†These authors contributed equally.
Academic Editor: Shikun He
Background: To compare clinical outcomes and subjective experience after bilateral implantation of two diffractive trifocal and one monofocal intraocular lenses (IOLs). Methods: Fourty-eight patients received bilateral implantation of the RayOne Trifocal IOL (Rayner), the AcrySof IQ PanOptix IOL (Alcon), or the AcrySof IQ SN60WF IOL (Alcon). At 1-month, 3-month, and 12-month follow-up visits, the tested outcomes were monocular and binocular uncorrected and corrected distance, intermediate at 70 cm, and near at 30 cm visual acuities, subjective refractive outcomes, defocus curves, contrast sensitivity and ocular aberrometry. Subjective patient satisfaction in terms of visual disturbance and spectacle independence was also evaluated. Results: Each group comprised 32 eyes (16 patients). Refractive outcomes of RayOne and PanOptix IOLs were comparable. Both trifocal IOLs demonstrated superior visual acuity to the AcrySof monofocal IOL at near and intermediate ranges and along the defocus curves at all points other than at 0.0 D. The patient satisfaction results were comparable between the RayOne and PanOptix trifocal IOL groups. Conclusions: Both trifocals performed similarly providing good visual outcomes at all distances, demonstrating superior visual acuity compared to the monofocal IOL. Patients implanted with these trifocal IOLs reported similar levels of quality of vision and satisfaction. The RayOne trifocal and PanOptix IOLs are a valuable alternative for patients wishing to seek spectacle independence and low visual disturbances when undergoing cataract surgery.
Current available cataract surgery technologies not only improve vision but also help to enhance the patient’s quality of life. Intraocular lenses (IOLs) play a key role in achieving the desired visual outcomes after surgery. Modern IOLs are available in a variety of materials, design, and optic features which can influence their visual performance [1].
Multifocal IOLs (MIOLs) are designed to distribute light to different foci dedicated to different distances and are designed to have either refractive or diffractive optics. In the past, conventional bifocal diffractive optics worked by splitting light using steps on the optic surface to create two principal focal points, thus providing good functional vision at distance and near [2]. Nevertheless, with bifocal IOLs the intermediate vision was compromised, thus making it difficult to perform some daily activities such as using a computer or seeing a car dashboard [1, 3] without wearing spectacles [4]. In addition, bifocal IOLs were associated with some visual disturbances (e.g., glare and halos) and reduction of contrast sensitivity [4, 5].
The types of MIOLs available have undergone refinement in recent years with the attempt to offer excellent vision at far, intermediate and near distances while providing a low incidence of photic phenomena and high patient satisfaction. A new generation of multifocal lenses (trifocal IOLs) have been commercially available since 2010 [6]. These new types of lenses incorporate a third focal point to help improve intermediate vision while maintaining performance at distance and near [6, 7, 8, 9, 10]. With these newer trifocal IOLs, the freedom from wearing spectacles for seeing at intermediate distance helps to improve the patient’s quality of life. However, the introduction of a third focal point might still have some drawbacks, such as dysphotopic phenomena such as halo and glare experienced under mesopic lighting conditions and reduced night vision. Moreover, splitting the light energy at three foci points (distance, intermediate, and near) may cause an increase in light loss, which may reduce the contrast sensitivity under certain lighting conditions.
At present, different types of trifocal IOLs are available, with different haptic, material and optical designs, all attempting to offer optimal vision while ensuring a low incidence of photic phenomena and high patient satisfaction.
The AcrySof IQ PanOptix (Alcon Laboratories, Fort Worth, TX, USA) which we will refer to as PanOptix hereafter, is a 1-piece aspheric hydrophobic presbyopia-correcting IOL launched in 2015. The non-apodized PanOptix IOL uses the ENhanced LIGHT ENergy (ENLIGHTEN; Alcon Laboratories, Fort Worth, TX) optical technology that provides high (88%) utilization of light energy, low dependence on pupil size in all lighting conditions, and a comfortable near-to-intermediate range of vision than traditional bifocal IOLs [11]. The outcomes obtained with this lens in cataracts patients were demonstrated in non-comparative [9, 12, 13, 14] and comparative studies versus other new trifocal IOLs such as the Finevision IOL (PhysIOL; Liège, Belgium) [15, 16].
