Trifocal-Lens Implant Frees Most From Spectacles After Cataract Surgery

By Anne Harding

October 21, 2020

NEW YORK (Reuters Health) - Patients who receive trifocal-lens implants after cataract surgery are much less likely to need glasses than those who receive monofocal implants, according to a new confirmatory study.

Eighty percent of patients given trifocal intraocular lenses (IOLs) said they never needed to use glasses, versus 8% of those who received monofocal IOLs, Dr. Satish Modi of Seeta Eye Centers in Poughkeepsie, New York, and colleagues report in Ophthalmology.

Many patients will need glasses after cataract surgery using a monofocal IOL, Dr. Modi and his team note in their report. Multifocal IOLs allow people to see without glasses over a wider range of distances, but "this comes at the cost of reduced contrast sensitivity and increased photic phenomena," they add.

The TFNT00 (PanOptix, Alcon, Fort Worth, TX), with three optical focal points for distance (about 13 feet), intermediate (26 inches) and near (about 16 inches) vision, was approved by the U.S. Food and Drug Administration (FDA) in 2019. It is the only trifocal IOL with FDA approval.

In the new study, the authors compared the TFNT00 with a monofocal IOL also made by Alcon, the SN60AT, in a multicenter parallel-group confirmatory trial. Patients were allowed to choose which lens they preferred, and assessors were masked. Out of 243 patients, 129 chose the TFNT00 and 114 the SN60AT.

The TFNT00 was non-inferior to the SN60AT in mean photopic monocular best-corrected distance visual acuity (BCDVA). The trifocal lens was superior for mean photopic monocular distance-corrected near visual acuity (DCNVA), with a significant difference of 0.42 logarithm of the minimum angle of resolution (logMAR).

Mean photopic monocular distance-corrected intermediate visual acuity (DCIVA) was also superior for the TFNT00, with a difference of 0.26 logMAR (P<0.001).

Overall, 80.5% of patients in the TFNT00 group reported never needing to use spectacles, compared to 8.2% of the patients who received monofocal IOLs. Over 95% of the TFNT00 patients said they were satisfied or very satisfied with their vision, would have the same lens implanted again, and would recommend it to family and friends.

Patients who received the TFNT00 were more likely than those implanted with the SN60AT to report severe starbursts and halos at months one and six. However, at six months fewer than 5% of TFNT00 patients said they were very bothered by visual disturbances.

"My personal experience is that these people are exceedingly happy with this implant," Dr. Modi told Reuters Health by phone. "It gives them a level of spectacle independence that we've never been able to give."

While the patients who received the TFNT00 reported more severe visual disturbances than those given the SN60AT, he added, most people neuroadapted to them, and didn't find them bothersome by three to six months after the surgery.

The TFNT00 can also be used to correct astigmatism, Dr. Modi noted. "This allows us to immediately treat the patient's astigmatism also, and that's been a big boon in terms of how many people can get this implant put into their eyes safely and successfully."

The study was sponsored by Alcon Research, LLC, which participated in study design, analysis and interpretation of data, and manuscript preparation, review and approval. Dr. Modi and several other study authors report consulting for Alcon and receiving personal fees from the company.

SOURCE: Ophthalmology, online September 28, 2020.