A prospective comparative study of the AMO ARRAY zonal-progressive multifocal silicone intraocular lens and a monofocal intraocular lens

Visual and optical performance with two different diffractive multifocal intraocular lenses compared to a monofocal lens

PURPOSE

To compare the visual acuity outcomes as well as the ocular optical performance of eyes implanted with either a monofocal or one of two diffractive multifocal intraocular lenses (IOLs).

METHODS

One hundred two consecutive eyes of 51 bilateral cataract patients (age 49 to 80 years) were divided into three groups: 22 eyes were implanted with a monofocal IOL (monofocal group), 40 eyes with the Acrysof ReSTOR SN6AD3 IOL (ReSTOR group), and 40 eyes with the Acri.Lisa 366D IOL (Acri.Lisa group). Visual acuity and contrast sensitivity were evaluated pre- and postoperatively. Additionally, ocular optical quality and intraocular aberrations were evaluated postoperatively.

RESULTS

Significant improvement after surgery in uncorrected and corrected distance and near visual acuity was observed in all three groups (P≤.05). Uncorrected near visual acuity was significantly better in eyes from the ReSTOR and Acri.Lisa groups compared to the monofocal group (P≤.01). Photopic contrast sensitivity was significantly better for the spatial frequency of 3 cycles/degree in the monofocal group (P<.01). Significantly higher values of the ocular Strehl ratio and cutoff modulation transfer function spatial frequency were also found in the Acri.Lisa group (P=.01). An acceptable range of vision between near and distance peaks was observed in the defocus curves of the ReSTOR and Acri.Lisa groups.

CONCLUSIONS

The AcrySof ReSTOR and Acri.Lisa 366D IOLs are able to successfully restore near and intermediate visual function after cataract surgery; however, the Acri.Lisa design seems to provide better optical performance. These results need to be confirmed in a randomized, prospective trial.

Visual performances with monofocal, accommodating, and multifocal intraocular lenses in patients with unilateral cataract

PURPOSE

To compare the visual performance of patients with unilateral cataract following implantation of monofocal, accommodating, refractive, and diffractive multifocal intraocular lenses (IOL).

DESIGN

Prospective nonrandomized clinical trial.

METHODS

Eighty-seven patients with unilateral cataract were enrolled in 4 groups for phacoemulsification and IOL implantation. Twenty-four patients had monofocal (Alcon Acrysof) (group 1), 21 patients had accommodating (Human Optics 1CU) (group 2), 22 patients had diffractive multifocal (Tecnis ZM900) (group 3), and 20 patients had refractive multifocal (AMO Rezoom) (group 4) IOL implantations. Ages of patients were between 40 and 70. Parameters analyzed at the 18th postoperative month were subjective refractions, monocular and binocular distance, intermediate and near uncorrected visual acuities, monocular distance and near best-corrected visual acuities, monocular distance-corrected intermediate and near visual acuities, stereopsis, visual complaints, and spectacle dependency.

RESULTS

No significant difference was observed between distance and near best-corrected visual acuities of IOL groups, and between intermediate visual acuities of groups 2, 3, and 4. Groups 3 and 4 had statistically better near vision than the other groups (P < .05). No significant difference was observed between near visual acuities of groups 3 and 4. Number of patients with better stereoscopic function, spectacle independence, and complaints of halo in groups 3 and 4 was significantly higher than in other groups (P < .05).

CONCLUSIONS

Multifocal IOLs provide better stereopsis, higher spectacle independence rates, and satisfactory functional vision over a broad range of distances in presbyopic patients with unilateral cataract compared with the monofocal and accommodating IOLs.

Visual and optical performance with hybrid multifocal intraocular lenses

During the past years, the wish to become independent of spectacles has been growing among cataract and presbyopic patients due to many factors, such as the increase in near visual demands, the aesthetic need for a spectacle-free image and ageing of refractive surgery patients, among others. This review assesses recently published studies that analyse visual and optical performance through different metrics of eyes implanted with multifocal intraocular lenses (IOLs), particularly hybrid IOL designs. The published evidence suggests that hybrid multifocal IOLs provide very good outcomes in a number of visual and optical performance parameters. Patients implanted with this type of IOL obtain a satisfactory full range of visual functions, including patients of particular characteristics such as highly ametropic or post-LASIK.