The RayOne Trifocal (Rayner, Worthing, UK) which we will refer to as RayOne T hereafter, is a newer addition to the MIOL family. It is a 1-piece aspheric hydrophilic IOL that was launched in 2017. It is designed with fewer diffractive rings on the optical surface than other currently used trifocal IOLs in order to reduce visual disturbances. RayOne T is designed to reduce light loss to only 11% compared to 12–14% with other available trifocal lenses. The light distribution is 52% to distance, 22% to intermediate and 26% to near, thus allowing a smooth transition from near to intermediate and distance vision [10]. The RayOne T has been objectively compared to the FineVision POD F and discussed in reviews along with other trifocal IOLs, such as the Sulcoflex Trifocal IOL [10, 17].
The purpose of this study was to evaluate the postoperative visual and refractive outcomes, satisfaction and spectacle independence in patients whom underwent bilateral cataract surgery implanted with the RayOne T or PanOptix. Since the two trifocal IOLs have different physical features and properties, we wanted to investigate whether the new RayOne T provides comparable results to the PanOptix, for which excellent outcomes have already been published [9, 12, 13, 14, 15, 16]. In addition, a monofocal IOL, the AcrySof IQ Monofocal SN60WF (Alcon Laboratories, Fort Worth, Tex., USA) which we will refer to as AcrySof monofocal hereafter, was also included into the study and used as a control for contrast sensitivity and ocular aberrometry.
This prospective, non-randomized case-series study was performed at the San Marino State Hospital (Republic of San Marino). The study was conducted in accordance with the tenets of the Declaration of Helsinki, and the Institutional review board approval was obtained from the Hospital medico-legal committee prior to study commencement. All patients were fully informed on the surgical procedure and any vision concerns after IOL implantation were addressed, they were required to provide written consent for their surgical procedure and for allowing use of anonymized medical records for investigation purposes.
Patients presenting with bilateral cataract were scheduled for routine phacoemulsification cataract surgery, receiving one of the following IOLs: RayOne T, PanOptix, or the AcrySof monofocal. Patients were included into the study if they were aged 18 years or older, if they had bilateral cataract limiting visual acuity, corneal astigmatism of 0.75 D or less, and regular corneal tomography.
Exclusion criteria included previous ocular surgery (including refractive surgery), regular corneal astigmatism greater than 0.75 D, irregular astigmatism, large angle kappa and other optical or systemic conditions affecting visual acuity (such as macular disease, amblyopia, infection, ocular trauma, etc.), or anomalies of the lens capsule or zonules which could affect postoperative centration or tilt of the IOL (such as pseudoexfoliation syndrome).
The RayOne Trifocal (Rayner, Worthing, UK) is a one-piece hydrophilic aspheric lens that has an overall diameter of 12.5 mm. The optic has a diameter of 6.0 mm. The diffractive region covers the central 4.5 mm of the optic and thereafter the zone provides monocular distance vision. RayOne Trifocal (model RA0603F) has a patented diffractive profile with 16 rings on the optic surface for reduced potential visual disturbances and improved night vision. The haptic, which has an angulation of 0 degrees, consists of a closed loop with anti-vaulting haptic (AVH) technology that ensures rotational and centrational stability. The powers are available from 0.00 to +30.00 D, in 0.50 D increments. The addition powers are +3.5 D for near and +1.75 D for intermediate vision [10]. The IOL is preloaded in the RayOne injector system (Rayner, UK) across the entire power range and allows implantation through a 2.2 mm incision. This injector has a syringe-style design to aid a single-handed IOL delivery technique.
The AcrySof IQ PanOptix (Alcon Laboratories Inc., Fort Wort, TX, USA) is a panfocal IOL with quadrifocal technology. The IOL is a single piece made from hydrophobic acrylic with a 6.0 mm optic, 2 open-loop haptics, and an overall diameter of 13.0 mm. The IOL incorporates an ultraviolet and blue light–filter. The optic diffractive structure is in the central 4.5 mm of the anterior surface with power additions of +2.17 D for intermediate and +3.25 D for near [9, 11].
