“The Grass Is Greener After Surgery”

“The Grass Is Greener After Surgery”

March 19, 2019

Dr. Johan Blaenckaert, President of the Belgian Society of Cataract and Refractive Surgeons, said, “Now I know why one of my patients said to me that the grass is greener after surgery.”

D r. Johan Blaenckaert, President of Belgian Society of Cataract and Refractive Surgeons shared his clinical studies and experience with Acriva Trinova— the world’s first and only sinusoidal trifocal intraocular lens (IOL) —and said that he now understands why one of his patients told him that the grass is greener after surgery.

Dr. Blaenckaert also shared the post-op results of 60 bilateral hyperopic patients upon whom he had operated, including the US Air Force resolution target test comparison of both Fresnel and sinusoidal IOL designs.

For instance , the doctor provided the following information when comparing Fresnel and sinusoidal IOL designs: “Early Fresnel type trifocals caused high light loss. When we have a look at the US Air Force target test results, there is an important difference between Fresnel type trifocal IOLs and the sinusoidal IOL. In photopic conditions, the US Airforce target test results are quite good with Fresnel type IOLs for far, intermediate, and near vision, but in mesopic conditions, it gets worse for those with near and intermediate vision. We receive complaints from patients who were Fresnel type IOLs implanted and who experience blurred vision at near and intermediate distances. So, we had some concerns when we were first introduced to the new sinusoidal IOL. They presented us with the MTF (modulation transfer function) graphic. However, it is difficult for a surgeon and even more difficult for a patient to understand the precise difference between these lenses because the MTF curves are not always clearly depicted.

Yet, when we look at the light distribution in the photopic condition of the sinusoidal IOL, it really represents a horizontal line according to the opening of the pupil – showing pupil independence. In mesopic conditions, the light goes a bit more for far vision, and the near and the intermediate light distribution switches. Therefore, more light goes to near vision, and it is still pupil independent.”

He also mentioned that there are many criteria for choosing an IOL, such as chromatic aberration control, retinal photoprotection, square edge for the PCO (posterior capsule opacity), etc. Yet, for me, light transmission, acceptable mesopic condition VA for far and near vision, and enhanced depth of focus are more important. So, it is good to know that Trinova has the highest light transmission with 92% in the trifocal competition.

He continued his explanations with the target test results and noted that “if we again look at the US Air Force target tests, then we can also translate the highest transmission to the image quality, and the Fresnel type trifocals are clearly inferior for image quality than the new sinusoidal trifocal in photopic conditions. However, what strikes me the most is that, in mesopic conditions, the far-range focus still has a much better image quality in sinusoidal design than that offered by the Fresnel type trifocals. Thus, it is really important that we can tell patients that the image quality for far is as good as what you can expect from monofocal IOLs, which is not the case in Fresnel type trifocals .”

He also talked about reading the test results of these patients: “When I was first presented with the idea of seamless continuous vision, I was very skeptical about it because we still have physiological limitations with IOLs. Later, the enhanced depth of vision really became something that I appreciated after performing some tests on my patients. I asked my patients specifically to read further away from the normal reading distance until it became unclear , and they could not read anymore. However, most of my patients said that their arms were too short for that and that they could read up to 82 centimeters at an intermediate distance—proving seamless continuous vision in patients. I had 60 bilateral hyperopic patients with no current disorders and had uneventful surgeries using the FLACS technique. Their uncorrected visual acuity was 10/10 and J2 for near vision, so my conclusion is that this lens has excellent far vision, even in a mesopic condition, which is related to the high light transmission. The lens provides continuous vision from 38 to 82 centimeters. I also had patients complete a quality of life questionnaire . They had very minimal halo complaints. When you compare Trinova with other trifocal IOLs, it shows very high patient results and spectacle independence more than 90% so I have had great patient satisfaction, even in mesopic conditions. Therefore, doctor and staff satisfaction are very high, and now I know why one of my patients asserted that the grass is greener after surgery.”