell G Gundersen,1 Richard Potvin2 1IFocus Øyeklinikk AS, Haugesund, Norway; 2Science in Vision, Bend, OR, USACorrespondence: Kjell G Gundersen Email kg@ifocus.noPurpose: To quantify the changes in the binocular defocus curve associated with the Vivity™ non-diffractive extended vision intraocular lens when the dominant eye was targeted for emmetropia and the non-dominant eye was artificially targeted for slight myopia using spectacles.Patients and Methods: This was a non-interventional research study of the corrected binocular defocus curve associated with binocular emmetropia (Setting A) and with emmetropia in the dominant eye and two different levels of myopia simulated in the non-dominant eye (− 0.50 D, Setting B and − 1.00 D, Setting C). Subjects were patients implanted with the AcrySof® IQ Vivity® intraocular lens in both eyes 3 to 12 months previously. Using the defocus data, the percentage of subjects with a continuous 2.5 D range of vision (distance to 40 cm) was calculated for various levels of minimum visual acuity (VA).Results: Forty subjects were enrolled. The mean spherical equivalent refraction was − 0.06 D ± 0.36 D, with 0.37 D ± 0.29 D of refractive cylinder. There was no statistically significant difference in the mean VA at − 0.25 D or at − 0.50 D vergences between the test Settings, but there was a statistically significant difference at all other vergences. Differences were particularly noticeable at − 2.00 D, − 2.50 D and − 3.00 D, where higher myopia in the non-dominant eye yielded better binocular VA. A 2.5 D range of functional vision (20/25) was achieved by 38% of subjects at Setting A, 68% of subjects at Setting B and 85% of subjects at Setting C. At setting C, all but one subject (39/40, 97.5%) had a 2.5 D range of vision with a VA of 20/32 or better.Conclusion: Significant gains in binocular near vision, with only a nominal effect on distance vision, can be achieved with the Vivity IOL by leaving the non-dominant eye of patients with 0.50 D or 1.00 D of myopia.Keywords: non-diffractive, extended vision, extended depth of focus, presbyopia, cataract

Presbyopia is often the first sign of ageing experienced by humans. Standardising terminology and adopting it across the BCLA CLEAR Presbyopia reports, improves consistency in the communication of the evidence-based understanding of this universal physiological process. Presbyopia can be functionally and psychologically debilitating, especially for those with poor access to eyecare. Presbyopia was defined as occurring when the physiologically normal age-related reduction in the eye's focusing range reaches a point that, when optimally corrected for far vision, the clarity of vision at near is insufficient to satisfy an individual's requirements. Accommodation is the change in optical power of the eye due to a change in crystalline lens shape and position, whereas pseudo-accommodation is the attainment of functional near vision in an emmetropic or far-corrected eye without changing the refractive power of the eye. Other definitions specific to vision and lenses for presbyopia were also defined. It is recommended that these definitions be consistently adopted in order to standardise future research, clinical evaluations and education. [ABSTRACT FROM AUTHOR]

The finite depth of focus (DOF) of a focusing lens gives rise to the degradation of lateral resolution at defocused positions. Consequently, the generation of a needle-shaped beam with sub-diffraction size and extended DOF can break through this limitation, but few studies have effectively balanced these two characteristics. In this paper, we propose a method based on the stochastic parallel gradient descent (SPGD) algorithm for designing multi-ring diffractive optical elements (DOEs) to produce the needle-shaped beam, which maintains a super-resolution and uniform spot within a large extended DOF range. Numerical simulations and experimental results have validated that our method can extend the DOF by 14 times longitudinally and reduce the lateral resolution to 73% of Airy spot, while maintaining up to 92% uniformity of the beam diameter. Furthermore, we demonstrate that the DOF of the needle-shaped beam extends with the increase of the number of rings and phase levels within the DOE. Our work provides an effective strategy for the design of DOF-extended DOE and it is anticipated to find potential applications in microscopy and three-dimensional imaging, photolithography, and optical manipulation. • Needle-shaped beam with super-resolution spot and large depth of focus. • Stochastic parallel gradient descent algorithm based optimization for diffractive optics. • Extremely high uniformity of the beam diameter within the extended depth of focus range. • Tunability of the needle-shaped beam through varying parameters within the diffractive optical element. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the surface profile of a new-generation extended range-of-vision intraocular lens (IOL) and to compare it with that obtained for a monofocal IOL based on the same platform. Methods: Prospective, experimental, laboratory study comparing the surface profile of the DFT015 (AcrySof IQ Vivity; Alcon Laboratories, Inc.), a new-generation presbyopia-correcting IOL, with the profile of the SN60WF (AcrySof IQ; Alcon Laboratories, Inc.), an aspheric monofocal IOL based on the same platform. Raw profiles were obtained using contact profilometry. The best-fit form was then subtracted from each raw profile to highlight potential differences. Results: No significant differences were appreciated in raw profiles. On the contrary, after form removal, the new extended range-of-vision IOL showed a peculiar profile characterized by the presence of two altitudinal symmetrical changes in the order of 1 µm, localized in the central portion of the optic. Conclusions: The new-generation extended range-of-vision IOL evaluated showed a smooth change of its surface compared to the same platform monofocal IOL. The altitudinal changes blended in the central design of the new presbyopia-correcting IOL, although micrometric, might play a crucial role in creating a continuous focal range while minimizing visual disturbances. [ABSTRACT FROM AUTHOR]

Dan B Tran,1 Ashley Owyang,1 Jin Hwang,1 Richard Potvin2 1Coastal Vision Medical Group, Orange, CA, USA; 2Science in Vision, Bend, OR, USACorrespondence: Dan B TranCoastal Vision Medical Group, 293 S. Main St., Suite 100, Orange, CA, 92868, USAEmail dantran@coastal-vision.comPurpose: To evaluate the visual acuity, quality of vision and patient reported outcomes for patients that were either bilaterally implanted with a trifocal intraocular lens (IOL) or an extended depth of focus (EDOF) IOL.Design: Single site, prospective, non-interventional, masked, two-arm comparative study.Methods: Subjects who had prior uncomplicated cataract surgery with bilateral implantation of one of the lenses above were evaluated. Subjects in each group were assessed during a single visit. The uncorrected and best distance-corrected binocular near (40 cm), intermediate (60 cm), and distance visual acuity (VA) were measured, along with a spectacle independence questionnaire, a quality of vision questionnaire and contrast sensitivity measured in both mesopic and photopic conditions.Results: The study included 23 EDOF and 25 trifocal subjects. Binocular Uncorrected VAs were similar at distance and intermediate, but about 1.5 lines better at near with the trifocal (p < 0.001). Binocular best corrected distance – VA was significantly better with the EDOF lens (0.5 lines, p < 0.001), though the mean VA was better than 20/20 in both groups. Distance-corrected intermediate and near VA were significantly better with the trifocal IOL (1 line and 1.5 lines respectively, p < 0.001). Significantly more trifocal subjects had 20/25 or better VA at all three test distances (64% vs 4%, p< 0.001). Patient reported spectacle independence was significantly higher in the trifocal group, driven primarily by differences in near vision. Mesopic and photopic binocular contrast sensitivity, satisfaction and subjective quality of vision scores were similar between groups.Conclusion: The trifocal IOL provided significantly better near vision (1.5 lines) with slightly worse distance vision (0.5 lines), while providing similar contrast sensitivity and visual quality. It may be the preferred choice for patients desiring more spectacle independence.Keywords: trifocal IOL, EDOF IOL, presbyopia correction, cataract surgery, extended depth of focus