Low Add Multifocal Versus Extended Depth of Focus Intraocular Lens
Study Details
Study Description
Brief Summary
The innovations in phacoemulsification surgery and advances in surgical equipment ensure a safe extraction of the crystalline lens and implantation of intraocular lenses (IOL). As a result of developing intraocular lens technologies and changing patient demands, many multifocal, accommodative, toric, toric-multifocal, and extended depth of focus (EDOF) IOLs have been introduced and the original aim of restoration of far vision with implanted monocular IOLs has been evolved to an objective of improved vision at different distances with total spectacle independence. This study aimed to compare the visual acuity at different distances, contrast sensitivity, spectacle needs, photic phenomena, and quality of life parameters of patients bilaterally implanted with a low add bifocal (Tecnis ZKB00) or an EDOF IOL (Tecnis Symfony), both with planned mini-monovision to improve near vision.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Detailed Description
The innovations in phacoemulsification surgery and advances in surgical equipment ensure a safe extraction of the crystalline lens and implantation of intraocular lenses (IOL). As a result of developing intraocular lens technologies and changing patient demands, many multifocal, accommodative, toric, toric-multifocal, and extended depth of focus (EDOF) IOLs have been introduced and the original aim of restoration of far vision with implanted monocular IOLs has been evolved to an objective of improved vision at different distances with total spectacle independence. This study aimed to compare the visual acuity at different distances, contrast sensitivity, spectacle needs, photic phenomena, and quality of life parameters of patients bilaterally implanted with a low add bifocal (Tecnis ZKB00) or an EDOF IOL (Tecnis Symfony), both with planned mini-monovision to improve near vision. In this regard, binocular logMAR uncorrected visual acuities (UVA), monocular defocus curves, CS with CSV 1000-E and Pelli-Robson Test (PRT), spectacle needs and quality of life parameters with NEI RQL-42 questionnaire were evaluated at postoperative 1, 3, and 6 months.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: MIOL Group 30 eyes of 15 cataract patients undergoing cataract surgery were implanted with a low add (+2.75 Diopters [D]) bifocal (Tecnis ZKB00; Johnson and Johnson Surgical Vision Inc., Jacksonville, Florida, USA) IOL (MIOL Group). |
Device: Tecnis +2.75 D (ZKB00) and Tecnis Symfony (ZXR00)
This study included 30 eyes of 15 cataract patients undergoing cataract surgery with implantation of a low add (+2.75 Diopters [D]) bifocal (Tecnis ZKB00; Johnson and Johnson Surgical Vision Inc., Jacksonville, Florida, USA) IOL (MIOL Group) and 30 eyes of 15 patients with implantation of an EDOF (Tecnis Symfony [ZXR00]; Johnson and Johnson Surgical Vision Inc., Jacksonville, Florida, USA) IOL (EDOF Group).
|
| Active Comparator: EDOF Group 30 eyes of 15 cataract patients undergoing cataract surgery were implanted with an EDOF (Tecnis Symfony [ZXR00]; Johnson and Johnson Surgical Vision Inc., Jacksonville, Florida, USA) IOL (EDOF Group). |
Device: Tecnis +2.75 D (ZKB00) and Tecnis Symfony (ZXR00)
This study included 30 eyes of 15 cataract patients undergoing cataract surgery with implantation of a low add (+2.75 Diopters [D]) bifocal (Tecnis ZKB00; Johnson and Johnson Surgical Vision Inc., Jacksonville, Florida, USA) IOL (MIOL Group) and 30 eyes of 15 patients with implantation of an EDOF (Tecnis Symfony [ZXR00]; Johnson and Johnson Surgical Vision Inc., Jacksonville, Florida, USA) IOL (EDOF Group).
|
Outcome Measures
Primary Outcome Measures
- The visual acuity [Preoperative]
monocular and binocular uncorrected and corrected distance (UDVA, CDVA; at 6 m), intermediate (UIVA, CIVA; at 60 cm), and near (UNVA, CNVA; at 40 cm) logMAR visual acuity were assessed with electronic shelled chart.Distance visual acuity was measured with LCD screen version (CSO Vision Chart, Mod CVC02, version 1.3.0, Florence, Italy) of Snellen Charts under photopic conditions (85 cd/m2). Intermediate and near visual acuities were measured and recorded with a Turkish reading chart prepared with reference to Bailey-Lovie and ETDRS (Early Treatment Diabetic Retinopathy Study) reading charts covering international standards.13 The logMAR values of the chart designed for 35 cm distance were corrected with the formula "log10(standard distance/new distance [cm])" according to the distance used (40 and 60 cm).
- The visual acuity [Postoperative 1st month]
monocular and binocular uncorrected and corrected distance (UDVA, CDVA; at 6 m), intermediate (UIVA, CIVA; at 60 cm), and near (UNVA, CNVA; at 40 cm) logMAR visual acuity were assessed with electronic shelled chart.Distance visual acuity was measured with LCD screen version (CSO Vision Chart, Mod CVC02, version 1.3.0, Florence, Italy) of Snellen Charts under photopic conditions (85 cd/m2). Intermediate and near visual acuities were measured and recorded with a Turkish reading chart prepared with reference to Bailey-Lovie and ETDRS (Early Treatment Diabetic Retinopathy Study) reading charts covering international standards.13 The logMAR values of the chart designed for 35 cm distance were corrected with the formula "log10(standard distance/new distance [cm])" according to the distance used (40 and 60 cm).
