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Trifocal toric IOL provides good acuity at all distances
A premium diffractive-refractive trifocal toric IOL provided patients with astigmatism with effective near, intermediate and distance acuity.
In a multicenter European trial, 114 patients underwent phacoemulsification surgery with the AT LISA tri toric 939MP (Carl Zeiss Meditec). All but one patient had bilateral implantation.
All patients were at least 50 years old, had bilateral regular corneal astigmatism and required IOLs with sphere power up to +28.00 D and cylinder power between +1.00 D and +4.00 D.
Patients were evaluated postoperatively at 1 to 7 days and at 1, 3, 6 and 12 months. Binocular uncorrected visual acuities were no more than 0.3 logMAR in 99% for distance, 98.10% for intermediate and 91.40% for near, according to the study.
The authors reported stable uncorrected distance visual acuity (UDVA) at all follow-up times; at 12 months post-surgery, 76.2% had fully restored UDVA. They saw a significant improvement in binocular distance-corrected intermediate visual acuity at 1 month that remained stable up to 12 months. Also at 12 months, 39.8% had fully restored uncorrected intermediate visual acuity, and 22.6% had fully restored uncorrected near visual acuity.
Manifest cylinder was statistically significantly reduced at 1 day and even more significantly at 1 month. At 12 months, 79.7% of eyes had a cylinder value of ±0.50 D.
The researchers found the defocus curve of the trifocal to smoothly transition between the far and near focus. Contrast sensitivity was similar at each follow-up; specifically, it was in the normal range at 6 months.
The majority of patients said their quality of vision was good or very good at all follow-ups, and patient satisfaction for all visual outcomes was very high.
The authors concluded that the AT LISA tri toric provides “high levels of quality of vision at all distances and high level of spectacle independence.”
They did notice a slight trend towards overcorrection, which may be addressed with improvements in effective lens position calculations in the future, they said. – by Nancy Hemphill, ELS, FAAO
Disclosures: Piovella reports consulting for Acufocus, Carl Zeiss Meditec, Johnson & Johnson, Tear Lab and Tear Science. The other authors report no relevant financial disclosures.
Perspective
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Comanagement of ocular surgery is an important part of optometry’s scope expansion. Included in this is cataract surgery, which is used to both remove the opacified lens and surgically correct refractive error.
Multifocal IOLs perform well and continue to get better in their design. This paper describes a lens that not only provides good vision at distance, intermediate and near, but also incorporates an overall toric design, which, in the study, successfully compensates for corneal astigmatism. Overall patient satisfaction was quite high, with a large proportion of patients reporting spectacle independence.
While this study indicates a high level of satisfaction with the multifocal toric IOL, it’s important that we not lose sight of the fact that each individual has unique visual needs and desires. This compels us to consider all IOL options and, with the patient’s input, choose what is best for each particular patient.