Low Add Multifocal Versus Extended Depth of Focus Intraocular Lens

Not Applicable

Completed

• Conditions: Multifocal Intraocular Lenses; Extended Depth of Focus
• Interventions: Device: Tecnis +2.75 D (ZKB00) and Tecnis Symfony (ZXR00)

• Registration Number: NCT04865016
• Lead Sponsor: Marmara University

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.

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 Timeline

• Study Start: 2016-10-01
• Primary Completion: 2018-09-01
• Study Completion: 2019-03-01
• Status Verified: 2021-04
• Study First Submitted: 2021-04-27
• Study First Submitted QC: 2021-04-27
• Last Update Submitted: 2021-04-27
• Study First Posted: 2021-04-29
• Last Update Posted: 2021-04-29

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 29

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.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
MIOL Group	Tecnis +2.75 D (ZKB00) and Tecnis Symfony (ZXR00)	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).
EDOF Group	Tecnis +2.75 D (ZKB00) and Tecnis Symfony (ZXR00)	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).

Primary Outcome Measures

Name	Time	Method
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),	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	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.

Trial Locations

Locations (1)

Marmara University School of Medicine, Department of Ophthalmology; 🇹🇷 Istanbul, Turkey