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- Indian J Ophthalmol
- v.72(2); 2024 Feb
- PMC10941920
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Indian J Ophthalmol. 2024 Feb; 72(2): 181–184.
Published online 2024 Jan 25. doi:10.4103/IJO.IJO_681_23
PMCID: PMC10941920
PMID: 38273683
Gagandeep Singh,
K S Sidhharthan,1 Jagadeesh K Reddy,2 Vandana Sundaram,2 and Mithun Thulasidas3
Author information Article notes Copyright and License information PMC Disclaimer
Abstract
Purpose:
To compare the visual outcomes and monocular defocus curve of a new monofocal Tecnis Eyhance IOL (Tecnis ICB00) with Tecnis 1 single piece (ZCB00).
Methods:
Eighty patients diagnosed with cataract were divided into two groups: Tecnis ICB00 (n = 40) and ZCB00 (n = 40). The visual outcome was evaluated using the following parameters: uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), distance corrected intermediate visual acuity (DCIVA), corrected near visual acuity (CNVA), uncorrected visual acuity contrast sensitivity (UVACS), best-corrected visual acuity contrast sensitivity (BCVACS), manifest refraction, and defocus curve and was compared at the 6th week and 3 months after surgery.
Results:
The UIVA and UNVA were significantly (P < 0.05) better in ICB00 as compared with ZCB00 at 6 weeks and 3 months postoperative. The DCIVA was significantly better in ICB00 as compared with ZCB00 at 3 months postoperative (−0.015 ± 0.04 vs. 0.01 ± 0.020; P = 0.01). Regarding contrast sensitivity, UVACS and BCVACS were significantly better in ICB00 as compared with ZCB00 at 6 weeks and 3 months postoperative (P < 0.05). The defocus curves showed that the mean visual acuity of the ICB00 group was significantly better than that of the ZCB00 group at between – 0.5 D and – 2.50 D of defocus.
Conclusion:
In patients undergoing cataract surgery, Eyhance ICB00 provided better intermediate vision as compared with ZCB00.
Keywords: Cataract surgery, defocus curve, eyhance ICB00, visual outcomes, ZCB00
Cataract affects millions of people in the world and is a major cause of blindness.[1,2,3,4] Phacoemulsification surgery is widely used in developed countries for the treatment of cataracts, but, in underdeveloped countries, many people suffer from blindness due to untreated cataracts.[2] Currently, extended computer use and younger age at cataract surgery give rise to growing needs for intermediate vision.[3] Intraocular lenses (IOLs) used to replace the natural lens for refractive lens exchange or cataracts have evolved considerably over the years. There is currently a wide array of IOLs available spanning from advanced or enhanced monofocal designs to multifocals or extended-depth-of-focus lenses offering good vision at more than just one distance but with some optical quality sacrifice.[5,6]
One of the newer IOL models is the monofocal with enhanced intermediate vision Tecnis® Eyhance model ICB00 (Johnson and Johnson Vision, USA[7]). While this IOL can be classified as a monofocal lens, it offers a steady gradual change in lens power from the periphery toward the center [Fig. 1]. This design creates an anterior IOL surface that improves intermediate vision (66 cm) while maintaining the good distance vision quality offered by other aspheric monofocal IOLs and also minimizing the dysphotopsia phenomena that characterize distant-dominant multifocal IOLs and reducing spherical aberration to near zero.
Figure 1
Power maps of the TECNIS® Monofocal (ZCB00) and TECNIS Eyhance (ICB00) IOLs[8]
Tecnis Eyhance IOL, unlike other monofocal lenses, is not based on a spherical aberration (SA)-based or zonal design, but the continuous power profile is created with a higher-order asphere[8]
The performance of any IOL depends on many factors such as corneal astigmatism, biometry, effective lens position, pupil diameter, etc., thus, comparing IOLs’ performance in clinical practice can be difficult. Defocus curve is a strong, objective clinical measure of the efficacy of an IOL in correcting presbyopia[9,10,11,12] and is widely used to objectively measure an IOLs performance at various distances. Except for a few preliminary trials,[13] no peer-reviewed literature is available on defocus curve and visual performance of the new Tecnis Eyhance IOL. We chose to compare Tecnis Eyhance with Tecnis 1 single piece IOL as both IOLs are monofocal and based on the same aspheric IOL platform. Hence, the purpose of our study was to measure the visual outcomes and monocular defocus curve of this new Tecnis Eyhance IOL (Tecnis ICB00) and compare it with Tecnis 1 single piece (ZCB00).
Methods
This was an interventional, prospective, and comparative study conducted to evaluate the visual outcome of Tecnis ICB00 and Tecnis ZCB00 on 80 patients diagnosed with cataracts. The study was conducted at the Department of Ophthalmology, Shri Kanchi Kamakoti Medical Trust Hospital, Coimbatore, Tamil Nadu, India.
