A Comparative Evaluation Of Visual, Refractive, And Patient-Reported Outcomes Of Four Premium Intraocular Lenses

To compare visual, refractive, optical performance, and patient-reported outcome measures (PROM) of patients implanted with one of four different types of premium intraocular lenses (IOLs): Precizon Presbyopic (Pr), (Ophtec, The Netherlands), a refractive multifocal (MF) IOL;  AT Lisa Tri 839 (LT) (Zeiss, Germany), a diffractive trifocal IOL; Vivity (Vi) (Alcon, USA), an EDOF IOL, and Eyhance (Ey) (Johnson & Johnson, USA), a monofocal-plus IOL.

Prospective, consecutive, comparative clinical, four-arm, single-center, open-label study in the Cornea, Cataract and Refractive Surgery Unit, VISSUM (Miranza Group), Miguel Hernandez University, Alicante, Spain.

100 eyes of 100 patients underwent cataract surgery implanted with 1 of the 4 premium IOLs. Main outcome measures at 6 months were: visual acuities of uncorrected & corrected distance (UDVA, CDVA), uncorrected & corrected near (UNVA, CNVA), refraction, slit lamp biomicroscopy, defocus curve (DFC), ocular low and high order aberrations (LOA, HOA), ocular point spread function (PSF) with & without LOA, pupil size, contrast sensitivity (CS), and quality of vision (QoV) questionnaire. Based on the Vivity's UNVA variable outcome (16% ≤0.1 & 8% ≥0.4 logMAR) we targeted a subgroup analysis, an expanded sample of 79 eyes of 79 patients implanted with the Vivity, to elucidate potential correlation between postop UNVA and pre/postoperative parameters

Pr, Vi, LT & Ey postop UDVA were .04, .11, .02 & .07 logMAR, respectively. The LT excelled in aberrometric analysis & DFC with UNVA significantly better compared to the other IOLs. Vi had better retinal image quality & CS. Pr & Vi provided similar far, intermediate & near vision; Vi with slightly better vision at intermediate & Pr better vision at near. PROM showed lower score for Vi. Subanalysis of Vi UNVA indicated 16%, 72% & 8% achieved ≤.1, >.1 to <.4 & ≥.4 logMAR, respectively.  Predictive analyses of pre/postop factors for near outcomes found no significant correlations. Commonly considered factors as refraction were aligned with expected outcomes, but variables as angle kappa/alpha & pupil dynamics didn't demonstrate predictive value

This comprehensive evaluation of 4 premium IOLs, reveals each lens's unique strengths & limitations. The Vi cohort indicated that most of the group had a functional near vision with a substantial proportion achieving excellent near vision. Conversely, a smaller subset had limited near VA postop. These results underscore the variability in visual outcomes within the Vi patients. Our study revealed no significant pre/postop parameters that could predict the near visual outcome for the Vi, suggesting a pivotal role for neuroadaptation. The study highlights the necessity of individualized patient counseling regarding the potential for neuroadaptation with Vi IOL & the importance of setting realistic expectations for visual outcomes post-surgery