Journal Club Extended Depth of Field Lens.pptx

Journal Club Extended Depth of Field Lens
Discussing vision in EDOF, Monofocal and Trifocal IOLs

1. Journal Club Dr. Zaid Azhar PGY II Ophthalmology Shifa International Hospital

2. Chen-Cheng Chao , Hung-Yuan Lin, Chia-Yi Lee , Elsa Lin-Chin Mai, Ie -Bin Lian and Chao-Kai Chang Difference in Quality of Vision Outcome among Extended Depth of Focus, Bifocal, and Monofocal Intraocular Lens Implantation

3. Taipei Nobel Eye Clinic and Universal Eye Center Clinic, Taiwan 2018-2020 Location/Time Healthcare 2022, 10, 1000. https:// doi.org /10.3390/healthcare10061000 Journal To analyze the visual performance and quality of vision of the EDOF Symfony IOL and compare it with the bifocal Restor IOL and monofocal Sensar AR40e IOL. Aim Study details

4. Discussion Contents Introduction Materials and Methods Results

5. Cataracts are the leading cause of vision impairment and blindness worldwide. Intraocular lens (IOL) implantation is a procedure during cataract surgery to restore postoperative visual acuity. Many different designs of IOLs are available e.g monofocal , multifocal, and extended depth of focus (EDOF). Studies indicate that EDOF IOLs presented better quality of vision than bifocal IOLs, in addition to having similar intermediate visual restoration EDOF IOLs also yielded higher contrast sensitivity (CS) in a larger nonrandomized case series. Introduction

6. Discussion Contents Materials and Methods Results Introduction

7. Patient selection Presence of cataracts in both eyes. Male/female Age between 50 and 80 years CDVA of both eyes under 20/40. Right eyes were included in study. Inclusion criteria Complicated cataract; Corneal opacities Corneal astigmatism > 1.50D; severe dry eye (Schirmer’s test I ≤ 5 mm); Amblyopia; Anisometropia; Surgical complications -posterior capsular bag rupture, vitreous loss, IOL tilt/decentration Coexisting ocular pathologies - glaucoma, nondilating pupil, history of intraocular surgery, laser therapy, or retinopathy; optic nerve or macular diseases; Refusal or inability to maintain follow-up Exclusion criteria

8. Examination Biometry Slit lamp exam Uncorrected distance visual acuity (UDVA), Corrected distance visual acuity (CDVA) Fundoscopy Applanation tonometry Preoperatively, all patients underwent optical biometry with the IOL Master ( IOLMaster 500, Carl Zeiss) Calculations were performed using the SRK/T Postoperative refraction target was set at emmetropia Preop

9. Technique Topical anesthesia 3-step clear corneal incision (2.75 mm) at 180◦ 5.0 mm CCC Phacoemulsification using the stop-and-chop technique IOL implantation with an injector IOL centration Sutureless incision closure Surgery

10. Examination Assessment Questionairre Post -op day 1 Post -op 1 week Post -op 1 month UDVA, CDVA, and uncorrected near visual acuity (UNVA) (40 cm) Wavefront Analysis: aberration detection Vector Vision analysis: Contrast sensitivity Quality of vision questionnaire: score of 11 questions and their mean total score Near-activity visual questionnaire (NAVQ) The National Eye Institute Refractive Error Quality of Life Instrument-42 (NEI-RQL-42) Postop

11. Groups Bifocal: 24 EDOF: 29 Monofocal : 34 Total = 87

12. Stata version 13.0 ( StataCorp LP, College Station, TX, USA), was used for all statistical analysis. Analysis of covariance (ANCOVA) to compare the following measurements among the three IOL methods i ) Ophthalmic examinations: UDVA, CDVA, and uncorrected near visual acuity (UNVA) (40 cm); ii) Wavefront examination: HOAs, coma, spherical aberration, trefoil, iii) contrast sensitivity 3-CPD, 6-CPD, and 12-CPD with glare off and on, respectively; iv) quality of vision questionnaire: score of 11 questions and their mean total score. Questionnaire data were entered in WINSTEPS version 4.4.6. and evaluated by Rasch analysis. Statistical significance was set at p < 0.05. Other statistical tests included the Kruskal–Wallis rank test for continuous data and Pearson’s chi-squared test for ordinal data. Analysis

13. Discussion Contents Introduction Results Materials and Methods

14. Results

15. Results

16. Contents Introduction Materials and Methods Discussion Results

17. Discussion - vision General quality of vision is significantly better in the monofocal group than in the EDOF group and bifocal group. The overall quality of vision rating for daily life activities of EDOF group was similar to the bifocal group. Bifocal IOL performed better for reading small print than the EDOF IOL. (better UNVA).

18. Discussion – spectacle dependence, contrast and glare Spectacle dependence rate is prominently lower in the bifocal and EDOF groups than in the monofocal group. The EDOF group had a higher proportion of spectacle (27.6%) than the bifocal group (12.5%). CS in the EDOF group at all frequencies was not significantly different from the monofocal group. Significantly higher CS was noted in the EDOF group at all spatial frequencies compared to bifocal group. 17.2% of patients in our EDOF group not affected by halos and glare

19. Limitations: samples were collected retrospectively – selection bias Effect of preoperative demographics, e.g the mean age, axial length not considered. The different filtration functions among the three IOLs may influence the results. Effect of photic phenomena, not included in questionnaire Strengths: Comparision of 3 different lens type in 1 study Retrospective: large data pool can be used. Quick glance analysis of pros and cons of 3 different IOL types Good analysis of quality of vision which is a subjective measurement. Discussion - study

20. How do Extended Depth of Focus IOLs work?

21. The principle of EDOF imaging is to elongate the depth of focus from a single focal point and make it into a focused channel to avoid decreasing the optic quality caused by multiple images.

22. Thank You