EyeWorld India December 2018 Issue

EWAP REFRACTIVE 57 December 2018 Two trifocals tested and compared by Stefanie Petrou Binder, MD EyeWorld Contributing Writer The trifocal AcrySof IQ PanOptix IOL matched the AT LISA diffractive IOL for intermediate and far visual acuity and showed an ad- vantage for near vision in study T rifocal IOLs may be a patient’s best bet for achieving a full range of vision. Spectacle- free intermediate vision is argu- ably the most sought after visual correction among patients opt- ing for premium lenses, allowing them to carry out the majority of their daily activities without the use of glasses. However, surgeons have found that striving to attain spectacle independence using MFIOLs usually comes at the price of diminished far or near visual performance. European cataract surgeons have had great outcomes using trifocal IOLs, and some of the first comparative studies are out, allowing physicians to gauge the differences in these IOLs and choose the right technology for patients. Data from a study that com- pared a newer model diffractive IOL with an older model that were first presented as an e-poster at the 22nd ESCRS Winter Meeting demonstrated good outcomes in near, intermediate, and far visual acuity, and underlined how a thorough understanding of MFIOL capacity is essential in meeting each patient’s visual needs. Detlev Breyer, MD , Breyer, Kaymak & Klabe Eye Surgery and Premium Eyes, Düsseldorf, Germa- ny, the first author of the e-poster, said that both trifocal IOLs offered a broad range of good binocular vision. Study data The study involved the implanta- tion of the AcrySof IQ PanOptix (Alcon, Fort Worth, Texas) in 20 eyes and the AT LISA tri (Carl Zeiss Meditec, Jena, Germany) in 372 eyes. The male to female ratio in the AcrySof IQ study group was 34:66, and the patients had a mean age of 59.2±10.7 years. In the AT LISA group, the male to fe- male ratio was 50:50 with a mean patient age of 64.4±7.2 years. The mean spherical equivalent (SE) in the AcrySof IQ group was –0.4±3.9 D, and the mean cylinder was –1.1±1.0 D. Preoperatively, the corrected distance visual acuity (CDVA) was logMAR 0.20±0.18 and the uncorrected distance visual acuity (UDVA) was logMAR 0.62±0.40. The mean IOL power used in the group was 20.6±5.2 D and the target SE was –0.13±0.20 D. AT LISA patients had a mean SE of 0.4±3.8 D and a mean cylin- der of –0.4±0.3 D. The group had a mean CDVA of logMAR 0.15±0.20 and a mean UDVA of logMAR 0.71±0.32. The mean IOL power was 22.2±3.9 D, and the target SE was –0.13±0.25 D. Predictable visual outcomes According to Dr. Breyer, the pre- dictability of an intraocular device can be calculated by subtracting the target SE from the actual post- operative SE. In the 20 PanOptix patients, the difference in SE was –0.19±0.54 D, while in 269 AT LISA patients, the difference between target and postoperative SE was 0.08±0.62. The difference in SE was less than or equal to 0.5 D in 70.0% of PanOptix patients and 66.2% of AT LISA patients; it was less than or equal to 1.0 D in 90% of PanOptix patients and in 93.3% of AT LISA patients. The study showed a comparable devia- tion from target refraction after 3 months, with slight but significant undercorrection in the PanOptix group (p<0.05). Dr. Breyer thinks that more data is needed. The outcomes from binocular defocus curves revealed that the PanOptix eyes (n=10) achieved significantly better near vision (p<0.05) than AT LISA eyes did. The AT LISA eyes (n=36) achieved slightly better outcomes for far visual acuity. Both lenses demon- strated similar MFIOL capacities and showed vast improvements “ European cataract surgeons have had great outcomes using trifocal IOLs, and some of the first comparative studies are out, allowing physicians to gauge the differ- ences in these IOLs and choose the right technology for patients. ” continued on page 58