Inclusion criteria
Patients with senile cataracts aged between 45 and 75 years. Patients undergoing phacoemulsification surgery for cataracts in one eye. Patients choosing Tecnis Eyhance Monofocal and Tecnis 1-piece Monofocal IOL. Corneal Astigmatism ≤ 0.75D
Exclusion criteria
Patients with amblyopia, axial length over 25.0 mm, previous ocular surgery including corneal or refractive surgery, chronic or recurrent uveitis, external/internal infection, diabetes mellitus with retinal changes, glaucoma or intraocular pressure equal to or higher than 24 mmHg, pseudoexfoliation syndrome, pathological miosis, Keratoconus, corneal endothelial dystrophy, macular disorders, and optic nerve disorders were excluded from the study.
The patients were divided into two groups: patients choosing Tecnis Eyhance Monofocal ICB00 (n = 40) and patients choosing Tecnis 1-piece Monofocal IOL ZCB00 (n = 40)
Before surgery, all the patients were subjected to a detailed ophthalmological examination comprising of monocular measurement in terms of uncorrected distance visual acuity (UDVA) (3 m) and corrected distance visual acuity (CDVA) using an Auro chart visual monitor with 100% contrast, subjective and objective refraction, slit-lamp biomicroscopy, noncontact tonometry, keratometry, optical biometry, and fundus examination under dilation.
Phacoemulsification was performed in all patients under topical or peribulbar anesthesia. All the patients were discharged on the same day after their postoperative evaluation. Topical antibiotic drops and topical steroids will be advised and the patient will be called for follow-up at 1 week, 6 weeks, and 3 months. On the 6th week and 3rd-month follow-up, these patients were evaluated for the following in the operated eye.
The visual outcome was evaluated using the following parameters: uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), distance corrected intermediate visual acuity (DCIVA), corrected near visual acuity (CNVA), uncorrected visual acuity contrast sensitivity (UVACS), best-corrected visual acuity contrast sensitivity (BCVACS), and manifest refraction such as spherical, cylindrical power, and axis of refraction. Defocus curve will be plotted by adding + and – lenses to the manifest refraction.
The distance visual acuity was evaluated by logMAR visual acuity chart at 3 m using Appasamy visual monitor with 100% contrast. For testing intermediate (66 cm) and near (33 cm) visual acuity logarithmic visual acuity chart by Colanbrander visual acuity chart-Precision Vision. Contrast sensitivity was tested by Pelli–Robson contrast sensitivity chart at 1 m using Appasamy visual monitor.
Statistical analysis
Data were entered using MS Excel and Statistical package for the social sciences (SPSS) for Windows version 24.0 (IBM, Armonk, NY, USA). Mean values and standard deviation were calculated for every parameter. The normality of data samples was evaluated by means of the Chi-square test. When the parametric analysis was possible, the Student’s t test for unpaired data was used for the comparison between groups. A P value <0.05 was considered statistically significant.
Results
The mean age of the patients in Tecnis Eyhance ICB00 was 61.30 ± 8.43 years and in Tecnis 1-piece ZCB00 was 62.28 ± 6.16 years and it was found to be nonsignificant (P = 0.556).
In this study, there was no significant difference in the UDVA at follow-up of 6 weeks and 3 months and the values were almost similar between ICB00 and ZCB00. The UIVA was better in ICB00 as compared with ZCB00 at the follow-up period of 6 weeks (P = 0.003) and 3 months (P = 0.000) and was found to be significant.
The UNVA was better in ICB00 as compared with ZCB00 at the follow-up period of 6 weeks (P = 0.000) and 3 months (P = 0.01) and was found to be significant. Meanwhile, CDVA was similar between ICB00 and ZCB00 at 6 weeks (P = 1.00) and 3 months (P = 0.155) and was found to be nonsignificant. The DCIVA was found to be better at 3 months in ICB00 as compared with ZCB00 and (P = 0.01). The CNVA was similar in ICB00 and ZCB00 at 6 weeks and 3 months postoperative period and was not significant. The results were shown in Table 1.
