-
MMW Fortschritte Der Medizin Sep 2023
-
JAMA Ophthalmology Nov 2022A bayesian network meta-analysis (NMA) can help compare the various types of multifocal and monofocal intraocular lenses (IOLs) used in clinical practice. (Meta-Analysis)
Meta-Analysis
Visual Outcomes and Optical Quality of Accommodative, Multifocal, Extended Depth-of-Focus, and Monofocal Intraocular Lenses in Presbyopia-Correcting Cataract Surgery: A Systematic Review and Bayesian Network Meta-analysis.
IMPORTANCE
A bayesian network meta-analysis (NMA) can help compare the various types of multifocal and monofocal intraocular lenses (IOLs) used in clinical practice.
OBJECTIVE
To compare outcomes of presbyopia-correcting IOLs frequently recommended in clinical practice through a bayesian NMA based on a systematic review.
DATA SOURCES
Medline (PubMed) and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched on May 15, 2021, from inception.
STUDY SELECTION
Based on the research question, randomized clinical trials assessing multifocal IOLs in patients who underwent bilateral cataract extraction were searched. Nonrandomized studies, studies in patients with unilateral or contralateral cataract extractions, duplicated studies, conference abstracts, and nonpeer-reviewed articles were excluded.
DATA EXTRACTION AND SYNTHESIS
Descriptive statistics and outcomes were extracted. The NMA was conducted to compare different types of IOLs. The mean differences for continuous variables, odds ratios for binary variables, 95% credible intervals (CrIs), and ranks of interventions were estimated.
MAIN OUTCOMES AND MEASURES
The outcomes examined included binocular visual acuities by distance and optical quality, including glare, halos, and spectacle independence.
RESULTS
This NMA included 27 studies comprising 2605 patients. For uncorrected near visual acuity, trifocal IOLs (mean difference, -0.32 [95% CrI, -0.46 to -0.19]) and old bifocal diffractive IOLs (mean difference, -0.33 [95% CrI, -0.50 to -0.14]) afforded better visual acuity than monofocal IOLs. Regarding uncorrected intermediate visual acuity, extended depth-of-focus IOLs provided better visual acuity than monofocal IOLs. However, there were no differences between extended depth-of-focus and trifocal diffractive IOLs in pairwise comparisons. For uncorrected distant visual acuity, all multifocal IOLs were comparable with monofocal IOLs. There were no statistical differences between multifocal and monofocal IOLs regarding contrast sensitivity, glare, or halos.
CONCLUSIONS AND RELEVANCE
For patients considering a multifocal IOL due to presbyopia, bilateral implantation of a trifocal IOL might be an optimal option for patients without compromising distant visual acuity.
Topics: Humans; Presbyopia; Network Meta-Analysis; Bayes Theorem; Lenses, Intraocular; Cataract Extraction; Contrast Sensitivity; Cataract
PubMed: 36136323
DOI: 10.1001/jamaophthalmol.2022.3667 -
Ophthalmology Oct 2021To review the published literature assessing the efficacy and safety of presbyopia-correcting intraocular lenses (IOLs) for the treatment of presbyopia after cataract... (Review)
Review
PURPOSE
To review the published literature assessing the efficacy and safety of presbyopia-correcting intraocular lenses (IOLs) for the treatment of presbyopia after cataract removal.
METHODS
Literature searches were undertaken in January 2018 and September 2020 in the PubMed, Medline, and Cochrane Library databases. This yielded 761 articles, of which 34 met the criteria for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist. Thirteen studies were rated level I and 21 studies were rated level II.
RESULTS
Presbyopia-correcting lenses were effective at improving distance and near visual acuity after cataract surgery. Near acuity at different focal lengths was related directly to the effective add power of multifocal and extended depth-of-focus (EDOF) IOLs. Most multifocal and EDOF lenses that were compared with a control monofocal lens demonstrated that patient-reported spectacle independence was superior to the monofocal lens. All patients who had multifocal and EDOF lenses implanted showed decreased contrast sensitivity and reported more visual phenomena as compared with control participants who received monofocal lenses.
