Rotational Stability of the Clareon PanOptix Toric (CNWTTx) Hydrophobic Multifocal IOL: Real-World Clinical Outcomes

Purpose: To assess and validate rotational stability and visual outcomes data of the CNWTTx (Clareon ® PanOptix ® ) Toric multifocal intraocular lens (IOLs) in routine clinical practice. Methods: In this prospective, single-centre, real-world, confirmatory study, CNWTTx was implanted in 40 eyes from 22 patients that underwent bilateral routine phacoemulsification. Manifest refraction, uncorrected vision at distance (UDVA), intermediate (UIVA) and near at 40 cm (N-40) and 33 cm (N-33) were measured at 4– 6 weeks and 12-weeks postoperatively. Quality of vision was assessed using the Near Acuity Visual Questionnaire (NAVQ), stereoacuity and contrast sensitivity (CS). Toric alignment was primarily measured using slit lamp examination at 1 hour, 1 week, 4– 6 weeks and 12 weeks postoperatively. Rotational stability was assessed by measuring change in toric alignment from target axis at each time point. iTrace was used as an exploratory method of assessing IOL rotation. Results: Mean absolute and actual rotation at 12 weeks was 3.4° and − 1.3°, respectively, with 85% of eyes achieving ≤ 5° of rotation. Monocular uncorrected visual acuity was 0.06 ± 0.09, 0.1 ± 0.14, 0.13 ± 0.11 and 0.14 ± 0.11 LogMAR at 6 m, 60 cm, 40 cm and 33 cm, respectively. Postoperative spherical equivalent at 12 weeks was − 0.15 ± 0.28 D. NAVQ score increased significantly following surgery, and contrast sensitivity and stereoacuity were well maintained compared to age-normal values. Conclusion: Accurate visual and refractive outcomes were achieved with CNWTTx in this cohort, and the lens remained stable from 1 week following implantation. This was consistent with the high patient-reported satisfaction despite visual phenomena inherent to diffractive IOLs. However, the percentage of eyes achieving ≤ 5° of rotation within this cohort was 5% lower than the ANSI Z80.30 standard, which was likely due to the small sample size of this study. Future studies with larger sample size are warranted to fully ascertain the lens’ performance against the ANSI Z80.30 benchmark. Plain Language Summary: While offering patients a greater degree of spectacle independence following surgery, multifocal intraocular lenses (IOLs) require precise placement in the eye and to remain stable for optimal outcomes. The CNWTTx IOL is composed of a newer material than that of its predecessor, the TFNT00 toric IOL. It is unclear how this new material affects its stability within the eye. We followed 40 eyes from 22 patients who had received the CNWTTx IOL and measured its position within the eye at 1 hour, 1 week, 4– 6 weeks and 3 months. We found that the majority of eyes rotated ≤ 5°, largely within 1 week of surgery. Additionally, patients achieved good and predictable visual and refractive outcomes. These findings suggest that the stability of the CNWTTx IOL does not appear to be impacted by the new material and is an effective option for patients wanting spectacle independence.