The AcrySof IQ monofocal IOL (Alcon Laboratories Inc) model SN60WF is a single-piece IOL with proprietary blue light filtering chromophores that filter light in a manner that approximates the crystalline lens in the 400–475 nm blue light wavelength range. The lens is made from a high refractive index soft acrylate/methacrylate copolymer and its configuration is anterior asymmetric biconvex. The posterior aspheric surface is designed with negative spherical aberration to compensate for the positive spherical aberration of an average cornea [18].
More technical specifications of the three IOLs are summarized in Table 1.
Parameter | RayOne trifocal | AcrySof IQ PanOptix | AcrySof IQ SN60WF |
Material | Single piece Rayacril® hydrophilic acrylic | Acrylate, Methacrylate Copolymer | UV and blue filtering Acrylate, Methacrylate Copolymer |
Optical design | Diffractive | Diffractive-refractive hybrid | Refractive |
Optical diameter | 6.0 mm | 6.0 mm | 6.0 mm |
Diffractive zone | Central 4.5 mm zone (with 16 rings) | 4.5 mm | - |
Overall diameter | 12.50 mm | 13.0 mm | 13.0 mm |
Optic | Biconvex, aberration-neutral technology, with Amon-Apple 360° enhanced square edge | Biconvex (inner diffractive and outer refractive) | Biconvex, Aspheric |
Haptic Style: | Closed loop with anti-vaulting haptic (AVH) technology | 2 open-loop haptics | STABLEFORCE® Haptics |
Estimated A-constant (SRK/T, optical biometry) | 118.6 | 118.95 | 118.7 |
Incision size | 1.65 mm nozzle for sub 2.2 mm incision | ||
IOL, intraocular lens; D, diopters. The RayOne Trifocal intraocular lens is manufactured by Rayner, UK; the two AcrySof IQ intraocular lenses is manufactured by Alcon Laboratories, Fort Worth, TX. |
All surgeries were performed by the same experienced surgeon (AM) using topical anaesthesia. A standard technique of sutureless microincision phacoemulsification was performed for the implantation of the RayOne T, PanOptix, and Acrysof monofocal IOLs; 2.4 mm corneal incision was placed in temporal side, the capsulorhexis diameter was 5.2 mm and the IOL was implanted in the capsular bag. The IOL centering and capsulorhexis size were performed with the assistance of an intraoperative digital system (Verion Image Guided System, Alcon Laboratories, Inc., Fort Worth, TX). No intraoperative complications occurred at any level during all surgeries.
Preoperative assessments consisted of a full ophthalmologic examination for ocular morbidities, visual acuity, manifest refraction, and slit-lamp examination.
After surgery and at all follow-up visits, any visible decentration and tilt
were assessed and documented. Postoperative complications were also assessed and
documented. In addition to routine checks immediately after surgery,
postoperative examinations were performed 1 month, 3 months, and 12 months after
surgery. Postoperative follow-ups included assessments of the monocular and
binocular uncorrected and corrected visual acuity at far (4 m), intermediate (70
cm), and near vision (30 cm). Distance visual acuity was assessed using the MOS
22 optotype (Dueffe Tecnovision, Pergine Valsugana, Italy) and was measured in
LogMAR. Near and intermediate visual acuities were assessed using the MNREAD
Acuity Chart (Precision Vision, LaSelle, IL). Subjective refraction was assessed
only at the final follow-up visit and was performed using sphere, cylinder, and
manifest residual spherical equivalent (MRSE) notations. The binocular defocus
curves were evaluated under photopic conditions (85 candelas/m
The calculation of the required sample size was based on the monocular uncorrected distance visual acuity (UDVA). Based on previous data analyses for a similar study [20], a difference of 0.1 logMAR units was assumed to be clinically significant and considered a standard deviation of 0.05 logMAR. Based on this assumption, it was calculated that for an alpha value of 0.05 and power of 0.80, 30 eyes were required in each group.
