Short term visual outcomes of a new trifocal intraocular lens

Abstract

Background: Today, patients often expect to achieve spectacle independance after cataract surgery. New trifocal intraocular lenses have been developed to try and fullfill this demand. The purpose of this study is to report the short-term visual outcomes of a new trifocal intraocular lens (AcrySof PanOptix™).

Methods: Consecutive adult patients undergoing cataract surgery with bilateral implantation of the study intraocular lens in a private practice clinic were considered for inclusion. Exclusion criteria were the presence of other ocular pathologies or preoperative astigmatism >1.5 diopters (D). Patients with intraoperative complications were excluded from analysis. One month after surgery patients underwent: monocular defocus curve; monocular and binocular uncorrected visual acuity in photopic and mesopic conditions, for far (4 m), intermediate (60 cm) and near (33 cm) distances and binocular contrast sensitivity. Patients completed a visual satisfaction questionnaire between 9 and 12 months after surgery.

Results: One hundred and sixteen eyes of fifty-eight patients receiving bilateral implantation of the study intraocular lens were analysed. Mean binocular uncorrected visual acuity in photopic conditions was 0.03 LogMAR for far, 0.12 for intermediate and 0.02 for near distances. All patients achieved a binocular uncorrected visual acuity better than 0.3 LogMAR (20/40 Snellen equivalent) for distance and near vision and 94.8% of patients for intermediate vision. Mesopic binocular uncorrected visual acuity values were similar to photopic values. The monocular defocus curves showed that the best visual acuity was reached at a vergence of 0.00D. Visual acuity dropped slightly at -1.00D and peaked again at -2.00D. Visual acuities better than 0.2 LogMAR were maintained between -2.50D and +0.50D. Contrast sensitivity was high and similar in photopic and mesopic conditions. As regards patient-evaluated outcomes, only 2 patients (3.4%) were fairly dissatisfied with their sight after surgery. Three patients (5.1%) reported the need for spectacle correction for certain activities. All other patients (94.8%) reported never using spectacle correction.

Conclusions: The PanOptix trifocal IOL provides good short-term visual outcomes, with good intermediate performance and excellent patient-reported satisfaction. The similar values achieved in mesopic and photopic conditions in binocular uncorrected visual acuity and contrast sensitivity suggest low pupillary dependence for light distribution.

Trial registration number: ISRCTN60143265 , retrospectively registered on the 24th of April 2017.

Keywords: Cataract surgery; Multifocal intraocular lens; Trifocal intraocular lens.

Fig. 1

The PanOptix intraocular lens. It is a single-piece, aspheric, non-apodized diffractive lens with a 6.0-mm biconvex optic, a central trifocal zone of 4.5 mm, an overall diameter of 13.0 mm, and 0-degree haptic angulation

Fig. 2

LogMAR visual acuity distribution for uncorrected binocular visual acuity, for photopic (85 cd/m2) and mesopic conditions (3 cd/m2), for far (4 m) intermediate (60 cm) and near (33 cm) distances

Fig. 3

Monocular distance-corrected defocus curve given in logMAR 1 month after surgery

Fig. 4

Mean binocular contrast sensitivity function in photopic (85 cd/m2) and mesopic conditions (3 cd/m2) 1 month after surgery

Fig. 5

Patient’ answers to question 3 of the Catquest 9-SF questionnaire, which explores difficulties in performing different activities of daily life

Fig. 6

Patient’ reported incidence of halos and glare, as well as of difficulties when driving at night