The Purpose is to Evaluate Visual Acuity for Distance, Intermediate and Near and Additionally Contrast Sensitivity at 25% and 10% of Illumination After Implantation of Trifocal IOL, Extended Range of Vision IOL, Bifocal IOL With Low Addition and Monofocal IOL

NCT ID: NCT07008768

Last Updated: 2025-06-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

131 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-01-01

Study Completion Date

2022-03-30

Brief Summary

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The objective of this study was to evaluate the effect of intraocular lens (IOL) selection on visual acuity and refractive outcomes, to assess the impact of IOL type on postoperative contrast sensitivity, and to investigate whether IOL choice influences the induction and dynamics of higher-order ocular aberrations following cataract surgery/refractive lens exchange surgery in hyperopic patients.

Detailed Description

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A prospective randomized interventional clinical study was conducted in its entirety at the Department of Refractive Surgery, University Eye Hospital Svjetlost, Zagreb, Croatia. Participant enrolment occurred between January 1, 2018, and October 31, 2020. Each participant was followed prospectively for a period of 12 months.

The study was designed to include 4 groups, each comprising 50 participants. Eligible participants were those aged 45 years or older and present with hyperopia ranging from +0.50 dioptres (D) to +5.00 D, and astigmatism of up to +1.00 D. Participants with refractive errors must exhibit a best-corrected visual acuity (BCVA) of ≥0.05 Logarithm of the Minimum Angle of Resolution (LogMAR). For those with cataracts, inclusion requires a BCVA of ≥0.7 LogMAR, contingent upon cataract severity. Participants with BCVA \<0.05 LogMAR were enrolled only after the exclusion of low vision, as confirmed by prior ophthalmological records.

All patients underwent a comprehensive preoperative ophthalmologic evaluation. This included slit-lamp bio microscopy of the anterior segment and dilated fundus examination. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), as well as manifest and cycloplegic refractions were recorded. Corneal tomography was performed to assess the topography of both the anterior and posterior corneal surfaces, as well as corneal thickness. Wavefront aberrometry (Luneau Visionix L80 Wave+, Visionix, Prunay-le-Gillon, France), was conducted to evaluate higher-order aberrations. Pupil size was measured under photopic, mesopic, and scotopic conditions using a pupillometer (Peramis, CSO, Italy). Specular microscopy (Perseus specular microscope, CSO, Firenze, Italy), was employed to determine corneal endothelial cell density. Additional assessments included determination of ocular dominance, evaluation of ocular motility, and assessment of tear film stability using the Schirmer test and Tear Break-Up Time (TBUT) test. Contrast sensitivity (CS) at 10% and 25% illumination was also measured.

Phacoemulsification was performed using the Infinity Vision System (Abbott Medical Optics, WhiteStar Signature Phacoemulsification System). Surgical parameters, including phaco power, vacuum level, pulse mode, oscillation, and infusion bottle height, were adjusted according to the specific phase of the procedure. All surgeries were performed by a single experienced surgeon employing a standardized micro coaxial technique. Corneal incisions measuring 2.7 mm were created along the steepest meridian; in rare cases where intraoperative challenges were encountered, the incision was extended.

Following successful completion of anterior capsulorhexis and lens phacoemulsification, a foldable intraocular lens (IOL) was implanted into the capsular bag via the main incision using the Acrijet Blue injector (VSY Biotechnology, Amsterdam, Netherlands). Residual viscoelastic material was thoroughly removed by irrigation and aspiration. All corneal incisions were self-sealing and did not require suturing. At the conclusion of the procedure, an antibiotic drop was instilled intraocularly, and antibiotic ointment was applied to the conjunctival sac. Maxitrol eyedrops (Alcon, Fort Worth, Texas), a neomycin, polymyxin B sulphates, and dexamethasone ophthalmic suspension were prescribed for application after the surgery. At first postoperative day drops were administered every hour, then four times per days in first postoperative week, and then gradually tapered for next three weeks.

Patients underwent follow-up evaluations at 1 week, 1, 6, and 12 months postoperatively. During each examination, the anterior eye segment was thoroughly assessed and documented. Uncorrected and corrected visual acuity was measured at multiple working distances (6m, 80 cm and 35 cm). Additionally, refractive status was evaluated by quantifying spherical and cylindrical corrections. Contrast sensitivity was assessed under illumination levels of 10% and 25%, and higher-order aberrations of coma and SA (spherical aberration) were measured to determine optical quality.

Data from treated eyes were analysed. Details of visual acuities, sphere and cylinder refraction, contrast sensitivity at 10% and 25% illumination, and higher-order aberrations were recorded and stored on Excel spreadsheets (Microsoft, Redmond, WA) during the monitoring of the subjects. Descriptive statistics, including minimum and maximum values, means, standard deviations, medians, and interquartile ranges, were used for preliminary variable characterization by groups. Prior to inferential analyses, the Kolmogorov-Smirnov test was applied to assess the normality of variable distributions, which is a prerequisite for parametric tests such as ANOVA and the t-test. As the Kolmogorov-Smirnov test indicated non-normal distribution for the variables, nonparametric statistical methods were employed throughout subsequent analyses. Specifically, the Friedman test was utilized to evaluate differences across multiple measurement time points within groups. When the Friedman test revealed statistically significant differences, pairwise comparisons were conducted using the Wilcoxon signed-rank test to identify specific time points exhibiting significant changes. For comparisons between the two independent groups-patients implanted with a new generation multifocal intraocular lens and those receiving a monofocal lens implant-the Mann-Whitney U test was applied. All statistical tests were performed at a significance level of 0.05 (95% confidence interval).