Statistical analysis was carried out with Excel Version 14.0.0 for Mac
(Microsoft Corporation, Redmond, WA). Data from the three study groups were first
compared together using a repeated-measures ANOVA. If significant differences
were found, the groups were compared two at a time using the Student t
test for independent samples for parametric data and the Mann-Whitney test for
non-parametric data. A Welch test was used to compare two groups at a time in
some items in the patient questionnaire. Categorical data was evaluated using the
Fisher’s Exact test for small samples. Differences were considered to be
statistically significant if p
A total of 48 patients (96 eyes) with bilateral IOL implantation were included
into the study. Each IOL group comprised 32 eyes of 16 patients. Patients’ mean
age was 69.7
All patients had uneventful cataract surgery in both eyes and completed the 12-month follow-up. The intraocular lenses were well centered in all eyes and remained stable over time. No further surgical intervention was required after surgery.
Compared to the preoperative values, significant improvements in the residual
manifest sphere values over time were observed for each of the three IOLs (Time
effect F(1,47) = 15.21, p
The cylinder did not statistically differ among the three IOL groups over time
(Interaction effect, F(2,45) = 0.07, p = 0.9358), nor at each time visit
(Group effect, F(2,47) = 0.37, p = 0.6919). Overall, the
cylinder values remained stable over time for each group (Time effect F(1,47) =
1.73, p = 0.1949), with a mean cylinder value at 12-month follow-up of
–0.11
Postoperative refractive accuracy as measured at the 12-month follow-up visit. (A) Postoperative refractive cylinder; (B) Manifest spherical equivalent refraction (MRSE) accuracy. There were no significant differences among the three groups during the follow-up.
Compared to the preoperative values, a significant improvement in the
postoperative residual manifest spherical equivalent over time was observed for
each of the three IOLs (Time effect F (1,47) = 13.6, p
All postoperative monocular uncorrected and corrected visual outcomes calculated
at 1, 3, and 12 months after surgery are shown in Table 2, and all postoperative
binocular uncorrected and corrected visual outcomes are shown in Table 3. A
statistically significant difference was found in monocular and binocular
uncorrected distance visual acuity (UDVA) among the three IOL groups at each
follow-up visit (Group effect, F (2,141) = 4.05, p = 0.024; Group
effect, F (2,69) = 7.58, p = 0.003 for monocular and binocular UDVA,
respectively), with the RayOne T IOL leading to better improvement in distance
visual acuity compared to the other two IOLs (p
1 month | 3 months | 12 months | ||||||||
Parameter | RayOne T | PanOptix | SN60WF | RayOne T | PanOptix | SN60WF | RayOne T | PanOptix | SN60WF | |
UDVA | ||||||||||
Mean |
0.03 |
0.04 |
0.08 |
0.01 |
0.03 |
0.05 |
–0.01 |
0.01 |
0.04 | |
Range | 0.00, 0.10 | 0.00, 0.10 | 0.00, 0.20 | –0.10, 0.10 | 0.00, 0.10 | 0.00, 0.10 | –0.10, 0.10 | –0.10, 0.10 | 0.00, 0.10 | |