Table 1
Comparison of various visual acuities at postoperative between ICB00 and ZCB00
| Visual Outcomes | Tecnis Eyhance ICB00 | Tecnis 1 Piece ZCB00 | P |
|---|---|---|---|
| UDVA 6weeks | 0.09±0.08 | 0.09±0.11 | 1.00NS |
| UDVA 3 months | 0.11±0.11 | 0.12±0.11 | 0.92NS |
| UIVA 6weeks | 0.03±0.09 | 0.10±0.11 | 0.003* |
| UIVA 3 months | 0.32±0.11 | 0.50±0.11 | 0.000* |
| UNVA 6weeks | 0.43±0.09 | 0.56±0.09 | 0.000* |
| UNVA 3 months | 0.43±0.09 | 0.49±0.11 | 0.01* |
| CDVA 6weeks | 0.01±0.04 | 0.01±0.04 | 1.00NS |
| CDVA 3 months | 0.00±0.13 | 0.01±0.02 | 0.15NS |
| DCIVA 6weeks | −0.008±0.05 | 0.00±0.02 | 0.29NS |
| DCIVA 3 months | −0.015±0.04 | 0.01±0.02 | 0.01* |
| CNVA 6weeks | 0.00±0.00 | 0.00±0.00 | - |
| CNVA 3 months | 0.00±0.00 | 0.00±0.00 | - |
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NS, Nonsignificant; * denotes significant P<0.05
The postoperative contrast sensitivity between ICB00 and ZCB00 were shown in Table 2. There was a significant improvement in the UVACS in ICB00 when compared with ZCB00 at 6 weeks (P = 0.0007) and 3 months (P = 0.002) follow-up and it was found to be significant. Likewise, there was a significant improvement in the BCVACS in ICB00 when compared with ZCB00 at 6 weeks (P = 0.001) and 3 months (P = 0.003) follow-up and it was found to be significant. The results were shown in Table 2.
Table 2
Comparison of UVACS and BCVACS at postoperative between ICB00 and ZCB00
| Visual Outcomes | Tecnis Eyhance ICB00 | Tecnis 1 Piece ZCB00 | P |
|---|---|---|---|
| UVACS 6weeks | 1.77±0.10 | 1.69±0.11 | 0.0007* |
| UVACS 3 months | 1.75±0.12 | 1.67±0.12 | 0.002* |
| BCVACS 6weeks | 1.77±0.10 | 1.71±0.10 | 0.001* |
| BCVACS 3 months | 1.78±0.107 | 1.72±0.11 | 0.003* |
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NS, Nonsignificant; * denotes significant P<0.05
The cylindrical and axial refraction between the groups were shown in Table 3. In this study, there were no significant differences in the cylindrical and axial refraction at 6 weeks and 3 months postoperative between ICB00 and ZCB0.
Table 3
Comparison of cylindrical and axial refraction at postoperative between ICB00 and ZCB00
| Visual Outcomes | Tecnis Eyhance ICB00 | Tecnis 1 Piece ZCB00 | P |
|---|---|---|---|
| Cylindrical refraction 6weeks | 0.35±0.33 | 0.15±0.41 | 0.20NS |
| Cylindrical refraction 3 months | −0.50±0.28 | −0.29±0.48 | 0.09NS |
| Axial refraction 6weeks | 76.50±21.08 | 82.86±61.09 | 0.75NS |
| Axial refraction 3 months | 81.31±29.33 | 87.50±51.93 | 0.63NS |
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NS, Nonsignificant; *denotes significant P<0.05
The mean defocus curve in ICB00 and ZCB00 were similar at 1D and was found to be nonsignificant (P = 0.914). ICB00 has significantly better visual acuity across defocus levels from −0.50 to −2.50 D (P < 0.01). The defocus at −1.50 D corresponds to intermediate vision and at −2.50 D corresponds to near vision. Hence, Eyhance performed better not only at an intermediate distance but also at near (P < 0.01). The results were shown in Fig. 2.
Figure 2
Comparison of defocus curve at 3 months postoperative between the groups
Discussion
Tecnis Eyhance IOL increases the depth of focus and thus enhances the vision for performing intermediate tasks and elicits similar distance vision as that of the standard monofocal IOLs; however, it cannot provide near vision as multifocal IOLs do. It has a modified aspheric anterior surface. Due to its optic design, it does not cause decreased contrast sensitivity or photic phenomena like halos and glare. Tecnis Eyhance IOL does not have a zonal design and contains no rings thus, creating a unique anterior surface that provides improved intermediate vision.[14,15]
Although cataract surgery with monofocal IOL implantation is still the most common option, there is a gap between postoperative results and patient expectations as it limits to improvement of only distant vision. At this point, many investigators have developed other IOL designs to improve near and intermediate vision, but those IOLs also have limitations as they accompany unwilling phenomena such as reduced contrast sensitivity, halos, and glares. Besides, as the optical technologies differ, the subjects to apply those advanced IOLs are limited. Therefore, the Eyhance ICB00 IOL could be a good option as it shares the same geometry with the monofocal 1-piece IOL and provides an improved intermediate and near vision, and better spectacle independence as well, without accompanying other unwilling phenomena. So the present study was conducted to compare the visual outcomes after implantation of Tecnis Eyhance (ICB00) and Tecnis Monofocal 1-piece (ZCB00) IOL.