Biconvex posterior chamber accommodating intraocular lens implantation after cataract surgery: long-term outcomes

PURPOSE

To evaluate the long-term efficacy of a biconvex accommodating intraocular lens (IOL) to restore near visual performance.

SETTING

Department of Ophthalmology, Keio University Hospital, Tokyo, Japan.

METHODS

This 4-year study comprised eyes that had cataract surgery with implantation of a 1CU accommodating IOL. At all postoperative visits, the following were assessed: subjective spherical equivalent (SE) refraction; uncorrected (UDVA) and corrected (CDVA) distance visual acuities; uncorrected (UNVA), distance-corrected (DCNVA), and corrected (CNVA) near visual acuities; change in minimum additional (add) power (diopters) to attain CNVA; and accommodation amplitude. A questionnaire was administered at the last visit.

RESULTS

Twelve eyes of 8 cataract patients (mean age 59.0 years +/- 18.4 [SD]) were evaluated. Postoperatively, the mean SE at 1 year and 4 years was significantly more hyperopic than at 1 month (P<.05). The mean UDVA increased significantly at 4 years compared with 1 month (P<.05). There were no significant changes in CDVA, UNVA, CNVA, and DCNVA throughout the follow-up period. The change in the minimum add power to attain CNVA and in the subjective and objective accommodation amplitudes also did not change significantly over time. Eighty-three percent of patients reported being satisfied with the results.

CONCLUSION

Four years after implantation of an accommodating IOL, most patients had good vision and were satisfied, although the accommodation amplitude for near vision was not sufficient throughout the follow-up.

Visual function after monocular implantation of apodized diffractive multifocal or single-piece monofocal intraocular lens Randomized prospective comparison

PURPOSE

To compare visual function after phacoemulsification with implantation of a multifocal intraocular lens (IOL) or a monofocal IOL.

SETTING

Department of Ophthalmology, Affiliated Hospital of Qingdao University Medical College, Qingdao, Shandong, China.

METHODS

This study comprised patients with unilateral cataract who had phacoemulsification with implantation of an AcrySof ReSTOR SA60D3 multifocal IOL (multifocal group) or an AcrySof SA60AT single-piece monofocal IOL (monofocal group). Postoperative visual function, including uncorrected (UDVA) and corrected (CDVA) distance visual acuity; uncorrected (UNVA), corrected (CNVA), and distance-corrected near visual acuity; and contrast sensitivity were evaluated 1 week, 1 month, and 6 months postoperatively. Patient-reported vision and spectacle independence in the 2 groups were also compared.

RESULTS

Of the 161 eyes, 72 were in the multifocal group and 89 were in the monofocal group. The multifocal group had statistically significant better UNVA than the monofocal group from 1 week postoperatively to the final follow-up and statistically significant better CNVA at 6 months (both P<.05). There were no statistically significant differences in UDVA or CDVA between the 2 groups over the 6-month follow-up. The multifocal group had statistically significantly better pseudoaccommodation than the monofocal group; the monofocal group had significantly better contrast sensitivity (both P<.05). Patients with the multifocal IOL reported being more satisfied than those with the monofocal IOL.

CONCLUSIONS

The multifocal IOL provided better near visual acuity and more spectacle independence than the monofocal IOL.

Optical performance in rezoom and array multifocal intraocular lenses in vitro

PURPOSE

To investigate the modulation transfer function (MTF) of two refractive multifocal intraocular lenses (IOLs).

METHODS

The ReZoom and Array (AMO) multifocal IOLs were evaluated using the OPAL Vector system (Image Science Ltd) and a model eye with a variable aperture (2.1 to 5.5 mm). Modulation transfer functions were evaluated at distant, near, and intermediate (-1.50 diopter defocus) focus lengths.

RESULTS

The ReZoom IOL distant focus MTF for a 5.1-mm effective diameter was higher than that of the Array IOL. At intermediate distance, the ReZoom lens showed a slight increase compared with the Array. The near focus MTF for the ReZoom IOL began to increase at an effective diameter of 2.1 mm and remained constant for diameters > 3.45 mm.

CONCLUSIONS

The ReZoom IOL gave better image quality than the Array, particularly at distant focus. To enhance near vision with the ReZoom lens, the desirable real pupil diameter should be at least 3.45 mm.

Apodized diffractive versus refractive multifocal intraocular lenses: optical and visual evaluation

PURPOSE

To evaluate the optical and visual performance after implantation of refractive or apodized diffractive multifocal intraocular lenses (IOLs).

