The Impact Of Angle Kappa On Visual Outcome And Patient Reported Visual Disturbance After A Trifocal Iol Implantation

This study aims to assess visual outcomes and patient reported visual disturbulances in a Chinese cohort implanted with PanOptix and PanOptix Toric trifocal lenses and evaluate the impact of pre-operative offset of angle kappa.

This prospective, single surgeon, single centre study included 135 eyes of 88 individuals,  who were at 45-80 years old and had cataract removal and,  PanOptix/PanOptix Toric implantation at Peking Union Medical College Hospital from Oct. 2023 to Oct. 2024, with follow-up duration of 3 months.

The patients were divided into two groups based on the pre-operative offset of angle kappa: ≤0.3mm and >0.3mm. We evaluated monocular uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), uncorrected intermediate visual acuity (UIVA) at 3 months post-operatively. Visual disturbances were assessed using the QUVID questionnaire.

Of the 122 eyes(81 individuals) included in the final analysis, 40 had a kappa angle offset≥0.3mm and 82 had a kappa angle offset<0.3mm, with median kappa offset of 0.247(0.172, 0.350)mm. The 3-month postoperative UDVA, UIVA, and UNVA were 0.0(0.0,0.0) LogMAR, 0.0(0.0,0.0)LogMAR, and 0.0(0.0,0.1)LogMAR in larger angle kappa group, and 0.0(-0.1,0.075)LogMAR, 0.0(0.0,0.1) LogMAR, and 0.1(0.0,0.1)LogMAR in smaller kappa group, showing no significant differences(p=0.298, 0.609, and 0.504, respectively). These results indicate excellent visual acuity across the cohort. The incidence of moderate to severe glare, halo, and starburst across all cohorts was 18%, 18%, and 8%, with no significant differences(p=0.265, 0.738, and 0.477, respectively).

Conclusion: The angle kappa does not predict visual acuity outcomes or the incidence of visual disturbances post-surgery. These findings challenge the emphasis on angle kappa size in preoperative assessments for PanOptix/PanOptix Toric lens implantation.