Synthesis and Critical Appraisal of the Clinical Evidence  in Patients Implanted with Intraocular Lens


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Cientos de Lentes
Hundreds of Reports

Synthesis of scientific publications carried out since 2010 with critical appraisal using an algorithm that considers up to 192 factors described in the articles.

Resultados clínicos
Clinical Outcomes

Summary of results focused on the patient's interest: visual acuities at different distances, defocus curve, contrast sensitivity, patient reported outcomes, etc.

Comparación rápida
Quick Comparison

The results can be displayed as a list for the variables of interest, facilitating comparison between reports from different authors, lenses, procedures, etc.

Resumen individualizado
Summary of Outcomes

 The results of each study are summarized individually, showing the quality of the evidence for each of the sections evaluated and the overall assessment.

Grouped Evidence
Grouped Evidence

The evidence can be consulted in grouped form for each IOL model. In turn, different categories have been created according to the type of lens or the differentiating characteristics of the study.

To know the Expected Clinical Outcomes

Learning to use the App

What is the meaning of the abbreviations I can find within the App?

Main Abbreviations

  • Enh-Mono: Monofocals with Focus Extension around 1.5 D for 0.3 logMAR in monocular vision
  • FRoF-Bi: Multifocals in which a single near addition has been described by the manufacturer.
  • FRoF-Tri: Multifocal in which two additions of near and intermediate have been described by the manufacturer.
  • EDoF: Depth of field extension about 2.0 D for 0.3 logMAR in monocular vision
  • Mono: Conventional single vision lenses

Secondary Abbreviations

They are added to the above when any of the following clinical variations are present:

  • Toric: The study contains results with toric lenses (Example FRoF-Tri Toric).
  • M&M: Combination of two lenses (Mixed M&M indicates the use of 2 lenses of different categories).
  • MicroM: A major myopic target has been selected in either eye.

Example of concatenation of abbreviations:

Mixed M&M MicroM: Mix-and-Match with two lenses of different categories in which one of the eyes has been programmed with a higher myopic target.

What do the operators "&" and "or" mean when two different lenses appear?
  • The "&" operator means that both lenses have been used one in each eye. For example, "Acufocus IC-8 & Monofocal" indicates that one eye has been operated with "Acufocus IC-8" and the other with "Monofocal". 
  • The "or" operator means that the two lenses have been mixed in the sample (not recommended). For example, "Vivity DFT015 or Toric" indicates that this study contains, without being clearly differentiated, results from the Vivity lens in its spherical or toric version.
What does the numbering that accompanies each item represent?

This is the quality of evidence index of the article, it is calculated in an automated way based on 192 parameters that can be described in the article. As it is an algorithm, it can be improved in future versions, so the evaluation of an article could change with the optimization of the algorithm.

What are the numbers that appear in colored form in the report for each lens on the sides of the quality of evidence index?

The quality index is calculated considering 10 main questions or items. Each of these questions is answered considering the respective parameters of the 192 factors extracted within the article. The colors assigned indicate:

  • Green: The quality assessment question is met in a positive manner.
  • Yellow: The wording of the article does not allow for a clear answer to this question.
  • Red: The quality assessment question is not met in a positive manner.
What is the difference between photic phenomenon and positive dysphotopsia?

How to ask about artifacts that appear around lights may differ between studies.

  • Photic phenomena: Percentage of patients reporting glare, halos or starburst.
  • Positive dyspotopia: Cumulative percentage of patients "Bothered and Very Bothered" by photic phenomena.

Since the presence of photic phenomena does not bother all patients equally, the incidence of photic phenomena is usually higher than the incidence of positive dysphotopsias.

Can I access to PRO on all my devices with a single suscription?

Yes, with just one subscription you will have access to PRO on all your devices as long as they have the same Apple Store user account.  

Terms & Conditions for App users

Effective Date: February 3, 2023

Terms & Conditions

By downloading or using our Apps, these terms will automatically apply to you – you should make sure therefore that you read them carefully before using the app. You’re not allowed to copy or modify the app, any part of the app, or our trademarks in any way. You’re not allowed to attempt to extract the source code of the app, and you also shouldn’t try to translate the app into other languages or make derivative versions. The app itself, and all the trade marks, copyright and other intellectual property rights related to it, still belong to Indaloftal S.L. (“the developer”).