SETTING

Military Health Service Institute, Warsaw, Poland.

METHODS

Uncorrected distance visual acuity, best distance-corrected visual acuity, best distance-corrected near visual acuity, distance contrast sensitivity under photopic conditions (CSV-1000), residual refractive error, and wavefront aberrations (LADARWave Hartmann-Shack wavefront analyzer) were measured in 23 patients who had bilateral implantation of the AcrySof ReSTOR SN60D3 IOL and 23 patients who had bilateral implantation of the ReZoom IOL....

RESULTS

At the 6-month postoperative visit, the mean photopic uncorrected distance acuity was 0.03+/-0.05 (SD) in the ReSTOR group and 0.02+/-0.06 logMAR in the ReZoom group (both approximately 20/20) (P= .569). In all patients, the mean photopic best distance-corrected acuity was 0.00 logMAR (approximately 20/20) and the mean photopic best distance-corrected near acuity at 35 cm was 0.10 logMAR. The photopic contrast sensitivity was within the standard normal range in both IOL groups. The difference in photopic contrast sensitivity between groups was statistically significant (P<.001). Higher-order aberrations, in particular coma and spherical aberrations, were significantly higher in the ReZoom group (all P<.001).

CONCLUSIONS

AcrySof ReSTOR SN60D3 and ReZoom IOLs provided good visual performance at distance and near under photopic conditions. Optical quality measures were significantly worse in patients with ReZoom IOLs.

Post-capsulotomy dysphotopsia in monofocal versus multifocal lenses

PURPOSE

To compare the photic symptoms experienced by patients with the monofocal SI30 intraocular lens (IOL) with the refractive multifocal SA40 Array IOL after capsulotomy.

METHODS

In this prospective cohort study, 49 eyes of 49 patients (20 multifocal, 29 monofocal IOLs) were assessed following uncomplicated cataract extraction and Nd:YAG capsulotomy equal to the scotopic pupillary diameter. Subjects with post-operative refraction of +/-1.00 or more DS, +/-1.00 or more DC, concurrent ocular pathology, LogMAR acuity of worse than 0.3 for distance or 1.0 for near were excluded. Glare and halo were assessed objectively with computer-generated psychophysical tests (Glare and Halo) and subjective dysphotopic symptoms were evaluated with Tester, Javitt, Winther-Neilsen and Sedgewick questionnaires.

RESULTS

No significant difference was found for mean halo size (square degrees) between monofocals (121.33) and multifocals (97.32, p = 0.207) or for mean glare (percentage contrast), monofocals (7.881) and multifocals (7.353, p = 0.812). No significant differences in the subjective appreciation of dysphotopsia were found: Tester (p = 0.358), Javitt (p = 0.29), Winther-Neilson (p = 0.54) and Sedgewick questionnaires (p = 0.134).

CONCLUSION

The posterior capsule is an important optical medium, which has not been fully considered in other comparative studies and its complete removal eliminates any confounding contribution. The results suggest that after capsulotomy, there is no significant difference in objective or subjective photic phenomena between monofocal and multifocal silicone lenses. Dysphotopic symptoms in patients with refractive multifocal IOLs were comparable to monofocal IOL patients after capsulotomy.

A European survey of patient satisfaction with spectacles after cataract surgery and the associated costs in four European countries (france, Germany, Spain, and Italy)

With multifocal intraocular lenses, the majority of the patients do not wear glasses after cataract surgery which is a potential source of savings.

PURPOSE

To collect data in four European countries on the associated costs for society of wearing spectacles after cataract surgery and the patient willingness to pay to be free of spectacles.

METHODS

Cross-sectional survey of centers that recruited patients who wore refractive spectacles after cataract surgery. Costs were expressed in 2006 Euros Results: 408 patients were recruited by 22 centers. Patients with a mean age of 68.5 years underwent cataract surgery about 3 years prior to recruitment. In all countries, prescribed lenses were mainly mono-focal and the mean cost of spectacles was EUR366.3. Half the patient population with private health insurance was reimbursed for spectacles at a level of 50%, except Spanish patients who were reimbursed at only 5.3%. However, a large part of the cost was directly paid by the patients. Out of a total mean cost of EUR354.9, patients paid EUR285.2 and health insurances only EUR69.7. More than half the patients were willing to pay at least 0.5EUR/day to be free of spectacles.

