Performance of trifocal toric IOL highlighted in tests

In a prospective evaluation including 20 eyes, a trifocal toric IOL effectively reduced astigmatism, had good postoperative rotational stability, provided a full range of excellent uncorrected visual acuity with good contrast sensitivity, caused no significant phoic phenomena, and was associated with high patient satisfaction.

This article was reviewed by Yonca A. Akova

Findings from a study evaluating postoperative clinical and quality of life outcomes show that an aspheric, nonapodized trifocal toric IOL (AcrySof IQ PanOptix Toric IOL, Alcon) was associated with excellent visual and refractive results, leading to high spectacle independence and patient satisfaction, according to Yonca A. Akova, MD.

“Untreated preexisting corneal astigmatism is an important limiting factor for visual outcomes with multifocal IOL implantation,” said Dr. Akova, professor of ophthalmology, Bayindir Hospital, Ankara, Turkey.

Dr. Akova noted that the study could be among the first reporting clinical outcomes with the toric version of this trifocal IOL. 

Related: Toric options offer chance to expand patient's sweet spot

“The results of this investigation show that the IOL effectively reduced astigmatism, had good rotational stability, and provided excellent visual outcomes at all distances to provide excellent patient satisfaction,” she said. 

The trifocal toric IOL has a central trifocal zone of 4.5 mm and 15 diffractive rings. It features a +3.25 D add for near focus and a +2.17 D add for the intermediate focal point (60 cm).

This new trifocal toric IOL technology has brought the intermediate focal point from 80 cm to 60 cm, which aims to provide comfortable vision in daily life.

Dr. Akova conducted the noncomparative study evaluating the trifocal toric IOL with Oya Donmez, MD, ophthalmologist, Bayindir Hospital. It included 20 eyes of 15 patients operated on between April 2018 and June 2018. Eyes were selected for implantation of the toric version of the trifocal IOL based on having ≥1.25 D of with-the-rule astigmatism or ≥0.75 D of against-the-rule astigmatism.

Related: The future: Development of true accomodative IOLs

All patients underwent a complete ophthalmological examination preoperatively and three months after surgery. Astigmatism was measured with corneal topography (Sirius, CSO Italia) and optical biometry (IOLMaster 700, Carl Zeiss Meditec).

All of the surgeries were done using a femtosecond laser (LenSx, Alcon) for the corneal incisions, anterior capsulotomy, and lens pretreatment followed by phacoemulsification through a 2.2 mm incision (Centurion Vision Systems, Alcon). 

The patients ranged in age from 46 to 75 years; their mean age was 62 years, and all procedures were for cataract.

Related: Light-adjustable IOL technology creates novel treatment window 

Preoperatively, mean corneal astigmatism was 1.8 D (range 0.82 to 4.30 D). Mean predicted residual astigmatism was 0.12 D (range 0.01 to 0.71).
The eyes had average axial length (mean 23.9 mm, range 22.16 to 26.99) and anterior chamber depth (mean 3.1 mm, range 2.51 to 3.80).

At three months after surgery, all patients achieved uncorrected visual acuity (VA) of 0.1 logMAR or better at distance, intermediate, and near, and 90% of patients reported complete spectacle independence.

Mean logMAR uncorrected VA was 0.005 at distance, 0.06 at intermediate, and 0.05 at near. 

Defocus testing was also done over the range of +1.0 to – 3.0 D. The curve showed peaks at 0.00 D and -1.50 D.

Mean refractive astigmatism was 0.39±0.38 (0-(-)1 D) and mean manifest astigmatism was 0.05±0.22 (0-(-)1 D)

“Refractive astigmatism (This is manifest) was <1 D in all eyes and it was ≤0.50 D in 94% of eyes,” Dr. Akova reported.

Related: Precise alignment helps surgeons focus on best toric IOL post-op results 

Contrast sensitivity testing was also done, and the results showed that all patients maintained normal contrast at all spatial frequencies under both mesopic and photopic conditions.

No patients experienced any disturbing optic phenomena. Three patients (15%) reported mild halos, and only one patient (5%) reported glare, which was also mild.

Visual function was also assessed at three months after surgery using the Visual Function Index Test (VF-14). The best possible score on this instrument is 100, and the patients in the study had a mean VF-14 score of 97.63.

Rotational stability was assessed by evaluating IOL alignment at three months after surgery. Mean rotation was 3.3°, and in no case did the IOL rotate >10°. 

“We also saw no evidence of posterior capsule opacification, although the follow-up at three months is still a short duration,” Dr. Akova concluded.

Read more by Cheryl Guttman Krader 

Yonca A. Akova, MDE: yoncaakova@yahoo.com
This article was adapted from Dr. Akova's presentation at the American Academy of Ophthalmology 2019 annual meeting. Dr. Akova is a consultant to Alcon.