Introduction: During cataract surgery, intraocular lenses (IOLs) type influences spectacle independence, dysphotopsia risk and Quality of vision (QV), which depends on multiple visual parameters and patient-reported outcomes measures (PROMs). The purpose of this study was to compare postoperative QV among monofocal and presbyopia-correcting IOLs after bilateral cataract surgery and to graphically summarize QV using radar charts. Methods: This prospective, observational, cross-sectional study included patients undergoing consecutive bilateral cataract surgery with implantation of monofocal, extended depth-of-focus (EDoF), or trifocal IOLs. Postoperative assessment at 3 months included distance, intermediate and near visual acuity (VA), contrast sensitivity function (CSF) with and without glare, stereopsis, aberrometry, reading performance, light disturbance analysis and PROMs using the Quality of Vision (QoV) and Catquest-9SF questionnaires. Group comparisons were performed using Kruskal–Wallis tests, and correlations were assessed using Spearman’s rank correlation. Results: A total of 106 patients (212 eyes) were included. The trifocal IOLs were implanted in younger patients and were associated with better near and intermediate VA and higher Catquest-9SF scores, but also with higher QoV scores, indicating more dysphotopsia, and reduced CSF; the EDoF IOLs demonstrated more balanced outcomes, with improved near and intermediate VA and high Catquest-9SF scores; the monofocal IOLs showed superior CSF at 6 cpd with glare, but poorer near and intermediate uncorrected VA. Correlation analysis showed that Catquest-9SF scores were significantly associated with distance-corrected intermediate VA and with CSF at 1.5 cpd without glare. Postoperative outcomes for the three IOL types were visually summarized using a radar chart. Discussion: Radar plots facilitate an integrated understanding of overall QV for each IOL type: Trifocal IOLs were associated with higher risk of dysphotopsia but provided greater spectacle independence, which may explain their more frequent implantation in younger patients; EDOF IOLs demonstrated more balanced outcomes across optical parameters and functional QV; monofocal IOLs showed the most consistent optical performance at distance but offered limited functional independence. Conclusion: This study provides a comprehensive comparative evaluation of the main IOL types currently used for cataract surgery and presbyopia correction, highlighting distinct trade-offs between optical performance, functional vision, and PROMs and visually summarizing quality of vision across IOL types using radar plots.

Abstract Purpose: To assess long, intermediate and near uncorrected visual acuity after a tetrafocal diffractive intraocular lens implantation, presence of dystopic phenomenon and patient satisfaction after surgery. Methods: Retrospective, observational study performed in Puerta de Hierro Specialties Hospital, in Jalisco, México. That included 100 eyes after phacoemulsification surgery by femtosecond assistance, followed by tetrafocal diffractive intraocular lens implantation due to cataract. Long, intermediate and near visual acuity without correction was measured, and presence or absence of dystopic phenomenon, plus patient satisfaction after surgery. Results: A total of 100 eyes in 50 patients who underwent cataract surgery with phacoemulsification by femtosecond assistance were evaluated. 100% underwent bilateral phacoemulsification. Long, intermediate, and near visual acuity after three months was in the most patients 20/20 (46%), 20/15 (44%) and Jaeger 1 (48%) respectively. The percentage or patients who refers halos was 7%; and other associated symptoms in 18%, being astenopia the most prevalent. The removal of the lens was not required in any case. Conclusion: Tetrafocal diffractive intraocular lenses provides excellent intermediate vision (at 60 centimeters) and satisfactory near (30 centimeters) and long (6 meters) visual acuity.

ABSTRACT The term dysfunctional lens syndrome has gained acceptance in the field and encompasses natural changes due to aging of crystalline lens. The evolution of diagnostic devices has been a key factor in better staging, understanding and characterizing of these degenerative changes. Even with these technological advances and the use of subjective classifications, such as the classic Lens Opacities Classification System, an objective staging of early dysfunctional lens syndrome has yet to be established. Ocular wavefront aberrometry and objective scatter index, associated with Scheimpflug backscatter densitometry, have proven instrumental in detecting early dysfunctional lens syndrome. Staging of early dysfunctional lens syndrome has been proposed in the literature, but no classification has been recognized worldwide. The purpose of this literature review is to assess the current state of dysfunctional lens syndrome from a technological perspective and propose a new staging system to assist surgeons in making surgical decisions.

The authors conducted a review of classical and conflicting theories of accommodation and presbyopia. They make a critical comparison with the findings of magnetic resonance imaging (MRI) that have been developed in recent decades. Based on these studies, formulates a new approach on the subject, shifting the focus of the discussion of the lens to the posterior pole of the eye.

