Because we have recently received many inquiries, we present our clinic's first case with FineVision HP (POD F GF).
She had noticed difficulty seeing with her left eye for ten years and had been told of a cataract by a local doctor, who did not perform surgery, so she first visited us without a referral letter in March 2023.
As her symptoms suggested, the left eye had dense anterior subcapsular cortical opacity from the nasal side to the center, and corrected visual acuity had fallen to 0.8. Corrected vision in the right eye was still 1.5, but axial length was somewhat short, in the low 23 mm range, and both eyes had shifted toward hyperopia, so she wished to have surgery on both eyes.
She said she had come with Clareon Vivity in mind if she was a candidate, but in the preoperative questionnaire she said she hardly ever drives and wanted to live indoors almost without glasses. When we explained that Vivity's range of clear vision is far to intermediate, so reading glasses would be needed, Vivity dropped off her list by the second visit, and she was torn between FineVision HP (POD F GF) and PanOptix.
Corneal aberration analysis with the OPD-Scan III showed no significant astigmatism and low higher-order aberrations, so it seemed that multifocal function could work well with either of the two trifocal lenses above. We asked her to choose on the basis of PanOptix if she valued distance and FineVision if she valued near, and in the end she chose surgery with FineVision HP because "FineVision's near vision is attractive."
FineVision is a diffractive trifocal lens with a long history and track record, so the constants for power selection should be well optimized. This time, however, the material had changed from hydrophilic to a proprietary glistening-free hydrophobic acrylic, so we could not rule out a change in the constants. We therefore compared several calculation results, as shown below, and prepared candidate lenses. The power closest to emmetropia (zero) was 21.5 D, so, given our experience and the somewhat short axial length, we prepared three lenses, 21.5, 22.0 and 22.5 D, for surgery.
First, left eye surgery. Apart from the uneven cortical opacity, it was an ordinary cataract with little special risk, so lens removal went without problems, and we moved on to measurement with the ORA system, an intraoperative wavefront aberrometer.
Here, a brief explanation of setting the target refraction. Ordinary intraocular lenses are made in 0.50 D steps, so the predicted target refraction is almost never exactly zero. A 0.50 D difference at the lens plane becomes a difference of about 0.35 D at the corneal plane once inside the eye. For example, of target refractions of +0.10 D and −0.25 D, the +0.10 D lens is closer to zero, but if things go as predicted, distance vision at 5 m is usually 1.2 with both. At near, however, that 0.35 D difference means 50 cm (= 1/2.0 D) versus 45 cm (= 1/2.35 D), or 40 cm (= 1/2.5 D) versus 35 cm (= 1/2.875 D). With multifocal lenses it is not clear whether a 0.50 D difference at the lens plane translates directly into a difference in near focal distance, but in our own cases, when we made a slight difference between the two eyes of the same patient, it was almost always reflected in near distance, both objectively and subjectively. Whether patients think "only 5 cm" or "as much as 5 cm at near" varies, but if distance vision is the same, I want to choose a power that makes near even slightly easier for those who wish it, so we set the target accordingly and perform staged implants, one eye at a time.
With this in mind, comparing the preoperative predictions with the ORA results, we used a 22.0 D lens in the left eye (target refraction −0.41 D, toward myopia, by the Barrett Universal II formula in the figure above). I was worried because the refractive error tendency of a lens used for the first time cannot be predicted, so I was relieved when the day after surgery showed almost emmetropia, with a spherical equivalent of −0.125 D. Had we chosen 21.5 D (targeting −0.06 D) without intraoperative wavefront analysis, the eye would have become hyperopic, so this time the ORA system helped us. Moreover, even the day after surgery, she had 1.5 distance / 1.2 near, with quick recovery of vision at both distances, and she was very pleased. To be safe, we had left 10 days before right eye surgery, and to set the target, we tested the left eye again just before right eye surgery: uncorrected near vision at 30 cm was also 1.0, firmly reconfirming FineVision's strength at near. Personally I thought the right eye should naturally have the same target as the left, but she wished, "if possible, set the right eye a little more toward near."
For right eye surgery, too, we chose the lens power while watching the ORA system's wavefront results, so as not to be more toward distance than the left eye and to keep an appropriate difference between the eyes, and the surgery was completed without problems. The right eye's postoperative refraction was slightly toward near, as she wished, and she was satisfied with good vision here too, 1.5 distance / 1.2 near, as expected.
Below are retroillumination photos of FineVision and PanOptix. Can you see the difference in their diffraction grating patterns?
FineVision is, to put it negatively, an old lens, or, positively, a lens with a rich history and track record, and its near vision has long been well regarded. This was our clinic's first case since the material was improved from hydrophilic to a proprietary hydrophobic acrylic, and near vision (or rather sense of distance) was as expected, and recovery of vision after surgery also felt very quick.
The figure below compares the defocus curves of the former hydrophilic FineVision and other multifocal lenses; again, vision at close range, about 33 cm, tends to be better than with lenses such as PanOptix.
The figures also show that halos, glare and starbursts are equivalent to PanOptix (top of the figure below) and that dependence on glasses is very low (middle of the figure below). Whether the improved material affects vision or photic phenomena is still unknown, and we will update this information as it becomes available.
With these features, this old-yet-new FineVision seems suited to people who want life without glasses and value a sense of distance at near but want to avoid starbursts like those of TECNIS Synergy. However, it has been reported that, for the range of clear vision, TECNIS Synergy is somewhat wider than the former FineVision (seeing closer). Unfortunately, as this shows, no multifocal lens is perfect at present; each has strengths and weaknesses, so I think the most important thing for postoperative satisfaction is, as this patient did, to tell your doctor clearly about your lifestyle and what you want to prioritize when choosing a lens.
FineVision is also explained in a previous article, "Introducing the diffractive trifocal lens FineVision HP (POD F GF)" (Japanese), for anyone interested.
https://morohoshi-ganka.com/news/1428
2023.10.04