DCVA | ||||||||||
Mean |
0.00 |
0.00 |
0.00 |
–0.01 |
0.00 |
0.00 |
–0.02 |
0.00 |
0.00 | |
Range | 0.00, 0.00 | 0.00, 0.00 | 0.00, 0.00 | –0.10, 0.00 | 0.00, 0.00 | 0.00, 0.00 | –0.10, 0.10 | 0.00, 0.00 | 0.00, 0.00 | |
UIVA | ||||||||||
Mean |
0.19 |
0.19 |
0.68 |
0.10 |
0.14 |
0.66 |
0.06 |
0.09 |
0.56 | |
Range | 0.10, 0.30 | 0.10, 0.30 | 0.60, 0.80 | 0.10, 0.20 | 0.10, 0.30 | 0.60, 0.80 | 0.00, 0.10 | 0.00, 0.20 | 0.50, 0.60 | |
DCIVA | ||||||||||
Mean |
0.08 |
0.09 |
0.10 |
0.08 |
0.10 |
0.08 |
0.03 |
0.06 |
0.05 | |
Range | 0.00, 0.20 | 0.00, 0.20 | 0.00, 0.20 | 0.00, 0.10 | 0.00, 0.20 | 0.00, 0.10 | 0.00, 0.10 | 0.00, 0.20 | 0.00, 0.10 | |
UNVA | ||||||||||
Mean |
0.09 |
0.11 |
0.69 |
0.04 |
0.07 |
0.65 |
0.03 |
0.04 |
0.58 | |
Range | 0.00, 0.20 | 0.00, 0.20 | 0.50, 0.80 | 0.00, 0.10 | 0.00, 0.10 | 0.50, 0.80 | 0.00, 0.10 | 0.00, 0.10 | 0.40, 0.70 | |
DCNVA | ||||||||||
Mean |
0.00 |
0.00 |
0.00 |
0.00 |
0.01 |
0.00 |
0.00 |
0.00 |
0.00 | |
Range | 0.00, 0.00 | 0.00, 0.00 | 0.00, 0.00 | 0.00, 0.00 | 0.00, 0.10 | 0.00, 0.00 | 0.00, 0.00 | 0.00, 0.00 | 0.00, 0.00 | |
*: p |
1 month | 3 months | 12 months | ||||||||
Parameter | RayOne T | PanOptix | SN60WF | RayOne T | PanOptix | SN60WF | RayOne T | PanOptix | SN60WF | |
UDVA | ||||||||||
Mean |
0.01 |
0.03 |
0.05 |
–0.03 |
–0.01 |
0.03 |
–0.04 |
–0.03 |
0.01 | |
Range | 0.00, 0.00 | 0.00, 0.10 | 0.00, 0.10 | –0.10, 0.00 | –0.10, 0.00 | –0.01, 0.10 | –0.10, 0.10 | –0.10, 0.00 | –0.10, 0.10 | |
DCVA | ||||||||||
Mean |
0.00 |
0.00 |
0.00 |
–0.04 |
–0.01 |
0.00 |
–0.05 |
–0.01 |
–0.03 | |
Range | 0.00, 0.00 | 0.00, 0.00 | 0.00, 0.00 | –0.10, 0.00 | –0.10, 0.00 | 0.00, 0.00 | –0.10, 0.00 | –0.10, 0.00 | –0.10, 0.00 | |
UIVA | ||||||||||
Mean |
0.09 |
0.1 |
0.63 |
0.04 |
0.03 |
0.61 |
0.02 |
0.02 |
0.56 | |
Range | 0.00, 0.10 | 0.00, 0.20 | 0.60, 0.70 | –0.10, 0.10 | –0.10, 0.10 | 0.60, 0.70 | –0.10, 0.10 | –0.10, 0.10 | 0.50, 0.60 | |
DCIVA | ||||||||||
Mean |
0.00 |
0.03 |
0.05 |
–0.01 |
0.01 |
0.03 |
0.00 |
0.01 |
0.01 | |
Range | 0.00, 0.00 | 0.00, 0.10 | 0.00, 0.10 | –0.10, 0.00 | –0.10, 0.10 | 0.00, 0.10 | –0.10, 0.10 | –0.10, 0.10 | 0.00, 0.10 | |
UNVA | ||||||||||
Mean |
0.06 |
0.06 |
0.65 |
–0.01 |
0.01 |
0.61 |
–0.03 |
–0.01 |
0.54 | |
Range | 0.00, 0.10 | 0.00, 0.10 | 0.60, 0.70 | –0.10, 0.00 | –0.10, 0.10 | –0.10, 0.00 | –0.10, 0.00 | –0.00, 0.00 | 0.40, 0.60 | |
DCNVA | ||||||||||
Mean |
0.00 |
0.00 |
0.00 |
–0.03 |
–0.01 |
–0.01 |
–0.05 |
–0.01 |
–0.03 | |
Range | 0.00, 0.00 | 0.00, 0.00 | 0.00, 0.00 | –0.10, 0.00 | –0.10, 0.00 | –0.10, 0.00 | –0.10, 0.00 | –0.10, 0.00 | –0.10, 0.00 | |
*: p |
Fig. 2A, shows the cumulative distribution of monocular UDVA and DCVA for the three IOLs. The UDVA was 20/20 or better (logMAR equivalent 0.0 or better) in 63% of eyes in the AcrySof monofocal group, in 75% of eyes in the PanOptix group, and in 100% of eyes in the RayOne T group. All eyes treated with each of the tested IOLs achieved a DCVA of 20/25 or better (logMAR equivalent 0.1 or better).
