A meta-analysis of Nd:YAG capsulotomy rates for two hydrophobic intraocular lens materials

Figures & data

Table 1 Published 3-year Nd:YAG capsulotomy rates of different IOLs

Reference	Lens studied (manufacturer)	3-year Nd:YAG rate
This study	AcrySof (Alcon)	4.19%
	Clareon (Alcon)	1.82%
Kahraman et al^Citation60	Tecnis^® ZCB00 (Abbott medical optics)	6.0%
Leydolt et al^Citation59	Tecnis^® ZCB00 (Abbott medical optics)	26.1%
Vasavada et al^Citation58	C-flex^® 570C (Rayner)	12.9%
	Akreos adapt (Bausch & Lomb)	16.1%

Abbreviations: Nd:YAG, neodymium-doped yttrium aluminum garnet; IOLs, intraocular lenses.

Table 2 Data extracted from clinical study reports

Study number	Model	Clareon material	Single piece	Japan	Number of Nd:YAGs	Years	Number of eyes
14	MA30BA	n	n	n	0*	1.17	51
14	MA30BA-CET	n	n	n	0	1.17	51
14	SA30AL	n	y	n	1	1.17	46
15	MA60BM	n	n	n	0	1.17	66
1	SA30AL	n	y	n	1	1.17	287
1	SB30AL	n	y	n	0	1.17	301
2	SA60AT	n	y	n	4	0.50	284
2	SA60T3-5	n	y	n	5	0.50	301
3	MA60BM	n	n	n	6	1.17	375
4	SA60AT	n	y	n	0	0.33	75
4	SN60WF	n	y	n	0	0.33	77
6	SN60T8-9	n	y	n	2	0.50	30
8	SN60WF	n	y	n	2	0.50	268
8	SN6AT2	n	y	n	8	0.50	279
9	SN60WF	n	y	n	10	0.50	328
10	SN60WF/SN6CWS	n	y	n	2	1.17	352
10	SN6AT6-9	n	y	n	8	1.17	456
11	RCA_100	n	y	n	0	0.33	25
11	SN60WF	n	y	n	0	0.33	25
12	SN60WF	n	y	n	1	1.17	20
13	DFT300	n	y	n	2	0.33	35
13	SN6AT3	n	y	n	1	0.33	35
16	Monofocal	n	n	n	0	0.50	200
15	MA60NM	y	n	n	2	3.17	189
5	SY60WF	y	y	n	6	1.22	395
7	SY60WF	y	y	y	0	1.17	110

Note:

* Zero means that no Nd:YAG capsulotomy procedures were performed during the study time frame, ie, a count of zero was observed during the study for that lens model. Credible intervals are marked in parentheses.

Abbreviations: Nd:YAG, neodymium-doped yttrium aluminum garnet; n, no; y, yes.