1. Purpose of our Apps

1.1 Please be aware that all our apps have been designed for research and not for medical purposes. They are not intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease. The information provided by our Apps is not intended to use for the benefit of individual patients, but it is intended to evaluate the results along a sample of patients in order to conduct research. By downloading and using our apps you agree to use them only for research purposes.

2. About the Data Stored in your Device

2.1 This App does not storage any personal data of the user.

3. Services and Subscriptions

3.1 The developer is committed to ensuring that the app is as useful and efficient as possible. For that reason, we reserve the right to make changes to the app or to charge for its services, at any time and for any reason. We will never charge you for the app or its services without making it very clear to you exactly what you’re paying for. The scope of the services may depend on the subscription you have. The developer may change, update, suspend, make improvements to, or discontinue aspects of the services.

3.2 For Apps with PRO subscription the apps can offer an automatically renewable subscription (“PRO”) for a period of time. A subscription enables you to access and use the fill scope of the services for the subscription period. Payment will be charged to your iTunes account upon confirmation of purchase. It is your responsibility to turn-off your subscription at least 24-hours before the end of the current period if you do not want to renew the subscription.

4. About your device and third parties

4.1 It’s your responsibility to keep your phone and access to the app secure. We, therefore, recommend that you do not jailbreak or root your phone/tablet, which is the process of removing software restrictions and limitations imposed by the official operating system of your device. It could make your phone vulnerable to malware/viruses/malicious programs, compromise your phone’s security features and it could mean that the app won’t work properly or at all.

4.2 You should be aware that there are certain things that the developer will not take responsibility for. Certain functions of the app will require the app to have an active internet connection. The connection can be Wi-Fi, or provided by your mobile network provider, but the developer cannot take responsibility for the app not working at full functionality if you don’t have access to Wi-Fi, and you don’t have any of your data allowance left.

4.3 If you’re using the app outside of an area with Wi-Fi, you should remember that your terms of the agreement with your mobile network provider will still apply. As a result, you may be charged by your mobile provider for the cost of data for the duration of the connection while accessing the app, or other third party charges. In using the app, you’re accepting responsibility for any such charges, including roaming data charges if you use the app outside of your home territory (i.e. region or country) without turning off data roaming. If you are not the bill payer for the device on which you’re using the app, please be aware that we assume that you have received permission from the bill payer for using the app.

4.4 Along the same lines, the developer cannot always take responsibility for the way you use the app. i.e. You need to make sure that your device stays charged – if it runs out of battery and you can’t turn it on to avail the Service, the developer cannot accept responsibility.

4.5 With respect to the developer’s responsibility for your use of the app, when you’re using the app, it’s important to bear in mind that although we endeavor to ensure that it is updated and correct at all times, we do rely on third parties to provide information to us so that we can make it available to you. The developer accepts no liability for any loss, direct or indirect, you experience as a result of relying wholly on this functionality of the app.

4.6 At some point, we may wish to update the app. The app is currently available on iOS – the requirements for system (and for any additional systems we decide to extend the availability of the app to) may change, and you’ll need to download the updates if you want to keep using the app. The developer does not promise that it will always update the app so that it is relevant to you and/or works with the iOS version that you have installed on your device. However, you promise to always accept updates to the application when offered to you, We may also wish to stop providing the app, and may terminate use of it at any time without giving notice of termination to you. Unless we tell you otherwise, upon any termination, (a) the rights and licenses granted to you in these terms will end; (b) you must stop using the app, and (if needed) delete it from your device. The developer it is not also responsible if any of the services result in malfunction after any update even though he will do his best to solve any bug you report as soon as possible.

5. Changes to this Terms and Conditions

5.1 The developer may update our Terms and Conditions from time to time. Thus, you are advised to review this page periodically for any changes. I will notify you of any changes by posting the new Terms and Conditions on this page. These changes are effective immediately after they are posted on this page.

6. Contact

If you have any questions or suggestions about my Terms and Conditions, do not hesitate to contact us.

What Information from Evidence is Synthesized by the App?

Related to the Study

The app processes various information to provide a comprehensive overview of a manuscript focused on intraocular lens (IOL) cases. It first identifies the manuscript using the given IOL case and study identifiers. It then extracts key details such as the authors, title, publication source, year, volume, and pages of publication. Additionally, the app provides the manuscript's URL and indicates whether it is new.