Cumulative distribution of post-operative monocular visual acuity for distance, intermediate and near as measured at the 12-month follow-up visit. RayOne T and PanOptix performed better in uncorrected intermediate and near visual acuity compared to AcrySof monofocal. (A) UDVA and DCVA. (B) UIVA and DCIVA. (C) UNVA and DCNVA.
Improvements in monocular and binocular uncorrected intermediate visual acuity
(UIVA) significantly varied among the three IOL groups at each follow-up visit
(Interaction effect, F (6,135) = 105.51, p
A statistically significant difference was found in monocular and binocular
uncorrected near visual acuity (UNVA) among the three IOL groups at each
follow-up visit (Interaction effect, F (6,135) = 81.42, p
Defocus curves for the three treatment groups at 1 month, 3 months, and 12 months postoperative are depicted in Fig. 3. At each evaluation, peak visual acuity occurred in all three groups at 0.0 D, at which point there were no differences in visual acuity among the three treatment groups. With a couple of exceptions, both the RayOne T and the PanOptix groups had significantly better visual acuity than the AcrySof monofocal group at every other defocus interval at every postoperative examination. The exceptions were: at 1 month postoperative, the RayOne T and AcrySof monofocal groups were not significantly different at –0.5 D (p = 0.097); and at 12 months postoperative, the RayOne T and AcrySof monofocal groups were not significantly different at –0.5 D (p = 0.089) and the PanOptix and AcrySof monofocal groups were not significantly different at +1.0 D (p = 0.061). There were no significant differences between the RayOne T and the PanOptix groups at any defocus interval.
Binocular defocus curves under photopic conditions after cataract surgery. The defocus curves did not significantly change at (A) 1 month, (B) 3 months, (C) 12 months of follow-up.
Photopic and mesopic contrast sensitivity graphs (measured in log contrast
threshold) for the three treatment groups at 1 month, 3 months, and 12 months
after surgery are depicted in Fig. 4. Under both photopic and mesopic conditions,
all three treatment groups peaked in contrast sensitivity at 3 cycles per degree
of visual angle at all three postoperative timepoints. Likewise, under both
photopic and mesopic condition and in all three postoperative evaluations,
contrast sensitivity was significantly higher for the AcrySof monofocal group
than either the RayOne T or the PanOptix groups at every level in the range
tested (p
Results of contrast sensitivity under photopic and mesopic conditions during the follow-up after cataract surgery. Contrast sensitivity under photopic conditions did not significantly change at (A) 1 month, (B) 3 months, (C) 12 months as well as under mesopic conditions at (D) 1 month, (E) 3 months, and (F) 12 months.
Aberrometric examination was performed after surgery with the CSO aberrometer
(OSIRIS) to evaluate Low order (LOA) and High Order (HOA) aberrations. Ocular,
corneal and internal aberrations were assessed at 12 months after surgery in the
three groups at full pupillary diameter. Full results are described in Table 4.
