To assess the impact on visual function of different residual astigmatic situations combined with 0.50D negative defocus at different distances in patients with trifocal intraocular lenses (IOLs).
Clínica Rementería, Madrid, Spain.
Prospective case series.
The study included patients with the AcrySof® IQ PanOptixTM IOL. Visual acuity (VA) was measured at far distance (0.00 diopters [D] of vergence), at -1.5D, -2.5D and -3.0D of vergence. Residual astigmatism was induced by adding 0.50 and 1.00D cylindrical lenses placed at 90° (against the rule – ATR), 45° (oblique) and 180° (with the rule – WTR). All measurements were made with distance correction (emmetropia as the reference situation) and with a simulated residual myopia of 0.50D.
The study included 61 eyes of 61 patients. Residual astigmatism of 0.50D and 1.0D was induced in 28 and 33 eyes, respectively. For both groups distance and intermediate VA was better for the reference situation (P<0.001 for all cases). With 1.0D of cylinder (without and with induced defocus), the proportion of patients who lost ≥2 lines was higher for the ATR astigmatism. For near vision, differences were smaller for all simulated situations.
Residual astigmatism of up to 0.50D, regardless of its orientation, seems to be tolerated at all distances. For astigmatisms of 1.0D, distance and intermediate VA decreased significantly, and ATR orientations showed worse results in a higher proportion of patients. The combination of astigmatism with residual myopia significantly decreased distance VA while this negative shift had less impact on near VA.

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