Conditions

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Cataract Presbyopia Correction Visual Acuity

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

NONE

Study Groups

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Group 3 - BIFOCAL IOL

The total number of patients who underwent cataract surgery or refractive lens exchange surgery with bifocal IOL with low addition implantation was thirty-four of the mean (±sd; range) age 59.94 (±9.1, 45-71).

Group Type EXPERIMENTAL

Cataract surgery and refractive lens exchange surgery

Intervention Type PROCEDURE

Cataract surgery or refractive lens exchange surgery was performed with standard phacoemulsification procedure using micro coaxial surgical technique. After superior clear corneal incision, anterior capsulorexis and lens phacoemulsification, the IOL was implanted into the capsular bag using an injector in all cases. Ophthalmic Viscosurgical Device (OVD) was completely removed by irrigation and aspiration. All incisions were self-closing.

BIFOCAL IOL

Intervention Type DEVICE

1-piece aspheric hydrophobic presbyopia-correcting intraocular lens, bifocal with low addition

Group 4 - MONOFOCAL IOL

The total number of patients who underwent cataract surgery or refractive lens exchange surgery with monofocal IOL implantation was thirty-two of the mean (±sd; range) age 61.33 (±8.7, 45-74), were recruited as controls.

Group Type ACTIVE_COMPARATOR

Cataract surgery and refractive lens exchange surgery

Intervention Type PROCEDURE

Cataract surgery or refractive lens exchange surgery was performed with standard phacoemulsification procedure using micro coaxial surgical technique. After superior clear corneal incision, anterior capsulorexis and lens phacoemulsification, the IOL was implanted into the capsular bag using an injector in all cases. Ophthalmic Viscosurgical Device (OVD) was completely removed by irrigation and aspiration. All incisions were self-closing.

MONOFOCAL IOL

Intervention Type DEVICE

Control lens: 1-piece aspheric hydrophobic monofocal aspheric IOL

Group 1 - TRIFOCAL IOL

The total number of patients who underwent cataract surgery or refractive lens exchange surgery with trifocal IOL implantation was thirty of the mean (±sd; range) age 57.23 (±6.1, 45-69).

Group Type EXPERIMENTAL

Cataract surgery and refractive lens exchange surgery

Intervention Type PROCEDURE

Cataract surgery or refractive lens exchange surgery was performed with standard phacoemulsification procedure using micro coaxial surgical technique. After superior clear corneal incision, anterior capsulorexis and lens phacoemulsification, the IOL was implanted into the capsular bag using an injector in all cases. Ophthalmic Viscosurgical Device (OVD) was completely removed by irrigation and aspiration. All incisions were self-closing.

TRIFOCAL IOL

Intervention Type DEVICE

1-piece aspheric hydrophobic presbyopia-correcting intraocular lens, trifocal

Group 2 - EROV

The total number of patients who underwent cataract surgery or refractive lens exchange surgery with extended range of vision IOL implantation was thirty-five of the mean (±sd; range) age 59.12 (±5.4, 45-71).

Group Type EXPERIMENTAL

Cataract surgery and refractive lens exchange surgery

Intervention Type PROCEDURE

Cataract surgery or refractive lens exchange surgery was performed with standard phacoemulsification procedure using micro coaxial surgical technique. After superior clear corneal incision, anterior capsulorexis and lens phacoemulsification, the IOL was implanted into the capsular bag using an injector in all cases. Ophthalmic Viscosurgical Device (OVD) was completely removed by irrigation and aspiration. All incisions were self-closing.

EROV IOL

Intervention Type DEVICE

1-piece aspheric hydrophobic presbyopia-correcting intraocular lens, extended range of vision (EROV)

Interventions

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Cataract surgery and refractive lens exchange surgery

Cataract surgery or refractive lens exchange surgery was performed with standard phacoemulsification procedure using micro coaxial surgical technique. After superior clear corneal incision, anterior capsulorexis and lens phacoemulsification, the IOL was implanted into the capsular bag using an injector in all cases. Ophthalmic Viscosurgical Device (OVD) was completely removed by irrigation and aspiration. All incisions were self-closing.

Intervention Type PROCEDURE

TRIFOCAL IOL

1-piece aspheric hydrophobic presbyopia-correcting intraocular lens, trifocal

Intervention Type DEVICE

EROV IOL

1-piece aspheric hydrophobic presbyopia-correcting intraocular lens, extended range of vision (EROV)

Intervention Type DEVICE

BIFOCAL IOL

1-piece aspheric hydrophobic presbyopia-correcting intraocular lens, bifocal with low addition

Intervention Type DEVICE

MONOFOCAL IOL

Control lens: 1-piece aspheric hydrophobic monofocal aspheric IOL

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Age of ≥ 45 years
* Hyperopic correction ranging from +0.50 D to +5.00 D, and astigmatism of up to +1.00 D
* Best corrected visual acuity of ≥0.05 LogMAR

Exclusion Criteria

* Previously performed eye surgical procedures or eye injuries
* Glaucoma
* Fuchs' endothelial dystrophy or other corneal diseases (corneal degeneration and dystrophy)
* Zonular weakness or subluxated lens
* Systemic autoimmune and rheumatic disease
* Insulin dependent diabetes
Minimum Eligible Age

45 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University Eye Hospital Svjetlost

OTHER

Sponsor Role lead

Responsible Party

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Mateja Jagic

MD, Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Univestity Eye Hospital Svjetlost

Zagreb, , Croatia

Site Status

Countries

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Croatia

Other Identifiers

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KS001-2018

Identifier Type: -

Identifier Source: org_study_id

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