Pairing Trifocal IOLs With Complementary Light Distributions: Visual Outcomes and Patient Satisfaction with Vivinex Gemetric IOLs

Spectacle independence is the common goal for a growing number of patients presenting for cataract surgery, and today people spend more than 40% of their time on near tasks.¹ Spectacle independence therefore requires high-quality vision from far to near distances, and trifocal IOLs remain the most consistent technology available for providing such spectacle independence.

This randomized multicenter clinical study² investigated whether the contralateral pairing of two trifocal IOLs with the same add powers, but with complementary light distributions (the Vivinex Gemetric and Vivinex Gemetric Plus from HOYA Surgical Optics), enables patients to achieve the widest range of high-quality vision.

STUDY DESIGN

The study included 124 patients across 10 European centers (eight in Germany and two in Spain) with the aim of determining the rates of spectacle independence after cataract surgery following implantation of Vivinex Gemetric (G-G) bilaterally (n = 36), Vivinex Gemetric Plus (GP-GP) bilaterally (n = 52), and “paired” Vivinex Gemetric/ Vivinex Gemetric Plus (G-GP) contralaterally (n = 36). Eye dominance was not considered in the paired G-GP group given that the difference between the lenses is very nuanced.

Two-thirds of all eyes received a toric IOL (1.0 D to 3.0 D of cylinder at IOL plane) to achieve a predicted residual postoperative refractive cylinder of 0.50 D or less to minimize the need for spectacles after surgery.

RESULTS

At the 4-to-6-month follow-up, 124 patients were available, 69 of which had a toric IOL in both eyes and 28 of which had bilateral non-toric IOLs.

Monocular refraction and visual acuity

Both the toric and non-toric G and GP provided patients with excellent distance, intermediate, and near visual acuity, and 84% were within a spherical equivalent of ±0 50 D.

Distance-corrected visual acuity was excellent with both the G and GP IOLs. There was, however, variance in the intermediate and near distance-corrected monocular visual acuity achieved between eyes implanted with the G and GP lenses (Figure 1).

Residual astigmatism

Postoperatively, 96% and 91% of non-toric and toric patients, respectively, had less than 0.50 D of residual astigmatism. All eyes were within 1.00 D of astigmatism.

Binocular Visual acuity under photopic and mesopic conditions

A difference in visual acuity following implantation of the bilateral G-G, bilateral GP-GP, and the paired G-GP groups was seen in the distance visual acuity outcomes. The bilateral G-G and the paired G-GP groups outperformed the bilateral GP-GP group in this regard.

In the intermediate vision range, bilateral G-G achieved the best results, with the paired G-GP group performing similarly well. In the near vision range, the paired G-GP and the bilateral GP-GP groups achieved better results than the bilateral G-G group (Figure 2).

Binocular Defocus curve

Pairing Vivinex Gemetric and Vivinex Gemetric Plus achieves similar outcomes at far distance to the bilateral G-G group and similar outcomes at near distance to the bilateral GP-GP group. The bilateral G-G group appears to have an advantage in the intermediate range, with the paired G-GP group a close second (Figure 3).

Patient satisfaction

Across all groups, more than 95% of patients were satisfied with the visual quality in both photopic and mesopic conditions, and 98% stated they would select the lens again. Patients rated visual disturbances as very low for both frequency and severity. The highest subjective score was achieved in the paired G-GP group, with over 90% of patients reporting being completely spectacle independent at far, intermediate, and near distances.

CONCLUSION

We can conclude from the binocular visual acuity data and the bilateral defocus curves that both bilateral Vivinex Gemetric IOL implantation and paired Vivinex Gemetric and Vivinex Gemetric Plus groups are solid choices regarding overall visual outcomes in terms of quality and range achieved, while the paired Vivinex Gemetric and Vivinex Gemetric Plus group achieved the broadest range of high-quality vision from far to very close near distances.