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Seo, Choi, Seo, Kim, and Kim: Clinical Outcomes of Patients Fitted with Bifocal and Trifocal Diffractive Intraocular Lenses
Original Article

J Korean Ophthalmol Soc 2018;59(4):325-331.

Published online: 7 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.4.325

Clinical Outcomes of Patients Fitted with Bifocal and Trifocal Diffractive Intraocular Lenses

Jeong Gi Seo, MD, Moon Jung Choi, MD, Kyoung Yul Seo, MD, PhD, Eung Kweon Kim, MD, PhD, Tae Im Kim, MD, PhD

The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

Address reprint requests to Tae Im Kim, MD, PhD Department of Ophthalmology, Severance Hospital, #50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: 82-2-2228-3570, Fax: 82-2-312-0541, E-mail: TIKIM@yuhs.ac

Received 28 September 2017       Revised 7 January 2018       Accepted 28 March 2018

Copyright © 2018 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We compared the short-term visual outcomes of patients fitted with trifocal diffractive intraocular lenses (IOLs) and bifocal IOLs 3 months after IOL implantation.

Methods

We included 38 eyes undergoing IOL implantation at a single tertiary hospital. In all, 21 eyes received bifocal IOLs (TECNIS® 1 ZLB00; Abbott Medical Optics Inc., Santa Ana, CA, USA) and 17 received trifocal diffractive IOLs (FineVision® POD F; PhysIOL SA, Liège, Belgium). The primary outcomes were corrected and uncorrected visual acuities at 4 m, 50 cm, and 33 cm on postoperative weeks 1,4, and 12, and the spherical equivalence values at those times. The secondary outcomes included contrast sensitivity measured using an Optec 6500® instrument (Stereo Optical Co. Inc., Chicago, IL, USA) 4 weeks after surgery, the numbers of total and internal optical aberrations assessed using the iTrace® (Tracey Technologies, Houston, TX, USA) instrument at 12 weeks, symptoms including glare or halo, and the need for spectacles when engaging in daily activity.

Results

One week after surgery, eyes implanted with trifocal IOLs exhibited significantly better uncorrected near vision compared to eyes that had received bifocal IOLs, and at weeks 4 and 12, uncorrected intermediate vision was also better in the former eyes. The mean spherical equivalence did not significantly differ between the two groups, nor did the contrast sensitivity measured on postoperative week 4 or the numbers of optical aberrations evident at postoperative week 12. Eyes fitted with trifocal IOLs appeared to suffer less from glare or halo, but the between-group difference was not significant. The two groups did not significantly differ in terms of the need to wear supplementary spectacles.

Conclusions

Trifocal diffractive IOLs seem to afford superior intermediate vision compared to traditional bifocal IOLs, and may therefore improve visual outcomes at varying distances in patients undergoing cataract surgery.

Keywords: Cataract, Diffractive, Intermediate visual acuity, Multifocal, Trifocal

REFERENCES

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Figure 1.
Contrast sensitivity score in patients implanted with the bifocal or trifocal intraocular lenses at different lighting condition (photopic and mesopic) and different glare at 1 month after cataract surgery. (A) Photopic with glare. (B) Photopic without glare. (C) Mesopic with glare. (D) mesopic without glare. CPD = cycle per degree.
jkos-59-325f1.tif
Table 1.
Preoperative subject characteristics and demographics in patients implanted bifocal or trifocal intraocular lenses
Bifocal intraocular lens Trifocal intraocular lens p-value*
Number of eyes (patients) 21 (14) 17 (11)
Right eye:Left eye 12:9 7:10
Ages (years) 58.53 ± 10.68 63.17 ±7.36 0.21
UCDVA (logMAR) 0.41 ±0.35 0.42 ± 0.26 0.94
SE (D) −0.30 ± 2.30 −0.44 ± 2.56 0.88
Mean K (D) 44.02 ± 0.97 43.82 ± 1.19 0.65
Axial length (mm) 23.75 ±0.73 23.65 ± 1.02 0.77
ACD (mm) 3.38 ±0.29 3.23 ± 0.44 0.32
IOL power (D) 20.20 ± 2.08 19.67 ± 2.42 0.54

Values are presented as mean ± standard deviation unless otherwise indicated.

UCDVA = uncorrected distance visual acuity; logMAR = logarithm of the minimum angle of resolution; SE = spherical equivalent; D = diopter; K = keratometry; ACD = anterior chamber depth; IOL = intraocular lens.

* Student t-test.

Table 2.
Uncorrected distance, intermittent, near visual acuity, and spherical equivalent for subjects with bifocal or trifocal intraocular lenses
1 week
 1 month
 3 months
Bifocal intraocular lens Trifocal intraocular lens p-value* Bifocal intraocular lens Trifocal intraocular lens p-value* Bifocal intraocular lens Trifocal intraocular lens p-value*
UCDVA (logMAR) 0.09 ± 0.11 0.12 ± 0.11 0.45 0.07 ± 0.08 0.11 ± 0.14 0.36 0.07 ± 0.07 0.07 ± 0.12 0.86
CDVA (logMAR) 0.03 ± 0.05 0.02 ± 0.02 0.22 0.02 ± 0.04 0.03 ± 0.05 0.68 0.02 ± 0.04 0.03 ± 0.06 0.91
UCIVA (logMAR) 0.16 ± 0.10 0.18 ± 0.11 0.58 0.19 ± 0.10 0.12 ± 0.08 0.04 0.18 ± 0.08 0.08 ± 0.12 0.02
UCNVA (logMAR) 0.18 ± 0.06 0.10 ± 0.07 <0.01 0.12 ± 0.09 0.08 ± 0.10 0.26 0.13 ± 0.10 0.08 ± 0.03 0.17
S.E (D) −0.12 ± 0.33 −0.22 ± 0.40 0.46 −0.28 ± 0.41 −0.22 ± 0.45 0.68 −0.22 ± 0.35 −0.22 ± 0.40 0.99

Values are presented as mean ± standard deviation unless otherwise indicated.

UCDVA = uncorrected distance visual acuity; CDVA = corrected distance visual acuity; UCIVA = uncorrected intermittent visual acuity; UCNVA = uncorrected near visual acuity; S.E = spherical equivalent; D = diopter.

* Student t-test.

Table 3.
Internal aberrations of eyes implanted with bifocal or trifocal intraocular lenses
Parameter (μM) Bifocal intraocular lens Trifocal intraocular lens p-value*
RMS total 0.57 ± 0.27 0.64 ± 0.29 0.48
Total HOA 0.37 ± 0.22 0.37 ± 0.23 0.93
Coma 0.18 ± 0.12 0.15 ± 0.09 0.55
Spherical −0.05 ± 0.10 −0.06 ± 0.09 0.71
Trefoil 0.17 ± 0.12 0.18 ± 0.12 0.72

Values are presented as mean ± standard deviation unless otherwise indicated.

RMS = root mean square; HOA = high-order aberration.

* Student t-test.

Table 4.
Response to presence of discomfort due to glare or halo, needs for spectacles 3 months after cataract surgery, for subjects with bifocal or trifocal intraocular lenses
Bifocal intraocular lens Trifocal intraocular lens p-value*
Glare 26.7 (4) 17.6 (3) 0.28
Halo 33.3 (10) 17.6 (3) 0.16
Needs of spectacles
 For near 9.5 (2) 0 (0) 0.20
 For intermittent 0 (0) 0 (0) -
 For distance 4.8 (1) 5.9 (1) 0.88

Values are presented as n (%) unless otherwise indicated.

* Student t-test.

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