Aberrometric data points were quantified in root mean square (RMS) values in
micrometers (
RayOne T | PanOptix | SN60WF | |||||
Aberrations | Mean RMS Value (µm) | St Dev | Mean RMS Value (µm) | St Dev | Mean RMS Value (µm) | St Dev | |
Ocular | Total | 0.538 | 0.254 | 0.543 | 0.184 | 0.453 | 0.198 |
LOA | 0.462 | 0.239 | 0.491 | 0.175 | 0.408 | 0.181 | |
HOA | 0.141 | 0.043 | 0.187 | 0.103 | 0.157 | 0.068 | |
Corneal | Total | 0.226 | 0.111 | 0.246 | 0.061 | 0.243 | 0.066 |
LOA | 0.162 | 0.112 | 0.188 | 0.059 | 0.181 | 0.098 | |
HOA | 0.145 | 0.057 | 0.146 | 0.058 | 0.154 | 0.062 | |
Internal | Total | 0.490 | 0.270 | 0.539 | 0.242 | 0.426 | 0.205 |
LOA | 0.438 | 0.272 | 0.471 | 0.183 | 0.348 | 0.170 | |
HOA | 0.145 | 0.049 | 0.176 | 0.076 | 0.147 | 0.060 | |
LOA: Defocus | –0.451 | 0.295 | –0.422 | 0.216 | –0.287 | 0.269 | |
LOA: Astigmatism | 0.196 | 0.090 | 0.165 | 0.110 | 0.147 | 0.045 | |
HOA: Primary Coma | 0.058 | 0.033 | 0.071 | 0.059 | 0.085 | 0.049 | |
HOA: Trefoil | 0.071 | 0.038 | 0.094 | 0.061 | 0.128 | 0.107 | |
HOA: Primary Spherical Aberration | –0.004 | 0.049 | 0.013 | 0.032 | 0.014 | 0.036 | |
Pupil Diameter (mm) | 3.486 | 0.499 | 3.739 | 0.598 | 3.808 | 0.878 |
Ocular, corneal and internal aberrations at the 12-month follow-up visit. Low order (LOA) and High Order (HOA) aberrations are reported for each IOL.
In the RayOne T group, mean full pupillary diameter was 3.486
In the PanOptix group, mean full pupillary diameter was 3.739
In the AcrySof monofocal group, mean full pupillary diameter was 3.808
The aberrometric values were similar in the three groups. The total ocular and
internal aberrations showed lower values in the Acrysof Monofocal group compared
to the PanOptix and RayOne T groups, as well as the total ocular and internal LOA
values. No statistically significant differences were identified between the
three groups regarding total ocular and internal HOA values (p
At the 12-month follow up, all patients implanted with either the RayOne T or the PanOptix IOLs rated all items on the NEI RQL-42 Questionnaire highly (Fig. 6). All of these patients gave a score of 100 (corresponding to complete satisfaction) in the following categories: clarity of vision; diurnal fluctuations; activity limitations; worry about eyesight; appearance of their eyes; dependence on corrective lenses; problems with suboptimal correction; how well their expectations were met; and overall satisfaction with their correction. Patients in the RayOne T group gave a mean score of 100 for near vision satisfaction, and those in the PanOptix group gave a mean score of 96.88 (range: 93.75–100); the mean score given for distance vision satisfaction in the RayOne T group was 95.62 (range: 88.33–100), and was 92.08 (range: 78.33–100) in the PanOptix group. When scoring on dysphotopic phenomena, patients in the RayOne T and PanOptix groups scored 92.23 (range: 70.83–100) and 84.38 (range: 37.5–100) for glare respectively. Additionally they gave a score of 100 and 91.52 (range: 71.42–100) for other optical symptoms, respectively. There were no significant differences in the responses to any of the questions between the RayOne T and PanOptix groups.
Results of the NEI RQL — 42 questionnaire on the visual QoL outcomes obtained at 12 months after cataract surgery.
The goal of this study was to analyse and compare the clinical performance and subjective outcomes after the bilateral implantation of the RayOne Trifocal or the AcrySof IQ PanOptix intraocular lenses. In addition, the AcrySof IQ Monofocal SN60WF was also included into the study, in particular for the comparison of the performance in terms of contrast sensitivity and ocular aberrometry.
Recently, the RayOne Trifocal IOL has been objectively compared to the AcrySof IQ PanOptix trifocal IOLs [20]. This study compared the RayOne Trifocal to the AcrySof IQ PanOptix with a 12 months follow-up, adding new informations such as the influence of these trifocal IOLs on ocular and internal aberrations.