This was an interventional, prospective, and comparative study among the patients diagnosed with senile cataracts. In this study, 80 patients were recruited and divided into two groups as follows: Tecnis Eyhance (ICB00) and Tecnis Monofocal1-piece (ZCB00), respectively.
In this study, the UDVA was similar in both ICB00 and ZCB00 at a follow-up period of 6 weeks and 3 months and it was not significant. Similar to our report, in Kang et al.’s[16] study, there was no significant difference in UDVA values postoperatively between ICB00 and ZCB00 conducted on the Asian population. Similarly, in the first published study examining this new IOL, Mencucci et al.[17] reported similar values of both monocular and binocular UDVA after 6 months postoperative period.
Furthermore, in our study, UIVA was better in ICB00 with a follow-up period of 6 weeks and 3 months as compared with ZCB00 and was found to be significant. Similarly, in the study by Mencucci et al.[17] and Yangzes et al.,[18] the UIVA values are better in ICB00 as compared with ZCB00 at 6 months postoperative period and was found to be significant.
In addition, the CDVA was similar in both ICB00 and ZCB00 at a follow-up period of 6 weeks and 3 months and it was not significant, which is in line with the study done by Kang et al.,[16] and showed no significant difference in the CDVA values at 3 months postoperative between ICB00 and ZCB00. Likewise, in a study done by Cinar et al.[19] where they compared the visual outcome of Eyhance IOL and AcrySof IOL and the CDVA values were similar in both the groups.
Meanwhile, in the present study, DCIVA was similar in both the groups at 6 weeks postoperative, whereas at 3 months postoperative follow-up the DCIVA values was better in ICB00 as compared with ZCB00 and was significant. Similar to our report, in a study done by Huh et al.[20] and Ucar et al.,[21] the postoperative DCIVA value was significantly better in ICB00 as compared with ZCB00.
In our study, there was no significant change in the CNVA values between ICB00 and ZCB00 at 6 weeks and 3 months postoperative period, which is in line with the study done by Yangzes et al.[18] Furthermore, in the present study, the UVACS and BCVACS values showed significant improvement in ICB00 as compared with ZCB00, which can be attributed to the optical geometry of the ICB00, which allows a more gradual change in the contrast sensitivity in the range of vision avoiding the jump or skip phenomenon seen in the geometry of a standard monofocal such as ZCB00. However, the magnitude of improvement was small as Pelli–Robson chart evaluates the contrast sensitivity at a single frequency.[22] Mencucci et al.[17] reported similar photopic binocular contrast sensitivity between the Eyhance ICB00 and the ZCB00 groups. Their clinical study confirmed the predicted gain of approximately 0.1 logMAR at intermediate and comparable visual acuity at a distance when compared with the aspheric monofocal IOL that fully compensates for corneal primary spherical aberration. Furthermore, the authors reported that no significant differences between the two groups were found in photopic contrast sensitivity.
The mean defocus curve in ICB00 and ZCB00 were similar at 1D and found to be nonsignificant (P = 0.914). ICB00 has significantly better visual acuity across defocus levels from −0.50 to −2.50 D (P < 0.01). Hence, Eyhance performed better not only at an intermediate distance but also at near (P < 0.01). In Huh et al.[20] study, the ICB00 group achieved a smooth landing area with a less abrupt decrease in visual acuity. Furthermore, the mean visual acuity of the ICB00 group was significantly better than that of the ZCB00 group between −1.00 D and −3.00 D of defocus in their study. Similarly, in Kang et al.’s[16] study, the ICB00 showed a smoother curve with a broader landing zone than those of the ZCB00 along the whole curve. The defocus curve showed that the ICB00 provided a visual acuity equal to or better than 0.22 logMAR between defocus levels of +1.00 to −1.50 D.
Since this study was done in patients implanted with either ICB00 or ZCB00 only in one eye irrespective of the type of IOL in the other eye, we cannot comment upon the status of final refractive outcome and spectacle independence in these patients, which is a limitation of our study and can certainly be a source of bias. Though these limitations notwithstanding, the strength of this study is represented by the uniocular defocus curve, which assesses the quality of the IOL implanted removing patient bias.
Conclusion
Our study is the first Indian prospective study to prove and establish the superiority of Eyhance ICB00 IOL over Tecnis 1-piece ZCB00 in terms of intermediate vision and Near Vision. The new monofocal IOL, with a broader defocus curve provides better visual acuity across greater range of defocus levels (−1.00 D to − 3.00 D).
Financial support and sponsorship:
Nil.
Conflicts of interest:
There are no conflicts of interest.
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