CONCLUSION

Large differences were found among the 4 countries. Almost half of all subjects had private health insurance. The total cost of refraction includes a variety of resources not limited to spectacles. A large part of the cost was borne by patients and there is a high patient willingness to pay to be free of spectacles in this population.

Modelling lifetime cost consequences of ReSTOR in cataract surgery in four European countries

BACKGROUND

To compare the lifetime costs of liberating patients from spectacles after cataract surgery by implanting the multifocal intraocular lens (IOL) 'ReSTOR' versus monofocal IOLs in France, Italy, Germany and Spain.

METHODS

A Markov model was created to follow patient cohorts from cataract surgery until death. Prevalence rates of patients not needing spectacles after cataract surgery were obtained from clinical trials. Resource utilisation included implant surgery, IOLs, spectacles, visits to ophthalmologists and eye centres, transport, and time lost by patients. Economic perspectives were those of Society and Sickness Funds (SFs).

RESULTS

The mean number of spectacles purchased after ReSTOR was 1.34-1.61 and after monofocal IOLs 6.05-7.27. From the societal perspective, total cost estimates discounted by 3% were between 3,551 euros and 4,052 euros with ReSTOR compared to 3,989 euros and 5,548 euros with monofocal IOLs. Undiscounted savings related to ReSTOR ranged from 815 euros to 2,164 euros. From the SFs' perspective total cost estimates discounted by 3% were between 2,150 euros and 2,524 euros with ReSTOR compared to 2,324 euros and 2,610 euros with monofocal IOLs. Savings related to ReSTOR, once costs discounted, ranged from 61 euros to 219 euros. Discount and spectacle freedom prevalence rates were the most sensitive parameters.

CONCLUSION

The bulk of the savings related to ReSTOR were realized outside the SF. From both a societal and SF perspective, savings, after a 3% discounting, achieved by liberating patients from spectacles counterbalanced the initially higher cost of ReSTOR. ReSTOR is a cost saving alternative to spectacles for patients requiring cataract surgery.

Clinical evaluation of accommodative intraocular lens implantation in high myopic eyes

PURPOSE

To compare the clinical outcome of AT-45 implantation between high myopic eyes and non-high myopic eyes.

METHODS

Retrospective, non-randomized, comparative trial. The medical charts of 28 patients with 35 eyes who had phacoemulsification and AT-45 implantation were retrospectively reviewed. 13 eyes of 10 patients were included in the high myopic group (axial length > or = 26.0 mm) and 22 eyes of 18 patients were included in the non-high myopic group. The clinical data included unilateral best-corrected visual acuity (BCVA) and distance-corrected near visual acuity (DCNVA) at 6 months follow-up after the surgery. The results were compared between the two groups.

RESULTS

In the non-high myopic group, 22 eyes (100%) and 19 eyes (86.4%) achieved a BCVA of 20/25 and 20/20 or better respectively. For the high myopic group, the results were 13 eyes (100%) and 12 eyes (92.3%) respectively, at 6 months after the surgery. In the non-high myopic group, 21 (95.4%) and 7 eyes (31.8%) achieved a DCNVA of 20/40 and 20/25 or better. For the high myopic group, the results were 13 (100%) and 4 eyes (30.8%) respectively, at 6 months after the surgery, the differences between the two groups for a BCVA of 20/25 or better and 20/20 or better and a DCNVA 20/40 or better and 20/25 or better were not statistically significant.

CONCLUSIONS

Six months clinical outcome of cataract surgery with an AT-45 for the high myopic eyes was satisfactory; it was not significantly different from that of the non-high myopic eyes.

Refractive lens exchange for presbyopia

True presbyopia correction still remains one of the main challenges amongst eye professionals. Many corrective techniques exist including bifocal spectacle correction, monovision techniques both with corrective lenses and surgery, multifocal corneal excimer laser and refractive lens exchange with either accommodating or multifocal lenses. Refractive lens exchange was first described more than 10 years ago and has become more accepted in recent years with advancements in lens technology and improvements in surgical techniques. This article reviews developments in this field and current available lens options in the treatment of presbyopia.

Patient-reported benefit of ReSTOR multi-focal intraocular lenses after cataract surgery: results of principal component analysis on clinical trial data

Background

Restoration of functional distance and near vision independently of additional correction remains a goal for cataract surgery. ReSTOR^®, a new multi-focal intraocular lens (IOL) addresses this issue with an improvement in both distance and near vision, often without need for glasses. This analysis attempted to discuss the patient-reported benefit of ReSTOR^® using a full but organised representation of data.