The findings from this study indicated that RayOne Trifocal IOL continued to
demonstrate good refractive outcomes following cataract surgery. Interestingly,
the percentage of eyes treated with RayOne T with a MRSE within
The visual acuity results in this study demonstrated the RayOne T and the
PanOptix IOLs did not differ significantly in terms of visual acuity. Both
treatment groups were superior to the monofocal control group in uncorrected
monocular and binocular near and intermediate visual acuity. Interestingly, the
visual acuity outcomes with the RayOne T IOL calculated at 3 months after
cataract surgery in this study were quite in line with the findings from the
previous studies on RayOne T. In our study the monocular UNVA was 0.01
This study demonstrated that the two trifocal IOLs were superior to the monofocal lens not only in terms of visual acuity, but also along the defocus curves at all tested timepoints other than at 4 m (0.00 D of defocus), where the best visual acuity was achieved with all IOLs, as expected.
For both the RayOne T and PanOptix IOL, the visual acuity values achieved between –1.00 D and –2.50 D of defocus, corresponding to a distance between 80 cm and 40 cm, respectively, were within the range of 0.00 to 0.01 logMAR, thus confirming that the performances of RayOne T and PanOptix IOL in near, intermediate, and far vision were excellent and comparable between the two groups, Interestingly, the visual outcomes obtained with the RayOne T IOL are comparable with those obtained in other studies performed on patients implanted with the PanOptix IOL [13, 14, 15, 20, 21].
Compared to the AcrySof monofocal IOL, both trifocal IOLs yielded lower contrast sensitivity at all angular frequencies tested. These results are not surprising, as it has been widely reported the incoming light distribution between two or more foci reduces contrast sensitivity [16]. Although a trend of a slightly better contrast sensitivity in photopic condition was observed in the RayOne T group compared to PanOptix group, differences between groups did not show statistical significance for any spatial frequencies.
Aberrometry measurements did not on the whole differ between the three groups.
The AcrySof monofocal had lower RMS values (
Internal LOA and HOA aberrations at the 12-month follow-up visit.
In terms of image quality, photic phenomena, especially glare and halos are
known effects of MIOLs that may affect a patient’s quality of life. To compare
the incidence of visual disturbances between the two IOLs, we used the NEI-RQL-42
questionnaire [19]. All patients implanted with RayOne T lenses reported
complete satisfaction with their visual outcomes, ocular health, and appearance
one year after undergoing the surgery. Notably, all patients who received the
RayOne T IOL reported a 70% or higher satisfaction with regards to glare
problems (93.23
Finally, no posterior capsular opacification (PCO) was reported in any patients at the end of follow-up and the IOLs were centered and remained stable over time in all eyes (Fig. 8).
Digital photos of the anterior segment at the 12 month follow-up visit, showing stable centration and no opacification of the IOLs. The different diffractive profile can be appreciated. (A) RayOne Trifocal. (B) AcrySof IQ PanOptix.
In conclusion, when comparing the performance of the RayOne Trifocal to the PanOptix Trifocal IOL, (which has been commercially available since 2015 and FDA approved in 2019), RayOne T has been highly regarded among ophthalmologists, the results demonstrate that the RayOne Trifocal lens can provide as excellent visual acuity as the PanOptix IQ trifocal and high patient satisfaction without causing visual distortions, residual refractive error, optical discomfort, or other adverse effects.
Thus, this new trifocal IOL might represent a good alternative for patients undergoing cataract surgery who want to achieve a good range of vision and a low rate of visual disturbances.
IOL, intraocular lens; MIOL, multifocal intraocular lens; MRSE, manifest residual spherical equivalent; LOA, low order aberrations; HOA, high order aberrations; UDVA, uncorrected distance visual acuity; DCVA, distance-corrected visual acuity; UIVA, uncorrected intermediate visual acuity; DCIVA, distance-corrected intermediate visual acuity; UNVA, uncorrected near visual acuity; DCNVA, distance-corrected near visual acuity; RMS, root mean square; PCO, posterior capsular opacification.
AI conceived the work, wrote the article and analyzed the data; FG contributed reagents and material; GM and KM collected the data; AM supervised the work and designed the experiments.
The study was conducted in accordance with the tenets of the Declaration of Helsinki, and the Institutional review board of the San Marino State Hospital, Istituto per la Sicurezza Sociale, Republic of San Marino approved the study. All patients were informed about the risks and benefits of surgery and they were required to provide written consent.
We thank Mr. Christopher Willis and Charlotte Slater for technical assistance.
This research received no external funding.
The authors declare no conflict of interest.