The app also delves into the study's content, analyzing the functional classification, name of the intraocular lens, and the type of study conducted. It evaluates how the lens compares with other lenses and determines if the study is prospective or retrospective. Furthermore, the app assesses the case series to confirm if it is consecutive, including the recruitment timeframe. Finally, it verifies if all patients were included in the clinical trial without losses or if the series was consecutive.

Related to Population Characteristics

The app processes extensive data related to ophthalmological studies. It begins by analyzing the number of subjects included and the number of eyes examined. It considers corneal astigmatism in inclusion criteria and assesses if eyes with comorbidities were included.

The app further evaluates demographic and biometric details, such as the mean and standard deviation (SD) of the sample's age, the percentages of men and women, and the mean and SD of axial length, average keratometry, IOL power, corneal astigmatism, and anterior chamber depth.

Additionally, the app identifies which device was used for pupil measurement and reports the mean and SD of photopic and mesopic pupils for the sample. Lastly, it analyzes the preoperative corrected distance visual acuity and its SD. This comprehensive processing enables the app to provide a detailed understanding of the study's participants and their ocular characteristics, facilitating a thorough analysis of the research conducted.

Related to the Surgical Procedure

The app processes essential information regarding surgical procedures for intraocular lens (IOL) implantation. It identifies the site where the surgery was conducted and the number of surgeons involved. The app also distinguishes between phacoemulsification and femtosecond laser-assisted cataract surgery (femtoemulsification).

Details about the surgical approach are analyzed, including the clear corneal incision size, incision meridian, and any additional corneal incisions.

The app also considers the nomogram followed and the capsulotomy size. Furthermore, the app examines the mean target planned and its standard deviation, the formula and constant used for IOL power calculation, and the biometer utilized in the process. It also determines whether the surgeon planned for micromonovision or emmetropia.

By processing this information, the app enables users to gain a comprehensive understanding of the surgical techniques and planning involved in IOL implantation, thereby facilitating better assessment and comparison of the outcomes..

Related to Procedures' Safety

The app processes crucial data related to postoperative outcomes and complications for intraocular lens (IOL) implantation procedures. It shows the percentage of eyes that experienced a loss of 2 or more corrected distance visual acuity (CDVA) lines, providing insight into the surgical success and potential risks.

Additionally, the app presents the percentage of eyes with a CDVA of less than 0.3 logMAR. This information offers a deeper understanding of the factors contributing to suboptimal visual acuity results post-surgery. The app also evaluates the reported adverse events, presenting users with a comprehensive overview of potential complications and their frequency.

Moreover, it introduces the user to the percentage of eyes that required Nd:YAG (neodymium-doped yttrium aluminum garnet) laser procedures, which are often performed to address posterior capsule opacification following cataract surgery.

By processing these variables, the app offers valuable insights into postoperative outcomes and complications, enabling users to make informed decisions about IOL implantation procedures.

Related to the Efficacy and Predictability of the Intraocular Lens and the Procedure?

The app processes a wide array of visual acuity data at various distances for both monocular and binocular vision, offering a comprehensive understanding of postoperative outcomes in intraocular lens (IOL) implantation procedures. It evaluates far, intermediate, and near distances in meters and centimeters, respectively, and considers follow-up in monocular and binocular vision.

The app analyzes multiple visual acuity aspects, such as uncorrected and corrected distance visual acuity, intermediate visual acuity, and near visual acuity, along with their respective standard deviations.

It also shows the percentage of eyes achieving specific visual acuity benchmarks, such as 20/20 for far and 20/25 for intermediate and near distances, with the best distance correction. Additionally, the app examines residual refractive outcomes, including spherical equivalent and astigmatism, and their standard deviations.

It determines the percentage of eyes within specific diopter ranges, such as 0.50D and 1.0D. Lastly, the app identifies whether the ETDRS chart was used for measuring visual acuity at all distances and the luminance applied during the measurements.

This extensive processing allows users to thoroughly assess visual outcomes and compare the effectiveness of different IOL implantation procedures.

Related to Monocular and Binocular Defocus Curves

The app processes an extensive range of defocus curve data, which is vital in understanding the depth of focus and visual performance of intraocular lenses (IOLs) after implantation. It considers the follow-up period for defocus curves and the distance correction applied during the defocus curve assessment.