CONCLUSIONS
Presbyopia-correcting lenses improve uncorrected near and distance visual acuity and decrease spectacle dependence after cataract surgery. Mesopic contrast sensitivity is decreased compared with monofocal lenses, and patient-reported visual phenomena are more likely in patients receiving multifocal or EDOF lenses.
Topics: Academies and Institutes; Accommodation, Ocular; Depth Perception; Humans; Lens Implantation, Intraocular; Multifocal Intraocular Lenses; Ophthalmology; Patient Satisfaction; Presbyopia; Prosthesis Design; Refraction, Ocular; United States; Visual Acuity
PubMed: 33741376
DOI: 10.1016/j.ophtha.2021.03.013 -
Journal of Refractive Surgery... Sep 2023To assess the clinical and aberrometric outcomes of a new Implantable Collamer Lens (EVO Viva ICL; STAAR Surgical) to correct moderate to high myopia and presbyopia.
PURPOSE
To assess the clinical and aberrometric outcomes of a new Implantable Collamer Lens (EVO Viva ICL; STAAR Surgical) to correct moderate to high myopia and presbyopia.
METHODS
The study included 80 eyes of 40 patients who had bilateral EVO Viva ICL implantation. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, presbyopic add power, binocular through-focus visual acuity, total ocular spherical aberration (SA), coma aberration, and root mean square of ocular higher order aberrations (RMS HOAs) (i-Trace Aberrometer; Tracey Technologies) for a 4.5-mm pupil size were evaluated.
RESULTS
The mean binocular postoperative UDVA and CDVA were 0.09 ± 0.19 and 0.02 ± 0.03 logMAR, respectively. The postoperative spherical equivalent was -0.61 ± 0.54 diopters (D). The presbyopic add power reduced from +1.31 ± 0.74 D preoperatively to +0.44 ± 0.58 D after surgery ( < .0001). The mean visual acuity was 0.1 logMAR or better (20/25 or better) across the vergence range from +0.50 to -1.50 D, better than 0.2 logMAR (20/32 or better) up to the vergence of -2.00 D, and remained better than 0.3 logMAR (20/40 or better) up to the vergence of -2.50 D. The total ocular aberrations induced by EVO Viva ICL were -0.34 ± 0.09 µm of SA, 0.24 ± 0.18 µm of coma, and 0.26 ± 0.12 µm of RMS HOAs.
CONCLUSIONS
The outcomes support that the new ICL might be a good alternative for myopia and presbyopia correction in patients aged between 45 and 55 years. Further studies are needed to evaluate the threshold lens misalignment from which the patient´s visual quality would be affected. .
Topics: Humans; Middle Aged; Presbyopia; Coma; Myopia; Lenses, Intraocular; Refraction, Ocular
PubMed: 37675906
DOI: 10.3928/1081597X-20230726-02 -
Journal of Refractive Surgery... Sep 2023To determine the efficacy, safety, predictability, and stability of laser in situ keratomileusis (LASIK) in the treatment of presbyopia. (Meta-Analysis)
Meta-Analysis
PURPOSE
To determine the efficacy, safety, predictability, and stability of laser in situ keratomileusis (LASIK) in the treatment of presbyopia.
METHODS
The databases of CNKI, VIP, Wan-Fang, CBM, Chinese Clinical Registry, PubMed, The Cochrane Library, Web of Science, Embase, and ClinicalTrials.gov were searched until March 2023. The authors chose the studies of LASIK in the treatment of presbyopia. Outcomes were efficacy, safety, predictability, and stability. The review was registered in the international platform of registered systematic review and meta-analysis protocols (INPLASY202350005).
