AAO 2024: Defocus curve performance of trifocal IOLs and near activity vision questionnaire outcomes

Adam Muzychuck, MD, FRCSC, sat down to discuss his presentation on the defocus curve performance of trifocal IOLs and the outcomes of the near activity vision questionnaire given to patients implanted with the Envy full range of vision IOL at this year's American Academy of Ophthalmology meeting held in Chicago, Illinois.

Video Transcript:

Editor's note: The below transcript has been lightly edited for clarity.

David Hutton:

Hi, I'm David Hutton of Ophthalmology Times. The American Academy of Ophthalmology is holding its annual meeting this year in Chicago. At that meeting, Dr Adam Muzychuk is presenting a poster titled Defocused Curve Performance and Outcomes of Near Activity Vision Questionnaire Following Trifocal IOL Implantation. Thanks for joining me today. First, how does the defocus curve performance of trifocal IOLs compare to other types of multifocal or extended depth of focus lenses in terms of overall vision quality?

Adam Muzychuck, MD, FRCSC:

Hi, David, and thank you for having me. The defocus curve performance of trifocal IOLs, such as the enVista full range of vision Envy IOL, demonstrates a continuous range of vision across different defocus levels, especially in the intermediate and near ranges. Trifocal IOLs show excellent visual acuity at intermediate and near maintaining 20/32, or better, over 4 diopters of range with Envy, compared to just 2 diopters seen for monofocals in this study. Well, we only directly compared to monofocals In this study, diffractive trifocal eye wells have been found to offer improved range compared to earlier diffractive designs, and we would expect them to outperform non-diffractive, extended depth of focus lenses on defocus curve testing,

David Hutton:

What do the results of the near activity vision questionnaire reveal about patient satisfaction with near vision tasks following trifocal Iowa implantation.

Adam Muzychuck, MD, FRCSC:

The near activity vision questionnaire results reveal that patients implanted with the Envy full range of vision IOL report significantly higher satisfaction with near vision tasks compared to those with monofocal lenses. Specifically, a much higher proportion of trifocal IOL patients, approximately 88 to 96% reported no or a little difficulty with near vision tasks such as reading small print, reading labels, writing and maintaining focus for prolonged near work, compared to monofocal IOL patients, where these numbers range from approximately 37 to 69%. Moreover, 90% of trifocal IOL patients achieve spectral independence for near tasks. Finally, 83% of patients reported no to a little difficulty seeing objects close to you in poor or dim lighting. So the answer to the question that always arises, will I be able to see a menu in a dimly lit restaurant? The answer with Envy, for the vast majority of patients, is yes. In short, following Envy trifocal IOL implantation, patient satisfaction with near vision tasks is very high.

David Hutton:

Were there any notable differences in defocus curve performance between patients with different levels of preoperative refractive error or other individual factors?

Adam Muzychuck, MD, FRCSC:

The presentation does not explicitly detail variations in defocus curve performance based on preoperative refractive error or other individual patient factors such as age or axial length. However, it highlights that the performance of enVista, envy, full range of vision IOL is consistent across different pupil sizes, with smaller pupils under 3 millimeters, maintaining excellent intermediate near vision and larger pupils, which is the most challenging situation for most full range of vision IOLs, typically seen in mesopic conditions, still providing strong performance with the distance dominant design under mesopic conditions, reinforcing distance vision while continuing to offer excellent patient reported near vision. The current study primarily focused on comparing trifocal IOLs with monofocal IOLs over various defocus levels and pupil sizes, rather than stratifying outcomes based on individual preoperative factors. But that's certainly an idea for the future.

David Hutton:

And lastly, based on your findings, what key considerations should ophthalmologists keep in mind when recommending trifocal iols for patients who prioritize near vision activities?

Adam Muzychuck, MD, FRCSC:

Good question. When recommending trifocal iols to patients who prioritize near near vision activities, I think ophthalmologists should probably consider the following. So from this study, we know that trifocals, particularly the enVista Envy, provide vastly superior performance in terms of near vision tasks compared to monofocals, with a very high proportion of patients reporting minimal difficulty with reading small print, writing or engaging in hobbies at near. In this study, we saw 90% of patients reporting spectacle independence for near vision tasks, compared to just about 50% of monofocal IOL patients. This is a significant and dramatic improvement, and although we did not directly compare them in this study, we would expect Envy to easily outperform other designs such as non-diffractive, extended depth of focus, IOLs for near vision performance. In short, if patients strongly value spectacle, independence at near, intermediate and distance, a full range of vision IOL is most likely to be the IOL that's going to meet their needs. And finally, in terms of adaptability to varying lighting conditions and pupil sizes, enVista Envy maintained excellent defocus curve performance in various lighting conditions with performance that's fairly consistent across a broad range of pupil sizes. This is particularly beneficial for patients who frequently perform tasks in dim lighting, such as night drive. This is beneficial for surgeons, as this study should give them the confidence to recommend Envy trifocal IOL for their patients, given that the defocus curve performance and reported patient satisfaction was very high, including in dim lighting circumstances.