Methods

Two non-randomised, open-label clinical trials conducted in Europe and the United-States were conducted to compare the efficacy of ReSTOR^® to AcrySof^® mono-focal IOLs. A total of 710 patients in need of bilateral cataract extraction were included in the pooled study. The TyPE, a patient questionnaire, was fully completed by 672 of them before and after each eye surgery. The TyPE, composed of 67 items measuring overall visual functioning in both conditions (with and without wearing glasses), evaluates limitations, troubles and satisfaction in distance and near vision. A principal component analysis (PCA) of the TyPE questionnaire was performed on pooled data from baseline and post-surgery observations in order to fully represent the change in the TyPE data over time. ReSTOR^® and mono-focal groups were used as illustrative variables. The coordinates of the first 2 factors were compared between visits and between IOLs (ReSTOR^® vs. mono-focal), using paired t-tests and t-tests, respectively.

Results

The first factor of the PCA explained 55% of the variance and represented 'visual functioning and patient satisfaction'. The second factor explained 6% of the variance and was interpreted as 'independence from glasses'. An overall difference in factorial coordinates in both factors was seen between baseline and the first eye surgery, and between the first and the second eye surgery. No difference between ReSTOR^® and mono-focal IOL groups was observed at baseline. After surgery, ReSTOR^® treated-patients had higher coordinates on both "visual functioning and satisfaction" and "independence from glasses" factors. Findings observed on the factorial plan were supported by statistical comparisons of factorial coordinates.

Conclusion

Both mono-focal and ReSTOR^®-implanted patients improved their visual functioning after bilateral cataract surgery. Moreover, ReSTOR^® patients reported an additional benefit in independence from glasses as well as in visual functioning and patient satisfaction.

Pupil size influence on the intraocular performance of the multifocal AMO-Array intraocular lens in elderly patients

PURPOSE

To study the relationship between pupil size and AMO-Array multifocal intraocular lens (MIOL) performance in a population of elderly patients.

METHODS

This prospective trial included 62 patients (mean age 76 years; range 70 to 86) undergoing bilateral cataract phacoemulsification and MIOL (AMO-Array SA-40N, Allergan) implantation. Patients were divided into two groups based on preoperative pupil diameter: small pupil group (pupil size of 2.5-2.9 mm; 45 subjects) and large pupil group (pupil size of 3-5 mm; 17 subjects). The analysis included uncorrected (UC) and best-corrected (BC) near and distance visual acuity (VA), spectacle dependence, and photic phenomena complaints (postoperative follow-up 16.6+/-6.2 months; range 11-26 months).

RESULTS

Patients in the small pupil group showed postoperatively significantly higher distance UCVA and BCVA, but lower near UCVA compared to those in the large pupil group (Mann-Whitney test, p< or = 0.02). Patients with small pupils also tended to: be more (not statistically significant) spectacle independent for distance (73.3% versus 47.1%) and spectacle-dependent for near vision (55.6% versus 28.4%); report significantly less photic phenomena complaints (37.8% versus 93.1%, chisquare test, p<0.001); and, more satisfied with the surgery (95.5% versus 76.5%). Posterior capsular opacification (PCO) was observed in 19.4% of the patients.

CONCLUSIONS

Bilateral AMO-Array MIOL implantation in elderly patients seems to be an effective and safe surgical procedure that improves distance and near UCVA, providing spectacle independence in many cases. The use of these MIOLs, however, can induce photic phenomena and cause PCO. Patients with small preoperative pupils (<3 mm) presented less photic phenomena complaints and expressed a higher visual outcome satisfaction after surgery.

Visual performance of patients with bilateral vs combination Crystalens, ReZoom, and ReSTOR intraocular lens implants

PURPOSE

To compare the visual performance of patients with bilateral vs combination Crystalens, ReZoom, and ReSTOR intraocular lens (IOLs) implants.

DESIGN

Prospective, nonrandomized study.

METHODS

Forty-nine patients were implanted with bilateral Crystalens (Eyeonics, Aliso Viejo, California, USA), ReSTOR (Alcon Laboratories, Fort Worth, Texas, USA), and ReZoom (American Medical Optics, Santa Clara, California, USA) or combined Crystalens and ReSTOR or Crystalens and ReZoom IOLs after phacoemulsification. Monocular and binocular testing four to six months after surgery included uncorrected and best-spectacle corrected visual acuity at distance, intermediate, and near vision; mesopic contrast sensitivity function with and without glare; and quality-of-life and vision surveys six months after surgery.