RESULTS
A total of 28 non-randomized controlled trials (15,861 eyes) were included. The results showed that after LASIK, (1) the distance efficacy decreased (mean difference [MD]: 0.02, 95% CI: 0.0 to 0.03, < .05) and the near efficacy increased (MD: -0.01, 95% CI: -0.19 to-0.02, < .05); (2) the distance safety decreased (MD: 0.07, 95% CI: 0.04 to 0.10, < .0001) and near safety increased (MD: -0.19, 95% CI: -0.39 to 0.02, > .05); (3) the predictability within ±1.00 and ±0.50 D was 94% (relative risk [RR]: 0.94, 95% CI: 0.90 to 0.98, < .001) and 80% (RR: 0.80, 95% CI: 0.74 to 0.86, < .001), respectively; and (4) 6 months postoperatively, the percentage of spherical equivalent changing within ±0.50 D was 95% (RR: 0.95, 95% CI: 0.89 to 0.99, < .001).
CONCLUSIONS
The near efficacy, predictability, and stability of LASIK for presbyopia correction were satisfactory; however, the distance efficacy and distance safety decreased. .
Topics: Humans; Databases, Factual; Keratomileusis, Laser In Situ; Presbyopia; Refraction, Ocular
PubMed: 37675909
DOI: 10.3928/1081597X-20230802-02 -
Current Opinion in Ophthalmology Jan 2021Corneal refractive surgery has achieved spectacle-free vision for millions of patients, but this aging population is now developing cataracts. Many of these patients may... (Review)
Review
PURPOSE OF REVIEW
Corneal refractive surgery has achieved spectacle-free vision for millions of patients, but this aging population is now developing cataracts. Many of these patients may wish to avoid reliance on glasses after cataract surgery. Presbyopia-correcting intraocular lenses (IOLs) offer a solution, but corneal changes after refractive surgery may compound higher order aberrations and dysphotopic symptoms associated with these IOLs. This review aims to discuss potential factors that could aid in determining suitable postkeratorefractive candidates for presbyopia-correcting IOLs.
RECENT FINDINGS
Studies investigating which preoperative measures influence outcomes are lacking. The few studies that have examined presbyopia-correcting IOLs in postkeratorefractive patients report that satisfactory outcomes are possible. However, recommendations for preoperative thresholds appear limited to expert opinion and studies involving virgin corneas.
SUMMARY
As the number of presbyopia-correcting IOLs and postkeratorefractive patients grows, continued investigation into relevant preoperative factors and appropriate IOLs is required to make evidence-based decisions. The current literature shows that with rigorous counseling and appropriate patient selection, presbyopia-correcting IOLs can provide postkeratorefractive patients with satisfactory results and spectacle independence. In addition, the development of postoperative modifiable IOLs may prove to be the preferred option.
Topics: Depth Perception; Humans; Keratomileusis, Laser In Situ; Lens Implantation, Intraocular; Multifocal Intraocular Lenses; Photorefractive Keratectomy; Presbyopia; Visual Acuity
PubMed: 33122489
DOI: 10.1097/ICU.0000000000000722 -
Taiwan Journal of Ophthalmology 2022Small 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... (Review)
Review
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.
PubMed: 36248074
DOI: 10.4103/tjo.tjo_45_21 -
Der Ophthalmologe : Zeitschrift Der... Oct 2020The functional results and the occurrence of side effects (especially photic phenomena) for multifocal intraocular lenses (IOL) are difficult to predict. Furthermore, in... (Review)
Review
The functional results and the occurrence of side effects (especially photic phenomena) for multifocal intraocular lenses (IOL) are difficult to predict. Furthermore, in the course of life patients can develop diseases in which a multifocal optic would be a disadvantage. In these cases exchange of the IOL is the only treatment option. Implantation of a monofocal or monofocal toric IOL in the capsular bag and a supplementary trifocal IOL in the ciliary sulcus in a single operation, known as a duet procedure, provides trifocality that can be easily reversed if necessary.
