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Moderator
James T Murphy III, MD, ABO
Panelists
Seth M. Pantanelli, MD, MS, ABO; Nir Shoham-Hazon, MD
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Christine B Hill, MD
Co-Authors
Karolinne Rocha (MD, PhD), Larissa Gouvea (MD), Marcela Barros (MD)
Purpose
To compare aberrometry and depth of focus following the implantation of an aberration-free monofocal IOL and a novel enhanced monofocal of the same platform.
Methods
This prospective observational study included consecutive patients with healthy eyes that underwent routine cataract surgery. Twenty-six eyes were implanted with an aberration-free monofocal IOL and 29 eyes received an enhanced monofocal IOL of the same platform. Uncorrected and corrected distance visual acuity (UDVA, CDVA), monocular defocus curve, manifest refraction spherical equivalent (MRSE), total and internal coma and spherical aberration (HOAs), and total, internal and corneal modulation transfer function (MTF) at 2mm at natural pupil size were assessed between 1 and 3 months postoperatively.
Results
Mean MRSE was comparable between the two groups (0.02 vs -0.18 D, p=0.277). Mean CDVA was also comparable between the two groups (p=0.098). Defocus curve performance demonstrated one line of improved mean monocular visual acuity at -2.00 D defocus in the enhanced monofocal group (p = 0.003). Internal, corneal, and total MTF values were not statistically different between the two groups (all p>0.05). Minimal HOAs were measured, without clinically significant difference between the two groups.
Conclusion
The enhanced monofocal IOL group demonstrated superior intermediate vision and UDVA without compromise in MTFs or HOAs.
Presenting Author
Liliana Werner, MD, PhD
Co-Authors
Marcia Ong (MS), Ethan Driffill (BSc), Zoha Mian (MD, MSc), Max Liu (BSc)
Purpose
Previous studies demonstrated that hydrophobic acrylic intraocular lenses (IOLs) exhibit more attachment to the capsular bag, mediated by protein ("Sandwich theory"). The aim of this study was to quantify protein attachment on the surface of these lenses.
Methods
67 human eyes obtained postmortem, containing AcrySof (Alcon) IOLs (single-piece and three-piece designs) were obtained from eye banks nationwide. The eyes were immersed in 10% neutral buffered formalin upon enucleation; then, the IOLs were carefully explanted from the eyes and stained with Coomassie blue dye for proteins. Photographs were obtained from each lens in a standard magnification. The photographs were imported to an open-source image processing and analysis software (ImageJ); the areas on the anterior optic surface of each lens stained in blue were outlined and the percentage of the surface covered by proteins was calculated.
Results
The IOLs included in the study were implanted 3.95 +/- 3.20 years before enucleation (range: 0 to 10 years). Protein coverage quantification is currently ongoing, showing so far high percentages of protein coverage on the anterior surface of the lenses, which is mostly localized in the optic periphery.
Conclusion
This is the first study in a large cohort of human eyes obtained postmortem quantifying protein coverage on the surface of AcrySof IOLs. The analysis indicate that the majority of protein coverage is observed in the periphery of the anterior optic surface, which is the area usually covered by the anterior capsule, confirming the "Sandwich theory".
Presenting Author
Austin M. Pereira, MD, FRCSC
Co-Authors
Amandeep Rai (MD), Carmen Balian (MBBS, PhD), Julia Di ianni (BSc), Jack Teplitsky (MSc), Amrit Rai (MD, FRCSC)
Purpose
Monofocal intraocular lenses (IOLs) with enhanced intermediate function aim to provide quality distance visual acuity, while also delivering functional intermediate vision with spectacle independence. Our study compared the visual outcomes and patient satisfaction of three enhanced monofocal IOLs from a Canadian surgical centre.
Methods
In this prospective, double-masked, comparative analysis, patients undergoing cataract surgery targeted for postoperative emmetropia were randomized for implantation of either Clareon (Alcon), Eyhance (Johnson & Johnson), or RayOne EMV (Rayner) monofocal IOLs. Patients and data collectors were blinded to the lens implanted. The primary outcome was monocular uncorrected intermediate visual acuity (UIVA) at 66 cm. Secondary outcomes included uncorrected and corrected distance visual acuity (UDVA, CDVA), corrected intermediate visual acuity (CIVA), monocular defocus curves (+2.0D to -4.0D), binocular UIVA, and patient-reported satisfaction outcomes through a validated VFQ-25 questionnaire.
