Results Of A Prospective Study On The Bilateral Implantation Of A Wavefront- Shaping Technology Intraocular Lens In Patients With Cataracts And Glaucoma.

Glaucoma is a relative contraindication for implantation of premium intraocular lenses (IOL), including extended depth of focus (EDOF) IOLs. The potential for decreased contrast sensitivity and increased dysphotopsia discourage the implantation of these IOLs in patients with an already compromised visual function due to optic nerve and macular disorders. Nonetheless, new designs in EDOF IOLs (which include the X-WAVE^®-based technology AcrySof^® IQ Vivity^®; Alcon, USA) may decrease risk of those symptoms, as already reported in non-diseased eyes. This study aims to describe the visual performance of these IOLs in patients with bilateral cataracts and glaucoma.

This study was conducted between 2021-2023 in OMIQ (Oftalmologia Mèdica i Quirúrgica) clinic, a private institution in Barcelona, Spain. Here we provide the results of the first 18 patients, and further recruitment and follow-up are being conducted and will be presented in the ESCRS Meeting in September.

This was a prospective, longitudinal, interventional, descriptive study of patients with bilateral cataracts and glaucoma operated with the AcrySof^® IQ Vivity^® IOL followed for 3 months. Patients were eligible if they showed early to moderate glaucoma (mean deviation in the 24-2 visual field between -2 and -12 dB) and no other ocular disease, aside from cataracts. The main outcome was contrast sensitivity as measured with the Pelli-Robson test. Other analyses included visual acuity at distance, intermediate and near distances, and dysphotopsia assessed with the McAlinden questionnaire.

As of March 9^th, 2023, 18 patients with 3 month-results had been included. There were 7/18 females (38.9%), the mean age was 74.3 years (standard deviation [SD] 9.3), 67% of eyes had mild and 33% moderate glaucoma. As compared to baseline, binocular contrast sensitivity with Pelli-Robson testing improved from 1.47 (SD 0.15) to 1.62 (SD 0.13), p=0.008. Low contrast visual acuity at 66 and 40 cm also improved (p<0.001). Binocular uncorrected visual acuity at distance, intermediate and near improved from month 1 to month 3, reaching -0.01 (SD 0.05), 0.07 (SD 0.09) and 0.20 (SD 0.13) logMAR, respectively (p≤0.005). The percentage of eyes with glare, haloes or starbusts was low. No significant complications occurred.

The preliminary results suggest that the AcrySof^® IQ Vivity^® IOL provides improved contrast sensitivity, visual acuity, and patient satisfaction with little dysphotopsia in patients with cataracts and glaucoma. Clinical trials are required to compare the performance of this EDOF IOL vs the standard or care in this population, monofocal IOLs.