Topics: Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Multifocal Intraocular Lenses; Phacoemulsification; Prosthesis Design; Visual Acuity
PubMed: 32296922
DOI: 10.1007/s00347-020-01096-4 -
The Medical Clinics of North America May 2021Cataract surgery is one of the most common surgical procedures performed in the United States. The decision to remove a cataract is determined by the patient's ability... (Review)
Review
Cataract surgery is one of the most common surgical procedures performed in the United States. The decision to remove a cataract is determined by the patient's ability to perform activities of daily living, such as reading, driving, and watching television. Cataract surgery also offers the potential of spectacle independence with a wide array of premium intraocular lens options. In addition, with the continuing advances in ophthalmology, patients now also have the option of selecting between traditional approaches and femtosecond laser-assisted procedures. Cataract surgery continues to be an effective and ever-improving procedure for vision restoration.
Topics: Cataract; Cataract Extraction; Corneal Surgery, Laser; Humans; Hyperopia; Lenses, Intraocular; Myopia; Ophthalmologic Surgical Procedures; Presbyopia
PubMed: 33926640
DOI: 10.1016/j.mcna.2021.01.002 -
Journal of Refractive Surgery... Dec 2023To compare visual outcomes and satisfaction in patients with emmetropia, presbyopia, and greater or lesser residual accommodation who undergo unilateral or bilateral...
PURPOSE
To compare visual outcomes and satisfaction in patients with emmetropia, presbyopia, and greater or lesser residual accommodation who undergo unilateral or bilateral implantation of a trifocal diffractive intraocular lens (IOL).
METHODS
A multicenter, multisurgeon study was performed to evaluate outcomes in patients with emmetropia and presbyopia who underwent refractive lens exchange followed by implantation of a FineVision trifocal IOL (PhysIOL). The inclusion criteria were as follows: emmetropia, sphere -0.25 to +0.50 diopters (D), cylinder less than 0.75 D, and manifest refractive spherical equivalent (MRSE) of -0.25 to +0.25 D. All patients also had to have an uncorrected distance visual acuity (UDVA) of Snellen 0.9 or better in each eye. The sample was divided into different clusters based on two variables: eyes operated on (monocular or binocular) and age either younger than 55 years or 55 years or older. Thus, four possible groups were created. Visual and refractive performance, patient satisfaction, and spectacle independence were assessed.
RESULTS
A total of 690 eyes from 431 patients were evaluated. There was no difference in postoperative uncorrected (UDVA) and corrected (CDVA) distance visual acuity between the groups. Binocular uncorrected near vision (UNVA) was better in patients who underwent surgery on both eyes regardless of age (median [interquartile range]: 0.00 [0.00; 0.10] vs 0.10 [0.00; 0.10] logMAR; < .001). Binocular uncorrected intermediate vision (UIVA) was better in patients who underwent surgery on both eyes aged younger than 55 years than in those who underwent surgery in one eye aged 55 years or older (median [interquartile range]: 0.18 [0.10; 0.18] vs 0.30 [0.18; 0.30] logMAR; < .001). The efficacy and safety indexes were 0.98 ± 0.09 and 1.01 ± 0.06, respectively. A total of 93.3% of eyes were within the 0.50 D range in postoperative MRSE. Visual dysphotopsia was worse in patients with both eyes operated on, although the differences were not statistically significant.
CONCLUSIONS
The study shows that after refractive lens exchange, patients with emmetropia and presbyopia who received a trifocal IOL in one or both eyes achieved good UNVA, UIVA, and UDVA. Regarding near binocular visual acuity, results were better for patients who underwent surgery on both eyes than for those who underwent surgery on one eye. Regarding binocular intermediate visual acuity, patients aged younger than 55 years with both lenses replaced had better results than those 55 years or older with only one lens replaced. However, no significant differences were observed in UDVA or patient satisfaction. .
Topics: Humans; Emmetropia; Presbyopia; Phacoemulsification; Lenses, Intraocular; Refraction, Ocular; Patient Satisfaction; Prosthesis Design
PubMed: 38063834
DOI: 10.3928/1081597X-20231018-01