The app analyzes defocus values at multiple diopter levels, ranging from 2.0 to -4.0 diopters, providing a comprehensive overview of the IOL's performance under different defocus conditions. This information allows users to evaluate the effectiveness of IOLs in various situations, such as near, intermediate, and far vision.

Additionally, the app takes into account any methods described for bias prevention by memorization. This ensures that the defocus curve data is reliable and minimizes the impact of potential biases on the results.

By processing this extensive defocus curve data, the app enables users to make informed decisions about IOL implantation procedures based on the depth of focus and overall visual performance under various conditions.

Related to the Contrast Sensitivity Function

The app processes a comprehensive range of contrast sensitivity data for both monocular and binocular vision, offering valuable insights into visual performance under various lighting conditions and with or without glare. It considers the test used for contrast sensitivity and the method for selecting the ceiling and floor effect.

For both monocular and binocular vision, the app shows contrast sensitivity measurements at different follow-up periods and with distance correction. It describes photopic and mesopic contrast sensitivity without glare at various spatial frequencies (cycles per degree, cpd) such as 3, 6, 12, and 18 cpd for photopic vision, and 1.5, 3, 6, and 12 cpd for mesopic vision.

Additionally, the app reports contrast sensitivity under glare conditions for both photopic and mesopic vision at the same spatial frequencies.

This comprehensive analysis allows users to understand the impact of intraocular lenses (IOLs) on visual performance under diverse lighting conditions and in the presence of glare, facilitating informed decision-making regarding IOL implantation procedures.

Related to Patient Reported Outcomes?

The app processes a wide range of data related to patient-reported outcomes. The app reports the percentage of patients achieving spectacle independence at far, intermediate, and near distances, providing insights into the effectiveness of IOLs in reducing spectacle dependency.

It also analyzes patient satisfaction levels, encompassing both positive (satisfied or very satisfied) and negative (dissatisfied or very dissatisfied) feedback.

The app examines the percentage of patients experiencing visual disturbances, such as halos, glare, and starbursts, as well as the proportion of those bothered by these phenomena or any other photic occurrences.

Furthermore, the app calculates the percentage of patients who would recommend the procedure, offering insights into overall satisfaction and success. Lastly, it assesses the acceptability of the statistical methods employed, ensuring the reliability of the presented data.

By processing this information, the app allows users to make informed decisions based on patient-reported outcomes and satisfaction levels following IOL implantation procedures.

Common Patients' Questions 

What is the average age for cataract surgery?

According to the clinical studies of intraocular lenses, the average age for cataract surgery is around 66 years, although cataract patients can range from adult patients in their 40s to those in their 90s. The prevalence of cataracts increases with age, making surgery more common among older individuals.

Can intraocular lenses become cloudy?

Yes, intraocular lenses can sometimes become cloudy due to a condition called posterior capsule opacification (PCO). This occurs when lens epithelial cells proliferate and migrate behind the intraocular lens, leading to a cloudy appearance and reduced visual acuity.

Why is vision different in each eye after cataract surgery?

Vision may be different in each eye after cataract surgery due to several factors, including refractive error, astigmatism, ocular comorbidity, or differences in the intraocular lens implanted. Additionally, the healing process can vary between eyes.

What is the scariest complication of cataract surgery?

Some of the scariest complications of cataract surgery include infection, retinal detachment, and vision loss. These complications are very rare, but they can have serious consequences for the patient's vision and eye health if not managed promptly and appropriately.

Why are your eyes still blurry after 2 months of cataract surgery?

Blurry vision after 2 months of cataract surgery could be due to several reasons, such as residual refractive error, corneal astigmatism, posterior capsule opacification, or ocular comorbidities like glaucoma. It is essential to consult with an eye care professional to determine the cause and appropriate treatment.

What is the most common complication of cataract surgery with iol insertion?

The most common complication of cataract surgery with IOL implantation is posterior capsule opacification, which can lead to reduced visual acuity and contrast sensitivity. However, this complication can be managed with a simple laser procedure called YAG capsulotomy.

What is the clinical outcome of lentis comfort and other intraocular lens implantation?

The clinical outcomes of Lentis Comfort intraocular lens can be found in the IOLEvidence Application. All the studies of intraocular lenses have been synthesized to know the expected visual acuities at far distance, intermediate and near, the defocus curve, the contrast sensitivity, satisfaction, dysphotopsia and many other outcomes relevant for the patient.

