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      Visual Performance of Eyes with Residual Refractive Errors after Implantation of an Extended Vision Intraocular Lens


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          To analyze the tolerance on distance vision of different combined residual astigmatic situations in patients implanted with a novel wavefront shaping extended depth of focus (EDoF) intraocular lens (IOL).


          The study included patients implanted with the Acrysof® IQ Vivity® IOL. Uncorrected (UDVA) and corrected distance visual acuity (CDVA) were measured three months after surgery, considering CDVA as the reference situation of the study. Distance VA was also measured in different refractive situations: (A) with 0.50 diopters (D) of positive (myopization) and negative (hyperopization) defocus and (B) with a residual mixed astigmatic refraction induced by adding a combination of −0.25 D spherical and 0.50 D cylindrical lenses placed in vertical (against the rule-ATR), oblique, and horizontal (with the rule-WTR) positions.


          The study included 30 eyes of 30 patients. UDVA and CDVA were −0.04 ± 0.05 and −0.05 ± 0.05 logMAR, respectively. VA values with +0.50 D and −0.50 D of defocus were 0.01 ± 0.06 and 0.00 ± 0.04 logMAR, respectively. VA was better with distance correction ( p < 0.001) and no differences were found between the myopic and the hyperopic situations ( p=0.09). Distance VA for the ATR, oblique, and WTR astigmatic situations was 0.01 ± 0.05, 0.01 ± 0.06, and 0.01 ± 0.04 logMAR, respectively. VA was better for the reference situation ( p < 0.001) and no differences were found among the three astigmatic situations ( p=0.21).


          Low residual defocus and mixed astigmatic errors, regardless of its orientation, seem to be tolerated by patients implanted with the studied EDoF IOL. This trial is registered with NCT05392998. Registered 26 May 2022-Retrospectively registered.

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          Most cited references14

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          The Freiburg Visual Acuity Test-variability unchanged by post-hoc re-analysis.

          The Freiburg Visual Acuity and Contrast Test (FrACT) has been further developed; it is now available for Macintosh and Windows free of charge at http://www.michaelbach.de/fract.html . The present study sought to reduce the test-retest variability of visual acuity on short runs (18 trials) by post-hoc re-analysis. The FrACT employs advanced computer graphics to present Landolt Cs over the full range of visual acuity. The sequence of optotypes presented follows an adaptive staircase procedure, the Best-PEST algorithm. The Best-PEST threshold obtained after 18 trials was compared to the result of a post-hoc re-analysis of the acquired data, where both threshold and slope of the psychometric function were estimated via a maximum-likelihood fit. Testing time was 1.7 min per run on average. Test-retest reproducibility was +/-2 lines (or +/-0.2 logMAR) for a 95% confidence band (using 18 optotype presentations per test run). Post-hoc psychometric fitting reproduced the Best-PEST result within 1%, although the individual slopes varied widely; test-retest reproducibility was not improved. The FrACT offers advantages over traditional chart testing with respect to objectivity and reliability. The similarity between the results of the Best-PEST vs. post-hoc analysis, fitting both slope and threshold, suggest that there is no disadvantage to the constant slope assumed by Best PEST. Furthermore, since variability was not reduced by post-hoc analysis, for high reliability more trials should be employed than the 18 trials per run used here.
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            Comparison of a trifocal intraocular lens with a +3.0 D bifocal IOL: results of a prospective randomized clinical trial.

            To compare visual outcomes in patients with cataract surgery and bilateral implantation of a trifocal or bifocal intraocular lens (IOL).
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              Intermediate visual function with different multifocal intraocular lens models.

              To compare visual acuity at different distances after bilateral implantation of 1 of 4 multifocal intraocular lenses (IOLs).

                Author and article information

                J Ophthalmol
                J Ophthalmol
                Journal of Ophthalmology
                4 May 2023
                : 2023
                : 7701390
                1Clínica Rementería, Madrid, Spain
                2Hospital Universitario Ramón y Cajal, Madrid, Spain
                3Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Madrid, Spain
                4Optics and Optometry Department, Universidad Complutense de Madrid, Madrid, Spain
                5Clinical and Experimental Eye Research Group, Universidad Complutense de Madrid, UCM 971009, Madrid, Spain
                Author notes

                Academic Editor: Andrea Lucisano

                Author information
                Copyright © 2023 Laureano A. Rementería-Capelo et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 19 October 2022
                : 7 March 2023
                : 27 April 2023
                Funded by: Alcon Investigator Initiated Trial
                Award ID: 66538975
                Research Article

                Ophthalmology & Optometry
                Ophthalmology & Optometry


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