RESULTS

Monocular testing showed that eyes with Crystalens accommodating IOL had statistically better best-spectacle corrected distance, uncorrected and distance-corrected intermediate, and best-corrected near vision. Eyes with the ReSTOR multifocal IOL had better uncorrected near vision, required the lowest reading add, and had the lowest uncorrected and distance-corrected intermediate vision. Monocular mesopic contrast sensitivity with and without glare was better with the Crystalens IOL vs either multifocal IOL at specific spatial frequencies. The binocular subjective quality of vision and quality of life questionnaires were favorable for the bilateral Crystalens group.

CONCLUSIONS

Any combination of Crystalens in one or both eyes was better for intermediate vision. Any combination of ReSTOR in one or both eyes was better for near vision. The Crystalens and ReSTOR combination had better mean intermediate and near vision overall. A multifocal IOL in one or both eyes was associated with lower contrast sensitivity and more subjective reports of photic phenomena. The accommodating and multifocal IOL combinations elicited less night glare symptoms than in patients with either bilateral multifocal IOL, but more than with bilateral Crystalens implantation.

Objective Accommodation Measurement with the Grand Seiko and Hartinger Coincidence Refractometer

PURPOSE

Subjective push-up tests and dynamic retinoscopy are standard clinical accommodation tests. These are inadequate for assessing if accommodation can be restored in presbyopes. Commercially available clinical autorefractors offer potentially reliable methods for objective accommodation measurement. This study evaluated accuracy and reliability of the Grand Seiko WR-5100K autorefractor for objective accommodation measurement in young adults.

METHODS

Twenty-two subjects, aged 21 to 30 years (mean 25.6 +/- 2.26) participated. Three methods were used to stimulate and measure accommodation: (1) subjective push-up test in free space, (2) a near target pushed-up on a near-point rod and the response measured with the WR-5100K and a Hartinger coincidence refractometer (HCR), and (3) a distant target viewed through increasing powered negative trial lenses and the response measured with the WR-5100K and the HCR. Trial lens calibration procedures were also used to test the accuracy of the instruments.

RESULTS

Average maximum accommodative amplitude with the subjective push-up test was 7.74 D +/- 0.36 D (mean +/- SE). For a 5 D stimulus, accommodation of 4.68 D +/- 0.10 D (mean +/- SE) and 4.13 D +/- 0.09 D was measured with the WR-5100K and the HCR, respectively. With a distant target viewed through a -5.00 D trial lens, the WR-5100K measured 4.07 D +/- 0.09 D and the HCR measured 4.05 D +/- 0.09 D of accommodation. Maximum mean response measured with trial lens-induced accommodation was 5.67 D +/- 0.15 D with the WR-5100K and 5.77 D +/- 0.18 D with the HCR.

CONCLUSIONS

The subjective push-up test overestimated accommodative amplitude relative to the objective measures. The WR-5100K showed good agreement in the responses measured for both pushed-up near targets and a distant target viewed through trial lenses with the HCR, a widely used laboratory instrument. The Grand Seiko WR-5100K, a commercially available instrument, has been demonstrated to be well suited for clinical, objective accommodation measurement using a population of normal young adults.

Comparison of higher-order aberration and contrast sensitivity in monofocal and multifocal intraocular lenses

PURPOSE

The visual performance of pseudophakic eyes depends on the type of intraocular lenses (IOLs) that are implanted. Aspherical and multifocal IOLs have recently been developed to improve visual quality after cataract surgery, but multifocal IOLs can be associated with decreased contrast sensitivity (CS), halos, and glare. This study compares the visual performance of monofocal and multifocal IOLs by measurement of higher-order aberrations (HOAs) and CS values.

MATERIALS AND METHODS

HOAs and CS values of 42 eyes with implanted monofocal IOLs and 40 eyes with implanted multifocal IOLs were measured preoperatively and more than 6 months after surgery. In the multifocal IOL group, HOAs and CS values were also measured with addition of a trial lens of -0.5 diopter (D) to evaluate the compensatory effect on spherical aberration.