- The visual acuity [Postoperative 3rd month]
monocular and binocular uncorrected and corrected distance (UDVA, CDVA; at 6 m), intermediate (UIVA, CIVA; at 60 cm), and near (UNVA, CNVA; at 40 cm) logMAR visual acuity were assessed with electronic shelled chart.Distance visual acuity was measured with LCD screen version (CSO Vision Chart, Mod CVC02, version 1.3.0, Florence, Italy) of Snellen Charts under photopic conditions (85 cd/m2). Intermediate and near visual acuities were measured and recorded with a Turkish reading chart prepared with reference to Bailey-Lovie and ETDRS (Early Treatment Diabetic Retinopathy Study) reading charts covering international standards.13 The logMAR values of the chart designed for 35 cm distance were corrected with the formula "log10(standard distance/new distance [cm])" according to the distance used (40 and 60 cm).
- The visual acuity [Postoperative 6th month]
monocular and binocular uncorrected and corrected distance (UDVA, CDVA; at 6 m), intermediate (UIVA, CIVA; at 60 cm), and near (UNVA, CNVA; at 40 cm) logMAR visual acuity were assessed with electronic shelled chart.Distance visual acuity was measured with LCD screen version (CSO Vision Chart, Mod CVC02, version 1.3.0, Florence, Italy) of Snellen Charts under photopic conditions (85 cd/m2). Intermediate and near visual acuities were measured and recorded with a Turkish reading chart prepared with reference to Bailey-Lovie and ETDRS (Early Treatment Diabetic Retinopathy Study) reading charts covering international standards.13 The logMAR values of the chart designed for 35 cm distance were corrected with the formula "log10(standard distance/new distance [cm])" according to the distance used (40 and 60 cm).
- The contrast sensitivity (CS), [Preoperative]
Contrast sensitivity (CS) was evaluated at 3, 6, 12 and 18 cycle per degree (cpd) spatial frequencies with CSV-1000 E test (VectorVision, Ohio, USA) under mesopic (3.5 candela [cd]/m2) conditions at 2.5 m with distance refractive correction. The test was conducted with and without glare, and as a glare source, two halogen lamps located either side of the test chart and producing 2.5 cd/m2 luminance at eye plane were used. CS at different spatial frequencies was compared with the physiologic CS range for normal subjects of similar age. CS was also evaluated with the LCD screen version (CSO Vision Chart, Mod CVC02, version 1.3.0, Florence, Italy) of Pelli-Robson Test (PRT) under photopic (85 cd/m2) and mesopic (3.5 cd/m2) conditions at 3 m monocularly with distance refractive correction. To the best of our knowledge, PRT CS normal values, performed under similar conditions, are not available in the literature, so the data was used only for intergroup comparisons.
- The contrast sensitivity (CS), [Postoperative 1st month]
Contrast sensitivity (CS) was evaluated at 3, 6, 12 and 18 cycle per degree (cpd) spatial frequencies with CSV-1000 E test (VectorVision, Ohio, USA) under mesopic (3.5 candela [cd]/m2) conditions at 2.5 m with distance refractive correction. The test was conducted with and without glare, and as a glare source, two halogen lamps located either side of the test chart and producing 2.5 cd/m2 luminance at eye plane were used. CS at different spatial frequencies was compared with the physiologic CS range for normal subjects of similar age. CS was also evaluated with the LCD screen version (CSO Vision Chart, Mod CVC02, version 1.3.0, Florence, Italy) of Pelli-Robson Test (PRT) under photopic (85 cd/m2) and mesopic (3.5 cd/m2) conditions at 3 m monocularly with distance refractive correction. To the best of our knowledge, PRT CS normal values, performed under similar conditions, are not available in the literature, so the data was used only for intergroup comparisons.
- The contrast sensitivity (CS), [Postoperative 3rd month]
Contrast sensitivity (CS) was evaluated at 3, 6, 12 and 18 cycle per degree (cpd) spatial frequencies with CSV-1000 E test (VectorVision, Ohio, USA) under mesopic (3.5 candela [cd]/m2) conditions at 2.5 m with distance refractive correction. The test was conducted with and without glare, and as a glare source, two halogen lamps located either side of the test chart and producing 2.5 cd/m2 luminance at eye plane were used. CS at different spatial frequencies was compared with the physiologic CS range for normal subjects of similar age. CS was also evaluated with the LCD screen version (CSO Vision Chart, Mod CVC02, version 1.3.0, Florence, Italy) of Pelli-Robson Test (PRT) under photopic (85 cd/m2) and mesopic (3.5 cd/m2) conditions at 3 m monocularly with distance refractive correction. To the best of our knowledge, PRT CS normal values, performed under similar conditions, are not available in the literature, so the data was used only for intergroup comparisons.