Results
A total of 217 eyes are currently enrolled, and 138 eyes have reached study completion to date. Full enrollment and data collection (n=279) is expected to be completed by the annual ASCRS meeting. Mean logMAR UIVA was 0.485 for RayOne EMV (n=47), 0.494 for Clareon (n=38), and 0.502 for Eyhance IOLs (n=53). There was no statistically significant difference in UIVA between the three cohorts (p=0.933), as well as for UDVA, CDVA, CIVA and binocular UIVA (p>0.05). Defocus curves from +2.0 D to -4.0 D were not statistically different between the three IOLs (p>0.05). Patient satisfaction of intermediate-range visual quality was not statistically significant throughout the questionnaire (p>0.05).
Conclusion
In this study with reliable methodology and no industry involvement, there was no clinically significant difference in visual outcomes and satisfaction gradings between the three enhanced monofocal IOLs. These results will help guide surgical and patient decision making for those seeking spectacle independence at a functional intermediate range.
Presenting Author
Shunsuke Hayashi, MD
Co-Authors
Motoaki Yoshida (MD), Ken Hayashi (MD, PhD), Kazuno Negishi (MD, PhD)
Purpose
To compare visual performance among three types of higher-order aspheric enhanced monofocal intraocular lenses (IOL) and a standard aspheric monofocal IOL.
Methods
Three hundred forty-four eyes of 172 patients scheduled for phacoemulsification were randomly assigned to one of four groups according to the IOL type: three types of enhanced monofocal IOL, 1) Johnson & Johnson Eyhance, 2) NEDEK Impress, and 3) KOWA NSP-3, and a standard monofocal IOL, 4) Tecnis monofocal. At 2 months postoperatively, monocular and binocular distance-corrected visual acuity (VA) from far to near simulated distances, photopic and mesopic contrast VA, and degree of halo and glare symptoms were measured and compared among groups.
Results
Mean monocular and binocular distance-corrected intermediate VA at 0.5, 0.7, and 1.0 m was essentially better in the three enhanced monofocal IOL groups than in the standard monofocal IOL group (P ? 0.04), whereas mean far and near distance-corrected VAs at 0.3, 2.0, 3.0, 5.0, and ? m did not differ significantly among the four groups. Mean photopic and mesopic contrast VA and the size and intensity of halo and glare symptoms did not differ significantly among groups.
Conclusion
The three enhanced monofocal IOLs provided significantly better intermediate VA than a standard monofocal IOL with no significant worsening in contrast sensitivity or photic symptoms. All visual performances were comparable among the three enhanced monofocal IOLs, suggesting that these IOLs can serve as a replacement for standard monofocal IOLs.
Presenting Author
Eric D. Donnenfeld, MD
Co-Authors
Morgan Micheletti (MD)
Purpose
To evaluate the visual acuity outcomes and defocus curve of an enhanced monofocal IOL implanted bilaterally in cataract patients.
Methods
This ambispective, single-arm, multicenter study included 82 subjects who had undergone bilateral implantation of an enhanced monofocal IOL, enVista Aspire (EA). EA is an IOL with intermediate optimized optics that provides a continuous depth of focus from distance to intermediate. The IOL uses an optical modification of the posterior aspheric surface to create a small continuous increase in IOL power within the central 1.5 mm diameter to slightly extend the depth of focus. Outcome measures included monocular (first implanted eye) and binocular visual acuities at distance, intermediate, and near, and the binocular defocus curve at least 2 months after IOL implantation in the second eye.
Results
Postoperatively, mean logMAR UDVA and CDVA in the first implanted eyes were 0.12 ± 0.14 and -0.01± 0.09, respectively. Mean postoperative MRSE was -0.38 ± 0.47 D. Mean monocular logMAR UIVA and UNVA were 0.21± 0.15 and 0.42 ± 0.17; 58.5% of eyes achieved UIVA 20/32 or better, and 34.1% of eyes achieved UNVA 20/40 or better. The mean binocular logMAR DCIVA and DCNVA were 0.21 ± 0.13 and 0.39 ± 0.14, respectively, with 65.9% of patients achieving DCIVA 20/32 or better, and 35.4% achieving DCNVA 20/40 or better. Defocus curve showed 20/32 or better visual acuity for a defocus range of ~ +1.00 D to -1.25 D.