What are predictors of outcome in patients who underwent cataract surgery?

Predictors of outcomes in patients who underwent cataract surgery include preoperative visual acuity, ocular comorbidities like glaucoma, corneal astigmatism, and the type of intraocular lens implanted (monofocal IOL, multifocal IOL, or toric IOL). Additionally, surgical technique and the patient's general health can influence the outcomes.

How improved is vision after cataract surgery?

Vision is typically significantly improved after cataract surgery, with many patients experiencing corrected distance visual acuity of 20/40 or better. In some cases, patients can achieve 20/20 vision after surgery. However, individual outcomes may vary depending on factors such as the type of IOL implanted, preoperative visual acuity, and any ocular comorbidities.

Is 20/40 vision good after cataract surgery?

A good visual acuity is that achieve patient's expectations and needs. Surgeons can help the patient's to achieve the visual acuity without spectacles according to patient's expectations at far, intermediate and near distances. However, same vision cannot be achieved at all distances without spectacles and therefore the patient should sometimes prioritize the vision at a particular distance.

Will blurry vision go away after cataract surgery?

In most cases, blurry vision will improve after cataract surgery as the eye heals and adjusts to the new intraocular lens. However, some patients may still experience some degree of blurry vision due to factors such as residual refractive error, astigmatism, or ocular comorbidities. It is important to consult with an eye care professional to address any ongoing visual concerns.

Is it bad to wait too long for cataract surgery?

Waiting too long for cataract surgery can result in worsening vision, reduced quality of life, and increased difficulty performing daily tasks. However, the urgency for surgery depends on the severity of the cataract and its impact on the patient's vision and lifestyle. In some cases, delaying surgery may not have significant consequences, but it is crucial to discuss the appropriate timing with an eye care professional.

What is the problem with iol lens implant?

Some potential problems with IOL lens implants include incorrect lens power, which may result in residual refractive error; increased risk of posterior capsule opacification; and reduced contrast sensitivity, particularly with multifocal IOLs. Additionally, some patients may experience glare, halos, or other visual disturbances.

Why is your eyesight getting worse after cataract surgery?

Eyesight may worsen after cataract surgery due to several factors, such as residual refractive error, posterior capsule opacification, or the development of other ocular conditions like glaucoma. It is essential to consult with an eye care professional to determine the cause and appropriate treatment.

How long does intraocular lens last after cataract surgery?

Intraocular lenses are designed to last a lifetime after cataract surgery. They are made of durable materials that do not degrade over time, and complications related to the lens itself are relatively rare. However, other factors, such as the development of posterior capsule opacification, may affect vision and require additional treatment.

What is the benefit of intraocular lens?

The primary benefit of intraocular lenses is the restoration of clear vision after cataract surgery. IOLs replace the eye's natural lens, which has become cloudy due to cataract formation, providing improved visual acuity and, in many cases, reducing the need for glasses. Additionally, certain types of IOLs, such as multifocal or toric IOLs, can correct presbyopia and astigmatism, respectively, further enhancing the patient's vision.

What are the pros and cons of IOL lenses?

Pros of IOL lenses include improved visual acuity after cataract surgery, potential spectacle independence for distance, intermediate, and near vision (depending on the type of IOL), and a long-lasting solution for clear vision. Cons include potential complications such as residual refractive error, glare or halos, reduced contrast sensitivity, and the possibility of needing additional corrective eyewear for certain tasks.

What is the life expectancy of an intraocular lens?

The life expectancy of an intraocular lens is designed to be lifelong. IOLs are made from durable materials that do not degrade over time, ensuring long-lasting clear vision after cataract surgery. While complications related to the lens itself are relatively rare, factors such as posterior capsule opacification may affect vision and require additional treatment.

Can you expect 20/20 vision after cataract surgery?

It is possible to achieve 20/20 vision after cataract surgery, but individual outcomes may vary depending on factors such as the type of IOL implanted, preoperative visual acuity, and any ocular comorbidities. In many cases, patients can expect significant improvement in their vision after surgery, with some achieving 20/20

Learn to Compare Procedures

We show you an example of how you can use the App to compare different interventional procedures, such as Micro-monovision with EDoF lens versus implantation of a trifocal intraocular lens with emmetropia oriented target.

Influence of Astigmatism

Influence of Spherical Equiv.

Crystalline lens and Cataracts

Variability in Studies

Demographic Data