Table 3 Data extracted from literature review

Row ID	IOL model	Year	Clareon material	Single piece	Japan	Number of Nd:YAGs	Number of years	Number of eyes
1	MA60AC	2015	n	n	n	0	0*	421
1	MA60AC	2015	n	n	n	7	1	421
1	MA60AC	2015	n	n	n	9	3	421
1	MA60AC	2015	n	n	n	5	5	421
1	MA60BM	2015	n	n	y	0	0	5,007
1	MA60BM	2015	n	n	y	65	1	5,007
1	MA60BM	2015	n	n	y	120	3	5,007
1	MA60BM	2015	n	n	y	120	5	5,007
1	MA60BM	2015	n	n	y	151	10	5,007
2	MA60BM	2015	n	n	n	0	0	1,501
2	MA60BM	2015	n	n	n	41	6	1,501
2	SN60AT	2015	n	y	n	0	0	1,399
2	SN60AT	2015	n	y	n	41	3	1,399
3	MA30BA	2011	n	n	n	0	0	31
3	MA30BA	2011	n	n	n	3	3	31
3	SA30AL	2011	n	y	n	0	0	31
3	SA30AL	2011	n	y	n	1	3	31
4	MA60BM	2010	n	n	n	0	0	240
4	MA60BM	2010	n	n	n	49	10	240
5	MA60AC	2009	n	n	n	0	0	247
5	MA60AC	2009	n	n	n	9	2	247
6	MA60BM	2009	n	n	n	0	0	50
6	MA60BM	2009	n	n	n	4	5	50
7	MA60BM	2009	n	n	n	0	0	99
7	MA60BM	2009	n	n	n	42	10	99
8	MA60BM	2009	n	n	n	0	0	22
8	MA60BM	2009	n	n	n	6	6	22
9	MA60	2008	n	n	y	0	0	45
9	MA60	2008	n	n	y	1	1	45
10	MA60BM	2008	n	n	n	0	0	139
10	MA60BM	2008	n	n	n	3	3	139
11	MA30AC	2007	n	n	n	0	0	30
11	MA30AC	2007	n	n	n	0	2	30
12	MA60BM/MA60MA	2006	n	n	y	0	0	83
12	MA60BM/MA60MA	2006	n	n	y	3	2	83
13	MA30BA	2004	n	n	n	0	0	6,575
13	MA30BA	2004	n	n	n	72	1	6,575
13	MA30BA	2004	n	n	n	112	2	6,575
13	MA30BA	2004	n	n	n	151	3	6,575
13	MA30BA	2004	n	n	n	165	4	6,575
13	MA30BA	2004	n	n	n	184	5	6,575
13	MA30BA	2004	n	n	n	190	6	6,575
13	MA30BA	2004	n	n	n	0	7	6,575
13	MA60BM	2004	n	n	n	0	0	376
13	MA60BM	2004	n	n	n	7	1	376
13	MA60BM	2004	n	n	n	8	2	376
13	MA60BM	2004	n	n	n	17	3	376
13	MA60BM	2004	n	n	n	9	4	376
13	MA60BM	2004	n	n	n	14	5	376
13	MA60BM	2004	n	n	n	5	6	376
13	MA60BM	2004	n	n	n	0	7	376
13	SA30AL	2004	n	y	n	0	0	2,024
13	SA30AL	2004	n	y	n	20	1	2,024
13	SA30AL	2004	n	y	n	23	2	2,024
13	SA60AT	2004	n	y	n	0	0	1,406
13	SA60AT	2004	n	y	n	13	1	1,406
14	MA30AC/MA60AC	2005	n	n	n	0	0	247
14	MA30AC/MA60AC	2005	n	n	n	7	1	247
14	MA30AC/MA60AC	2005	n	n	n	2	2	247
14	SA30AL/SA60AT	2005	n	y	n	0	0	187
14	SA30AL/SA60AT	2005	n	y	n	11	1	187
14	SA30AL/SA60AT	2005	n	y	n	3	2	187
15	MA60BM	2005	n	n	n	0	0	29
15	MA60BM	2005	n	n	n	0	1	29
15	MA60BM	2005	n	n	n	1	2	29
15	MA60BM	2005	n	n	n	0	3	29
16	Acrysof	2004	n	n	n	0	0	421
16	Acrysof	2004	n	n	n	30	3	421
17	MA30BA	2004	n	n	n	0	0	94
17	MA30BA	2004	n	n	n	1	1	94
17	SA30AL	2004	n	y	n	0	0	38
