Study finds advantages using trifocal IOL to correct presbyopia

Reviewed by Matteo Piovella, MD

A 4-year study following trifocal IOL implantation (AT LISA tri 839MP, Carl Zeiss Meditec) found that the lens provided good distance, near, and intermediate visual acuity. The lens also improved patient quality of vision with better diffraction and less reduction in contrast sensitivity, said Matteo Piovella, MD, medical director, Centro Microchirurgia Ambulatoriale-CMA in Monza, Milan, Italy.

Dr. Piovella reviewed highlights of the study. The co-author of the study is Barbara Kusa, MD, also from Centro Microchirurgia Ambulatoriale.

Their study, starting in 2012, included 111 eyes of 67 patients who had phacoemulsification and trifocal IOL implantation of the AT LISA lens. All surgeries were uncomplicated. Distance (5 m), near (40 cm), and intermediate (80 cm) visual acuity were measured after surgery, as well as corneal topography, contrast sensitivity and defocus curve. The follow up period was 4 years.

The study included 111 eyes from 67 patients, with a mean age of 67 years. The preoperative distance uncorrected visual acuity was 20/125 (0.8 logMAR), compared with 20/20 at 4 years postoperatively.

The monocular and binocular uncorrected near vision was respectively 0.06 and 0.02 logMAR. Monocular and binocular intermediate vision was 0.13 and 0.09 logMAR, respectively. Nearly 8% of patients still wear glasses occasionally.

By the year 2015, 73% of patients having cataract surgery at CMA surgical center received the trifocal technology.
“Ninety-four percent of eyes achieved postoperative refractive results within ± 0.50 D,” he said.

“In practice, intermediate vision is the most important vision because of iPad, smartphone, and computer use,” Dr. Piovella said.

He was surprised that the trifocal is the only technology submitted and approved to provide effective far, intermediate, and near vision.

Compare with EDOF

Although extended depth-of-focus IOLs are available, their strengths are only far and intermediate vision, he said.
Regarding trifocal IOLs, “if you learn to improve your preoperative organization to provide plano refractive results by doing a perfect biometry analysis, then every patient is happy,” Dr. Piovella said.

However, surgeons using the trifocal must provide dry eye therapy to ensure optimal ocular surface health, he said. His study found that over 16% of patients required pre - and postoperative dry eye management.

Dr. Piovella himself was implanted binocularly with the trifocal IOL.

Dr. Piovella added he is involved in a study on a trifocal toric IOL based on the same platform that should be in press soon. 

Matteo Piovella, MD

E: piovella@piovella.com

This article was adapted from Dr. Piovella’s presentation at the 2017 meeting of the American Society of Cataract and Refractive Surgery. Dr. Piovella is a consultant for Acufocus, Carl Zeiss Meditec, Johnson & Johnson Vision, and TearLab.