- The contrast sensitivity (CS), [Postoperative 6th month]
Contrast sensitivity (CS) was evaluated at 3, 6, 12 and 18 cycle per degree (cpd) spatial frequencies with CSV-1000 E test (VectorVision, Ohio, USA) under mesopic (3.5 candela [cd]/m2) conditions at 2.5 m with distance refractive correction. The test was conducted with and without glare, and as a glare source, two halogen lamps located either side of the test chart and producing 2.5 cd/m2 luminance at eye plane were used. CS at different spatial frequencies was compared with the physiologic CS range for normal subjects of similar age. CS was also evaluated with the LCD screen version (CSO Vision Chart, Mod CVC02, version 1.3.0, Florence, Italy) of Pelli-Robson Test (PRT) under photopic (85 cd/m2) and mesopic (3.5 cd/m2) conditions at 3 m monocularly with distance refractive correction. To the best of our knowledge, PRT CS normal values, performed under similar conditions, are not available in the literature, so the data was used only for intergroup comparisons.
- Quality of life measurement [Preoperative]
Quality of life parameters were evaluated by the validated Turkish version of the National Eye Institute Refractive Error Quality of Life Instrument 42 (NEI RQL-42) questionnaire. It includes 13 subscales of quality of life parameters calculated according to a scoring key, and a "total score" can be obtained by calculating the mean value of all 42 questions.
- Quality of life measurement [Postoperative 1st month]
Quality of life parameters were evaluated by the validated Turkish version of the National Eye Institute Refractive Error Quality of Life Instrument 42 (NEI RQL-42) questionnaire. It includes 13 subscales of quality of life parameters calculated according to a scoring key, and a "total score" can be obtained by calculating the mean value of all 42 questions.
- Quality of life measurement [Postoperative 3rd month]
Quality of life parameters were evaluated by the validated Turkish version of the National Eye Institute Refractive Error Quality of Life Instrument 42 (NEI RQL-42) questionnaire. It includes 13 subscales of quality of life parameters calculated according to a scoring key, and a "total score" can be obtained by calculating the mean value of all 42 questions.
- Quality of life measurement [Postoperative 6th month]
Quality of life parameters were evaluated by the validated Turkish version of the National Eye Institute Refractive Error Quality of Life Instrument 42 (NEI RQL-42) questionnaire. It includes 13 subscales of quality of life parameters calculated according to a scoring key, and a "total score" can be obtained by calculating the mean value of all 42 questions.
Eligibility Criteria
Criteria
Inclusion Criteria:
Inclusion criteria were patients with bilateral visually significant cataract seeking spectacle independence, especially at far and intermediate distances, age of ≥18 years, preoperative corneal astigmatism less than 1.00 D, axial length (AL) between 21 - 26.5 mm, and availability to attend all follow-up visits.
Exclusion Criteria:
Patients were excluded from the study if any of the following conditions were present: high visual demand for near vision, amblyopia, glaucoma, corneal opacity, severe/moderate to severe dry eye, pupillary abnormalities and dysfunction, corneal astigmatism ≥1.00 D, AL <21 mm or ≥26.5 mm, diabetes mellitus with retinal changes, active uveitis or history of uveitis, previous ocular surgery and lack of attendance to any follow-up visit.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Marmara University School of Medicine, Department of Ophthalmology | Istanbul | Turkey | 34854 |
Sponsors and Collaborators
- Marmara University
Investigators
- Study Director: Ayse Ebru Toker, Professor, Marmara University
Study Documents (Full-Text)
None provided.More Information
Publications
- Kim JS, Jung JW, Lee JM, Seo KY, Kim EK, Kim TI. Clinical Outcomes Following Implantation of Diffractive Multifocal Intraocular Lenses With Varying Add Powers. Am J Ophthalmol. 2015 Oct;160(4):702-9.e1. doi: 10.1016/j.ajo.2015.07.021. Epub 2015 Jul 21.
- Kretz FT, Gerl M, Gerl R, Müller M, Auffarth GU; ZKB00 Study Group. Clinical evaluation of a new pupil independent diffractive multifocal intraocular lens with a +2.75 D near addition: a European multicentre study. Br J Ophthalmol. 2015 Dec;99(12):1655-9. doi: 10.1136/bjophthalmol-2015-306811. Epub 2015 May 18.
- Pedrotti E, Bruni E, Bonacci E, Badalamenti R, Mastropasqua R, Marchini G. Comparative Analysis of the Clinical Outcomes With a Monofocal and an Extended Range of Vision Intraocular Lens. J Refract Surg. 2016 Jul 1;32(7):436-42. doi: 10.3928/1081597X-20160428-06.
- Rosen E, Alió JL, Dick HB, Dell S, Slade S. Efficacy and safety of multifocal intraocular lenses following cataract and refractive lens exchange: Metaanalysis of peer-reviewed publications. J Cataract Refract Surg. 2016 Feb;42(2):310-28. doi: 10.1016/j.jcrs.2016.01.014. Review.
- 09.2016.309