Conclusion
The implantation of an enhanced monofocal IOL resulted in improved depth of focus, yielding good visual acuity outcomes for intermediate vision with nearly 2/3rd of the subjects achieving distance corrected intermediate visual acuity of 20/32 or better, postoperatively
Presenting Author
Ahad Mahootchi, MD
Purpose
To evaluate the spectacle independence and frequency of photic phenomena following the implantation of an enhanced monofocal IOL with higher-order aspheric coefficients on the central part of the posterior surface.
Methods
This retrospective chart review included 87 patients who underwent cataract surgery and implantation of an enhanced monofocal IOL (enVista Aspire, Bausch & Lomb, Inc). This enhanced monofocal IOL encompasses higher-order aspheric coefficients on the central part of the posterior surface to slightly extend the depth of focus. Outcome measures were subjective assessment of spectacle independence and incidence of visual symptoms using the patient-reported spectacle independence questionnaire (PRSIQ).
Results
The proportion of patients who reported that they wore glasses or contacts ‘none’ or ‘a little of the time’ was 100% for distance and 96.6% for intermediate vision. The frequency of visual symptoms was low, with 8% of patients reporting glare, and 1.2% of the patients each reporting halos or starbursts to occur ‘all’ or ‘most of the time’. Patient satisfaction was high, with ~99% of patients being able to function comfortably without glasses/contacts “all” or most of the time” for distance and intermediate vision.
Conclusion
Implantation of enVista Aspire IOL exhibited excellent spectacle independence at far and intermediate distances. The frequency of photic phenomenon was low. Ninety-nine percent of patients could function comfortably without glasses/contacts.
Presenting Author
Seth M. Pantanelli, MD, MS
Purpose
To evaluate the visual performance for distance and intermediate vision as well as patient satisfaction following implantation of a new hydrophobic, non-constant aberration correcting, aspheric, monofocal IOL (CT LUCIA 621P).
Methods
This prospective, single-arm, post-market trial was conducted at 3 U.S. centers (clinicaltrials.gov NCT06428955). Participants ≥50 years with uncomplicated bilateral age-related cataract and no vision-limiting pathology underwent bilateral phacoemulsification with in-the-bag implantation of a CT LUCIA 621P IOL. Outcome measures were monocular and binocular Snellen corrected and uncorrected visual acuities at intermediate and distance under photopic and mesopic conditions, defocus curves (+1.00 to –3.00 D range), MRSE, and VFQ-25 scores. Follow-up was at 1 day, 1 week, 1 month, and 3 months.
Results
Results from 54 eyes of 28 patients are reported in this 3-month interim analysis. At 3 months, mean monocular photopic uncorrected distance (UDVA) and intermediate (UIVA) visual acuities were 0.06± 0.14 and 0.16± 0.10 logMAR, respectively. 97.6% and 71.4% of eyes had UDVA and UIVA of at least 20/40. Monocular and binocular defocus curves showed that the CT LUCIA 621P maintained VAs ≤0.3 logMAR across +0.50 D to –1.0 D. Mean MRSE was 0.07 ± 0.38 D at 1 month and 0.07 ± 0.40 D at 3 months, with 98% of patients within ±1.0 D. VFQ-25 total scores improved from ~68 at baseline to ~89 at Month 1 and ~90 at Month 3.
Conclusion
The current study demonstrates that the CT LUCIA 621P hydrophobic acrylic monofocal IOL, featuring an optimized non-constant aberration-correcting design, provides satisfactory distance and intermediate vision with high patient satisfaction.
Presenting Author
Christine B Hill, MD
Co-Authors
Larissa Gouvea (MD), Marcela Barros (MD), Rupal Trivedi (MD), Karolinne Rocha (MD, PhD)
Purpose
To compare the in vivo refractive outcomes of three enhanced monofocal intraocular lenses (IOLs) that each utilizes unique technology to extend depth of field.