17	SA30AL	2004	n	y	n	0	1	38
18	MA30BA	2004	n	n	n	0	0	267
18	MA30BA	2004	n	n	n	0	3	267
18	SA30AL	2004	n	y	n	0	0	252
18	SA30AL	2004	n	y	n	0	3	252
19	MA60BM	2004	n	n	n	0	0	127
19	MA60BM	2004	n	n	n	1	1	127
20	MA60BM/MA30BA	2003	n	n	n	0	0	107
20	MA60BM/MA30BA	2003	n	n	n	0	1	107
20	MA60BM/MA30BA	2003	n	n	n	2	2	107
20	MA60BM/MA30BA	2003	n	n	n	1	3	107
21	MA60BM	2003	n	n	n	0	0	38
21	MA60BM	2003	n	n	n	3	2	38
22	MA60	2003	n	n	n	0	0	38
22	MA60	2003	n	n	n	1	1	38
23	MA30BA	2003	n	n	n	0	0	156
23	MA30BA	2003	n	n	n	17	3	156
24	MA30BA	2003	n	n	n	0	0	335
24	MA30BA	2003	n	n	n	9	2	335
25	MA60MA	2002	n	n	n	0	0	485
25	MA60MA	2002	n	n	n	12	2	485
26	MA30	2002	n	n	n	0	0	56
26	MA30	2002	n	n	n	5	1	56
27	MA60BM/MA30BA	2002	n	n	n	0	0	108
27	MA60BM/MA30BA	2002	n	n	n	3	2	108
28	MA60BM	2002	n	n	n	0	0	40
28	MA60BM	2002	n	n	n	3	2	40
29	MA60BM	2001	n	n	y	0	0	96
29	MA60BM	2001	n	n	y	4	2	96
30	MA30BA	2001	n	n	y	0	0	85
30	MA30BA	2001	n	n	y	3	1	85
31	MA60BM	2000	n	n	n	0	0	32
31	MA60BM	2000	n	n	n	0	1	32
31	MA60BM	2000	n	n	n	0	3	32
32	MA60BM	2000	n	n	y	0	0	761
32	MA60BM	2000	n	n	y	11	1	761
32	MA60BM	2000	n	n	y	43	3	761
33	MA60BM	1999	n	n	n	0	0	19
33	MA60BM	1999	n	n	n	0	3	19
34	MA60BM	1998	n	n	n	0	0	73
34	MA60BM	1998	n	n	n	2	2	73
35	SA60AT	2016	n	y	n	0	0	59
35	SA60AT	2016	n	y	n	3	1	59
35	SA60AT	2016	n	y	n	3	2	59
36	SN60WF	2014	n	y	n	0	0	375
36	SN60WF	2014	n	y	n	28	3	375
37	SA60AT	2013	n	y	n	0	0	29
37	SA60AT	2013	n	y	n	3	5	29
38	SA60AT	2013	n	y	n	0	0	23
38	SA60AT	2013	n	y	n	5	3	23
39	SN60WF	2013	n	y	n	0	0	696
39	SN60WF	2013	n	y	n	10	2	696
40	SA60AT	2012	n	y	n	0	0	68
40	SA60AT	2012	n	y	n	0	3	68
41	SN60AT	2011	n	y	n	0	0	47
41	SN60AT	2011	n	y	n	1	2	47
41	SN60WF	2011	n	y	n	0	0	47
41	SN60WF	2011	n	y	n	2	2	47
42	SA60AT	2011	n	y	n	0	0	63
42	SA60AT	2011	n	y	n	1	2	63
43	SA60AT	2011	n	y	n	0	0	23
43	SA60AT	2011	n	y	n	0	2	23
44	SN60WF	2010	n	y	n	0	0	275
44	SN60WF	2010	n	y	n	16	2	275
45	SA60AT	2009	n	y	n	0	0	250
45	SA60AT	2009	n	y	n	30	3	250
46	SN60AT	2009	n	y	n	0	0	75
46	SN60AT	2009	n	y	n	13	1	75
46	SN60WF	2009	n	y	n	0	0	75
46	SN60WF	2009	n	y	n	3	1	75
47	SA60AT	2009	n	y	n	0	0	100
47	SA60AT	2009	n	y	n	1	1	100
47	SA60AT	2009	n	y	n	3	2	100
48	SA60AT	2009	n	y	n	0	0	92
48	SA60AT	2009	n	y	n	2	3	92
49	SA60AT	2008	n	y	n	0	0	58
49	SA60AT	2008	n	y	n	6	2	58
50	SA60AT	2006	n	y	n	0	0	59
50	SA60AT	2006	n	y	n	4	1	59