ABSTRACT Purpose: To compare visual acuity (VA), contrast sensitivity, stereopsis, and subjective visual performance of Acuvue® Oasys® for Presbyopia (AOP), Air Optix® Aqua Multifocal (AOMF), and Air Optix® Aqua Single Vision (AOSV) lenses in patients with presbyopia. Methods: A single-blinded crossover trial was conducted. Twenty patients with mild presbyopia (add ≤+1.25 D) and 22 with moderate/severe presbyopia (add ≥+1.50 D) who wore lenses bilaterally for 1 h, with a minimum overnight washout period between the use of each lens. Measurements included high- and low-contrast visual acuity (HCVA and LCVA, respectively) at a distance, contrast sensitivity (CS) at a distance, HCVA at intermediate (70 cm) and near (50 cm & 40 cm) distances, stereopsis, and subjective questionnaires regarding vision clarity, ghosting, overall vision satisfaction, and comfort. The test variables were compared among the lens types using repeated-measures ANOVA. Results: Distance variables (HCVA, LCVA, and CS) were significantly worse with multifocal lens than with AOSV lens (p≤0.008), except for AOMF lens in the mild presbyopia group in which no significant difference was observed (p>0.05). Multifocal lenses had significantly greater HCVA at 40 cm than AOSV lens (p≤0.026). AOMF lens had greater intermediate HCVA than AOP lens (p<0.03). AOP lens demonstrated greater improvements in stereopsis than AOMF and AOSV lens in the moderate/severe presbyopia group (p≤0.03). Few significant differences in subjective variables were observed, with no significant difference in the overall vision satisfaction observed between lens types (p>0.05). The proportions of patients willing to buy AOSV, AOMF, and AOP lenses were 20%, 40%, and 50%, respectively, in the mild presbyopia group and 14%, 32%, and 23%, respectively, in the moderate/severe presbyopia group; however, these differences were not statistically significant (p≥0.159). Conclusions: Further development of multifocal lenses is required before significant advantages of multifocal lenses over single vision lens are observed in patients with presbyopia.

OBJECTIVE: Investigate the average blinking time in conversation and in Video Display Terminal use of young adults and adults in the presbyopic age group. METHODS: A transversal analytical study in a readily accessible sample consisting of Volkswagen do Brasil - Curitiba, Paraná employees was performed. The cohort group consisted of 108 subjects divided into two age groups: Group 1, the young adult group (age range 20-39): 77 employees, mean age of 30.09 ± 5.09; Group 2, the presbyopic adult group, (age range 40-53): 31 employees, mean age of 44.17 ± 3. Subjects under 18 years of age, with a history of ocular disorders, contact lens wearers and computer non-users were excluded. The subjects had their faces filmed for 10 minutes in conversation and VDT reading. Student's t-test was used and the statistical significance level was 95%. RESULTS: The average time between blinks in Group 1 for conversation and VDT reading was 5.16 ± 1.83 and 10.42 ± 7.78 seconds, respectively; in Group 2. 4,9 ± 1.49 and 10.46 ± 5.54 seconds. In both age groups, the time between blinks in VDT reading situations was higher (p<0.0001). There was no statistically meaningful difference for conversation and VDT reading situations when the two studied age groups were compared (p>0.05). CONCLUSION: There was an increase in the blinking time between young adults and the presbyopic group in VDT use situations when compared with reading situations. The difference in the blinking frequency between young adults and the presbyopic group in VDT use and reading situations was not statistically significant.

ABSTRACT Purpose: To measure changes in the anterior ciliary muscle during accommodation at the nasal, superior, temporal, and inferior sectors by means of an anterior chamber optical coherence tomographer, and correlate them with vergence changes. Methods: Twenty-four subjects with healthy, phakic eyes, whose mean age was 27.1 ± 8.9 years, underwent measurement with an anterior chamber optical coherence tomographer. The anterior ciliary muscle was measured at the nasal, temporal, superior, and inferior sectors for 0, -1, -2, and -3 D of vergence. A linear model was used to assess the correlation of each eye parameter with the accommodative demand. Results: The anterior ciliary muscle area significantly increased with accommodation for each sector, with a maximum increase of about 30% for the nasal-temporal sectors and about 25% for the inferior-temporal sectors. The linear model showed a tendency toward a positive relationship between change in the ciliary muscle area of each sector and vergence. Conclusion: The anterior ciliary muscle area tends to increase with accommodation, although the increase has been shown to be symmetric between the pair sectors superior-nasal and inferior-temporal. These results may help to increase understanding of accommodation biometry and biomechanics.