Methods
This prospective, observational study included patients with healthy eyes that underwent routine cataract surgery and implantation of one of three enhanced monofocal IOLs. Uncorrected and corrected distance visual acuity (UDVA, CDVA), distance corrected intermediate and near visual acuity (DCIVA, DCNVA), total and internal coma and spherical aberration (HOAs), and total, internal and corneal modulation transfer function (MTF) at 2mm and at natural pupil size were assessed.
Results
There were no significant differences in UDVA, CDVA, DCIVA, or DCNVA among the three IOLs. All eyes achieved UDVA ?20/30. DCIVA ?20/40 was achieved by 89% of eyes with EA, 83% with DIB00, and 66% with EMV. DCNVA ?20/40 was achieved by 81% of eyes with EA, 70% with DIB00, and 50% with EMV. Pupil size did not correlate with intermediate or near acuity. Fourth-order aberrations at a 4.5-mm pupil differed significantly between each group, highest in eyes with EMV and lowest in those with DIB00. There were no significant differences in sixth-order aberrations or coma.
Conclusion
These three enhanced monofocal IOLs demonstrate comparable visual outcomes at distance, intermediate, and near. However, EMV invokes significantly more fourth-order aberrations, and DIB00 invokes significantly less. A larger sample size may elucidate minor differences between the three IOLs that were not statistically significant in this study.
Presenting Author
Kendrick M. Wang, MD
Co-Authors
Morgan Micheletti (MD), Deanna Moschitta (MS), Sungwook Lee (PhD), Behzad Bordbar (PhD), Nabil Hoque (PhD), Jonathan Goh (BSc), Jeff Lutkenhaus (PhD), Manoj Sharma (PhD)
Purpose
To predict how enhanced monofocal IOLs will perform under a variety of ocular eye parameters and simulated clinical conditions.
Methods
300 randomly generated eye models, based on clinically relevant parameters across population corneal spherical aberrations and pupil sizes, were imported into optical design software. Monte Carlo simulations were run for two IOL designs: Clareon TruPlus and reversely engineered Tecnis Eyhance. Through modulation transfer function (MTF) analysis, simulated visual acuity (SVA) curves were derived to evaluate IOL performance.
Results
Across the model eyes Clareon TruPlus enabled 10% more eyes to achieve 0.2 logMAR or better visual acuity compared to Tecnis Eyhance at intermediate simulations. Additionally, TruPlus demonstrated approximately 0.04 logMAR lower standard deviation in intermediate vision, indicating more consistent performance.
Conclusion
Intermediate SVA results indicate that Clareon TruPlus offers a performance advantage over Tecnis Eyhance, delivering more consistent outcomes at intermediate maintaining an excellent distance vision.
Presenting Author
Morgan Micheletti, MD
Co-Authors
Deanna Moschitta (MS), Evan Dackowski (MD), Jonathan Goh (BSc), Behzad Bordbar (PhD), Jeff Lutkenhaus (PhD)
Purpose
To compare the optical bench performance of enhanced monofocal IOLs through MTF measurement data, predicting image quality.
Methods
Clareon TruPlus and Tecnis Eyhance IOLs were tested. Through-focus modulation transfer function (MTF) measurements were performed on an Optikos MTF measurement system with model corneas matching the designed spherical aberration of the two IOLs. Measurements were performed with different pupil sizes and lighting conditions as follows: pupil-equivalent sizes of 2.4mm, 3.6mm, and 6 mm, approximating bright, photopic, and mesopic conditions respectively, and under both green and white light conditions, which provide the most sensitive vision response at 550nm and an all-light response, respectively. On-axis and decentered IOL positions were evaluated, at far distance and intermediate (-1.5 D).
Results
Under green light illumination, Clareon TruPlus exhibited overall higher MTF over Tecnis Eyhance, with MTF at 100 lp/mm being 0.18 higher at 2.4 mm pupil, 0.11 higher at 3.6 mm pupil, and equivalent at 6 mm pupil. At 3.6 mm pupil under white light illumination at 100 lp/mm spatial frequency, the far distance MTF of TruPlus and Eyhance are equivalent. As pupil size decreases to 2.4 mm, far distance MTF at 100 lp/mm decreases by 41% for Eyhance and by only 2% for TruPlus. At intermediate conditions (-1.5 D), the MTF at 3.6 mm pupil for TruPlus and Eyhance are similar. When the IOL is slightly decentered, the far distance MTF at 3.6 mm pupil decreases 0.11 for Eyhance and 0.06 for TruPlus.