RESULTS

CS values of the multifocal IOL group were significantly lower than those of the monofocal IOL group for all spatial frequencies tested (p<0.01), and the spherical aberration was significantly higher in the multifocal IOL group than in the monofocal IOL group (p<0.001). Addition of a -0.5 D lens to the multifocal IOL group decreased the difference in CS between the two groups (p=0.003).

CONCLUSION

Increased spherical aberration may contribute to lower CS in the multifocal IOL group. In such cases, CS can be improved by addition of a -0.5 D lens to compensate for the spherical aberration.

Prospective visual evaluation of apodized diffractive intraocular lenses

PURPOSE

To evaluate distance, intermediate, and near visual performance in patients who had multifocal apodized diffractive intraocular lens (IOL) implantation.

SETTING

Fernández-Vega Ophthalmological Institute, Oviedo, Spain.

METHODS

The best corrected distance visual acuity, best distance-corrected near visual acuity, intermediate visual acuity, distance contrast sensitivity under photopic and mesopic conditions, and patient satisfaction were measured in 325 patients and 335 patients who had bilateral implantation of the model SA60D3 IOL (AcrySof ReSTOR, Alcon) and model SN60D3 IOL (AcrySof Natural ReSTOR), respectively.

RESULTS

At the 6-month postoperative visit, binocular best corrected distance acuity with the ReSTOR IOL and the Natural ReSTOR IOL was 0.034 logMAR+/-0.004 (SD) and 0.019+/-0.020 logMAR, respectively (approximately 20/20). Binocular best distance-corrected near acuity was 0.011+/-0.012 logMAR and 0.035+/-0.013 logMAR, respectively (approximately 20/20). Intermediate visual acuity with both IOL models worsened significantly as a function of the distance of the test (P<.01). Photopic contrast sensitivity was within the standard normal range with both IOLs. Under mesopic conditions, contrast sensitivity with both IOLs was comparable to that with monofocal IOLs and lower, particularly at higher spatial frequencies, than under photopic conditions. No statistically significant differences in visual acuity or photopic and mesopic contrast sensitivity were found between the 2 IOL models (P>.1). A patient satisfaction questionnaire showed that both IOLs performed well and were comparable in satisfaction regarding distance, intermediate, and near activities under different lighting conditions.

CONCLUSIONS

The AcrySof ReSTOR IOL and AcrySof Natural ReSTOR IOL provided good visual performance at distance and near under photopic and mesopic conditions. Intermediate vision with both models was reduced compared with distance and near vision.

Visual performance and biocompatibility of 2 multifocal diffractive IOLs

PURPOSE

To evaluate the distance and near functional capacity, wavefront error and biocompatibility in patients with 2 diffractive multifocal intraocular lenses (MIOLs).

SETTING

Ophthalmology Department of Chieti-Pescara University (Italy).

METHODS

This prospective study comprised 28 eyes of 28 senile cataract patients having phacoemulsification and implantation of the Tecnis ZM900 MIOL (Group 1) and the AcrySof ReSTOR MIOL (Group 2). The main outcome measures, over a 6-month follow-up period, were spherical equivalent, distance visual acuity at high and low contrast, near visual acuity, and defocus curve. Wavefront error was evaluated in both groups. Capsule opacification was also assessed.

RESULTS

The high and low contrast uncorrected and best corrected visual acuity for distance did not show statistically significant differences between the 2 groups. The distance corrected near visual acuity was 1.86 +/- 1.66 in Group 1 and 1.93 +/- 1.12 in Group 2. The depth of focus was 4.5 diopters in both groups. The root mean square of total aberration and of spherical and coma aberrations were significantly lower in Group 1 than in Group 2. A higher percentage of patients with Tecnis MIOLs showed a more severe grade of anterior fibrosis. Posterior opacification was minimal and not significantly different between the 2 groups.

CONCLUSION

Diffractive MIOLs were effective in improving functional capacity for distance and near and provided a good quality of vision due to a significant reduction in spherical aberration, particularly in the Tecnis MIOLs. The higher capsular biocompatibility of the ReSTOR MIOL compared with the Tecnis MIOL could ensure long-term stability.

Functional outcomes after implantation of Tecnis ZM900 and Array SA40 multifocal intraocular lenses

PURPOSE

To evaluate the functional outcome after implantation of the Tecnis ZM900 multifocal intraocular lens (IOL) (AMO) and the Array SA40 multifocal IOL (AMO).