Dysphotopsia affects a significant number of patients, particularly after visual correction with multifocal optical designs. Purpose Evaluate light distortion (LD) in two modalities of contact lens (CL) wear: multifocal (MF) and monofocal (MV). Methods This was a randomized, double-masked, crossover study involving 20 presbyopic patients. Patients were randomized first into either MF or MV for 15 days of use with a 1 week wash-out period between each lens type. The LD was evaluated with the Light Distortion Analyzer (LDA, University of Minho) under monocular and binocular conditions. The light distortion index (LDI, %), among other parameters were analyzed. Subjective quality of vision was assessed with the Quality of Vision (QoV). Results The LD showed an increase in all parameters in both CL modalities being significant for MV in the non-dominant eye (p &lt; 0.030, for all LD parameters). For the MF, there was also a significant increase in LDI (p = 0.016) and in BFCrad (p = 0.022) in the non-dominant eye. After 15 days of MF lens wear, there was a significant decrease in all LD parameters (p &lt; 0.002) in the dominant eye. Binocularly, a significant improvement from 1 to 15 days was observed for LDI (p = 0.009) and BFCrad (p = 0.0013) with MF. The QoV questionnaire showed no significant changes with neither CL. Conclusions. Adaptation to light disturbances induced by MF CL is more effective compared to MV. Practitioners will have greater success if they prepare their patients for the adaptation required as their vision will get better and have less of an issue with light disturbance

No contexto do envelhecimento da população, a presbiopia representa um desafio para a qualidade de vida e independência visual dos indivíduos presbitas. O principal objetivo deste estudo é o de perceber de que forma cada um dos parâmetros avaliados contribuiu, de forma individual ou em sinergia, para a variabilidade do desempenho visual normalmente observada em pacientes adaptados com LCMF. Realizou-se a avaliação em sujeitos reais com recurso a equipamentos clínicos e a ferramentas de modelação ótica que permitiram isolar variáveis como o diâmetro pupilar, centragem da lente, aberrações oculares, perfil de potência da lente utilizada e realizou-se uma avaliação subjetiva do conforto e desempenho das LCMF. Vinte e oito pacientes presbitas, com idade mediana de 53 [11] anos e uma refração em equivalente esférico de 0,44 [1,38] D para OD e 0,25 [1,56] D para OE, com foram adaptados com a lente de contacto diária multifocal AquaConfort (Alcon). A qualidade ótica foi avaliada através das aberrações oculares para uma pupila de 4 mm, com um aberrómetro baseado no princípio de Hartman-Shack. A acuidade visual foi avaliada com o optótipo ETDRS (Precision Vision) a 4 metros e a 40cm, com 100% e 10% contraste. A avaliação subjetiva foi efetuada com recurso a um questionário. Todos os sujeitos apresentaram, uma menor HCVA com as LCMF, comparativamente aos resultados de AV obtidos com lentes de prova (SRx), em condições monoculares e binoculares. O valor de HOA aumentou em relação à condição de base, sem LCMF. As diferenças avaliadas foram estatisticamente significativas. Foi possível verificar que a aberração esférica de quarta ordem, Z4 0 foi sempre mais negativa na condição com LCMF, comparativamente à condição base sem lente. A condição com LCMF apresentou um incremento na aberração comática (COMA RMS) em relação à condição base, sem LCMF, tendo sido registadas diferenças estatisticamente significativas. A lente que mais se descentrou obteve piores resultados de HCDVA. Quanto à avaliação subjetiva do desempenho da LCMF não foram encontrados valores de correlação fortes com os parâmetros de avaliação objetivos.

The strong wavelength dependency of diffractive elements casts reasonable doubts on the reliability of near-infrared- (NIR)-based clinical instruments, such as aberrometers and double-pass systems, for assessing, post-surgery, the visual quality of eyes implanted with diffractive multifocal intraocular lenses (DMIOLs). The results obtained for such patients when using NIR light can be misleading. Ordinary compensation for the refractive error bound to chromatic aberration is not enough because it only considers the best focus shift but does not take into account the distribution of light energy among the foci which strongly depends on the wavelength-dependent energy efficiency of the diffractive orders used in the DMIOL design. In this paper, we consider three commercial DMIOL designs with the far focus falling within the range of (−1, 0, +1)-diffractive orders. We prove theoretically the differences existing in the physical performance of the studied lenses when using either the design wavelength in the visible spectrum or a NIR wavelength (780 to 850 nm). Based on numerical simulation and on-bench experimental results, we show that such differences cannot be neglected and may affect all the foci of a DMIOL, including the far focus.