Conclusion
Clareon TruPlus demonstrates higher MTF (better image quality predicted) at far distance than Tecnis Eyhance in green light. When the IOL is slightly decentered, far distance MTF degrades almost twice as much for Tecnis Eyhance than for Clareon TruPlus. For smaller pupil sizes, Clareon TruPlus far distance MTF exceeds that of Tecnis Eyhance.
Presenting Author
Shail A. Vasavada, DNB, FRCS
Co-Authors
Lajja Shastri (MS), Samaresh Srivastava (MD), Vaishali Vasavada (MS), Abhay Vasavada (MS, FRCS)
Purpose
To determine impact of pupil size on need of reading add and reading vision acuity with 3 types of monofocal /monofocal plus IOLs.
Methods
120 eyes randomized into 3 groups with 40 eyes each,Group 1 Clareon IOL,Group 2 Tecnis IOL and Group 3 Eyehance monofocal plus IOL.3 months post surgery,unaided and best corrected distance visual acuity measured in LogMAR units and Defocus curve plotted at 2 contrast levels, 100% and 25%.Distance Corrected Intermediate Visual Acuity(DCIVA,66cm)and Distance Corrected Near Visual Acuity(DCNVA,40cm)were recorded.Following this,the pupil was fully dilated and two contact lenses with fixed aperture of 3 and 4.5mm respectively were fitted one by one.With fixed pupil sizes,DCIVA,DCNVA and minimum add power needed to get 20/32 & 20/40 letter size was compared.
Results
This ongoing study results will be updated at the time of presentation. Conclusion: This study will demonstrate the role of pupil size in providing good unaided intermediate and near vision with different monofocal/monofocal plus IOL.
Conclusion
Preoperative pupil size can help us predict unaided postoperative visual outcome for intermediate & near vision, and spectacle dependence, when we implant one of the three, currently popular types of monofocal/monofocal plus IOL.
Presenting Author
Annisa C Permadi, MD
Co-Authors
Tjahjono Gondhowiardjo (MD, PhD), Johan Hutauruk (MD, PhD), Setiyo Riyanto (MD, PhD), Kevin Miller (MD)
Purpose
To compare visual and optical performance between two enhanced monofocal intraocular lens (IOL) with different designs
Methods
Cross-sectional study included patients who underwent femtosecond laser-assisted cataract surgery (FLACS) with implantation of Tecnis Eyhance (TE) and Rayone EMV (RE) IOLs. One month visual outcome of best corrected distance (BCVA), distance-corrected intermediate visual (DCIVA), distance-corrected near visual acuity (DCNVA) and depth of focus (DoF) were obtained. Optical quality of both groups was assessed using iTrace Visual Function Analyzer (Tracey Technologies, Houston, TX, USA) to measure Higher Order Aberration (HoA) and Modulation Transfer Function (MTF)
Results
A total of 29 eyes from 19 patients were included. Both groups showed comparable BCVA and DCNVA. RE provided better DCIVA compared to TE (0.28±0.13 logMAR vs 0.41±0.18 logMAR, p = 0.033). Lower HoA values were observed in the RE group (0.15?±?0.09) than in the TE group (0.24?±?0.11, p = 0.023). MTF values were significantly higher in the RE group at 10 cd/mm� (0.44?±?0.16 vs. 0.30?±?0.13, p = 0.022), 30 cd/mm� (0.14?±?0.08 vs. 0.08?±?0.03, p = 0.016), and average (0.39?±?0.11 vs. 0.31?±?0.79, p = 0.026). More myopic postoperative spherical equivalent (SE) was noted in RE group (-0.44?±?0.48 D) relative to TE group (-0.21?±?0.46 D, p = 0.211).DoF demonstrated a similar results in both groups
Conclusion
Both IOL resulted in comparable distance, near vision and DoF. However, RE was associated with better intermediate vision, HoA and MTF. Nevertheless, TE achieved more predictable post-operative SE compared to RE.