Note:

* Zero events were reported at baseline to force the model fit to also have an incidence of zero at baseline.

Abbreviations: IOL, intraocular lens; Nd:YAG, neodymium-doped yttrium aluminum garnet; n, no; y, yes.

Table 4 Parameter estimates and credible intervals

Parameter	Mean	SD	95% Lower credible limit	95% Upper credible limit
β0	−4.52	0.14	−4.80	−4.24
βJP	−0.11	0.14	−0.38	0.18
βClareon	−0.95	0.47	−1.88	−0.04
βSP	0.52	0.07	0.38	0.66
βLR	0.16	0.10	−0.03	0.35

Figure 1 Combined probability of a Nd:YAG by time for literature review, Alcon AcrySof and Clareon studies.

Abbreviation: Nd:YAG, neodymium-doped yttrium aluminum garnet.

Table 5 Probability (%) of an Nd:YAG in 3 years

Factor	AcrySof	Clareon	Difference
Literature review	4.53 (3.50 to 5.75)	1.97 (0.68 to 4.32)*	2.55 (0.20 to 4.21)
Alcon studies	3.89 (2.91 to 5.09)	1.68 (0.58 to 3.71)	2.20 (0.17 to 3.73)
Difference	0.64 (−0.07 to 1.41)	0.29 (−0.02 to 0.89)	0.35 (−0.07 to 0.92)
Japan	4.01 (2.82 to 5.54)	1.74 (0.59 to 3.96)	2.27 (0.17 to 3.91)
Non-Japan	4.41 (3.50 to 5.44)	1.92 (0.68 to 4.18)	2.49 (0.20 to 4.08)
Difference	−0.40 (−1.40 to 0.75)	−0.18 (−0.80 to 0.35)	−0.22 (−0.89 to 0.46)
Multi-piece	3.28 (2.51 to 4.18)	1.42 (0.49 to 3.15)	1.86 (0.15 to 3.10)
Single-piece	5.36 (4.12 to 6.85)	2.34 (0.81 to 5.09)	3.01 (0.23 to 5.00)
Difference	−2.08 (−2.92 to −1.37)	−0.92 (−2.06 to −0.31)	−1.15 (−2.03 to −0.09)
Overall	4.19 (3.24 to 5.30)	1.82 (0.63 to 4.02)	2.37 (0.18 to 3.91)

Notes:

* Estimated from model parameters (no published literature on Clareon currently exists). Credible intervals are marked in parentheses. Bold values represent results combined over subgroups.

Abbreviation: Nd:YAG, neodymium-doped yttrium aluminum garnet.

Table 6 Average number of cases expected per 100 surgeries per year (incidence)

Factor	AcrySof	Clareon	Difference
Literature review	1.58 (1.21 to 2.04)	0.68 (0.23 to 1.50)*	0.91 (0.07 to 1.50)
Alcon studies	1.35 (1.00 to 1.79)	0.57 (0.19 to 1.28)	0.78 (0.06 to 1.32)
Difference	0.23 (−0.03 to 0.52)	0.10 (−0.01 to 0.32)	0.13 (−0.03 to 0.35)
Japan	1.39 (0.97 to 1.96)	0.59 (0.20 to 1.38)	0.80 (0.06 to 1.40)
Non-Japan	1.54 (1.21 to 1.92)	0.65 (0.23 to 1.46)	0.88 (0.07 to 1.44)
Difference	−0.14 (−0.50 to 0.28)	−0.06 (−0.29 to 0.12)	−0.08 (−0.33 to 0.18)
Multi-piece	1.13 (0.86 to 1.46)	0.48 (0.17 to 1.08)	0.65 (0.05 to 1.08)
Single-piece	1.89 (1.43 to 2.46)	0.80 (0.27 to 1.79)	1.09 (0.09 to 1.81)
Difference	−0.76 (−1.09 to −0.50)	−0.32 (−0.75 to −0.10)	−0.44 (−0.77 to −0.03)
Overall	1.46 (1.12 to 1.87)	0.62 (0.21 to 1.40)	0.84 (0.07 to 1.39)

Notes:

* Estimated from model parameters. Bold values represent results combined over subgroups.

Figure 2 Forest plot comparing probability per person-year for Clareon and AcrySof studies from the Alcon internal clinical database (top 3 bars are Clareon data).

Notes: Order of bars is reverse from the study data listed in Table 2. The red bar is the Clareon overall mean and blue bar is the AcyrSof overall mean.
Abbreviation: Nd:YAG, neodymium-doped yttrium aluminum garnet.

Figure 3 Forest plot comparing probability per person-year for internal Clareon studies and published literature studies on AcrySof (top 3 bars are Clareon data).

Notes: Order of bars is reverse from the study data listed in Table 3. The red bar is the Clareon overall mean and the blue bar is the AcyrSof overall mean.
Abbreviation: Nd:YAG, neodymium-doped yttrium aluminum garnet.

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