SETTING

Department of Ophthalmology, Bundesknappschaft s Hospital, Sulzbach, and the Department of Ophthalmology, Marienhospital, Aachen, Germany.

METHODS

In a prospective comparative 2-center trial, Tecnis ZM900 and the Array SA40 multifocal IOLs were bilaterally implanted in 50 patients (50 eyes Tecnis, 50 eyes Array) by 1 surgeon at each center. The following parameters were assessed 30 to 60 days and 120 to 180 days after surgery in both eyes: refraction, pupil size, uncorrected and best corrected visual acuities for distance and near at different contrast levels, and photopic and mesopic contrast sensitivity at different spatial frequencies. Patient satisfaction (spectacle independence, photic phenomena, overall satisfaction) was assessed by a questionnaire.

RESULTS

The main differences between the 2 multifocal IOLs were the better uncorrected near visual acuity (P<.001), distance-corrected near visual acuity (P<.001), the mesopic contrast sensitivity at high spatial frequencies (P<.05) as well as greater independence from spectacles in patients with the Tecnis multifocal IOL, resulting in higher levels of patient satisfaction.

CONCLUSION

The aspherical diffractive Tecnis multifocal IOL gave better outcomes than the Array multifocal IOL.

Far and near visual acuity with multifocal intraocular lenses in an optomechanical eye model with imaging capability

PURPOSE

To compare the quantitative and qualitative visual performances of different multifocal intraocular lenses (IOLs) in an experimental model of the human eye.

SETTING

University Hospital San Raffaele, Milan, Italy.

METHODS

Five multifocal IOLs and 1 monofocal IOL were implanted in an optomechanical eye model with imaging capability. The comparative optical characterization of the imaging performance included aberrometry, simulated visual acuity testing at variable contrast for far and near distance, glare tests, and image records of optotype charts.

RESULTS

The maximum recorded far visual acuity for the monofocal IOL was between 20/12.5 and 20/16; the multifocal IOLs decreased visual acuity by 1 to 2 lines. The difference tended to increase at reduced contrast. Full-contrast near visual acuity with multifocal IOLs ranged between 20/63 and 20/25; the near distance performance of the monofocal IOL without an additional correcting lens was worse by 1 to 3 lines of acuity with large pupils but was comparable with small pupils. Multifocal IOLs of different designs showed marked differences as a function of contrast, which tended to balance between far and near behaviors.

CONCLUSIONS

Multifocal IOLs of different optical designs were well characterized and distinguished by simulated contrast acuity testing in an experimental eye model, allowing quantitative comparison. Their overall visual performance, averaged over contrast and distance, was not superior to the performance of a monofocal IOL without an additional correcting lens.

Subjektive und objektive Ergebnisse nach Implantation der apodisiert diffraktiven AcrySof ReSTOR

BACKGROUND

Our purpose in this study was to assess the postoperative subjective and objective results after implantation of the Acrysof ReSTOR lens and to evaluate the advantages and limitations of the apodized diffractive optic design of this new multifocal intraocular lens (MIOL).

METHODS

Phakoemulsification and implantation of an Acrysof ReSTOR was performed in 55 eyes of 32 patients. All patients were examined after a mean period of 7.9+/-1.9 months. The accuracy of lens calculation was evaluated for the Haigis, Holladay I, and SRK-T formulas. Uncorrected and corrected visual acuity for distance and for intermediate and near vision were assessed, as was stereoacuity. In addition, contrast sensitivity was tested under photopic and mesopic conditions, with and without glare. The patients were asked about dysphotic phenomena such as halos, glare or flare, and night vision using a standardized evaluation. The degree to which patients were able to manage without spectacles after the surgery was also documented.

RESULTS

The median monocular uncorrected visual acuity (UCVA) for distance was 20/25 (LogMAR 0.05) while the binocular UCVA was 20/20 (LogMAR 0). The monocular uncorrected acuity for near vision was 20/25 (LogMAR 0.1), the binocular near visual acuitiy was 20/20 (LogMAR 0), while the intermediate monocular visual acuity was 20/50 (LogMAR 0.4) and the binocular, 20/32 (LogMAR 0.2). Contrast sensitivity was within the normal range. Dysphotic phenomena were noted by 66% of patients but were so slight as not to cause any problem at all in 59%. For close work and distance vision 84% of all patients needed no correcting glasses, while 78% did not need to use glasses for intermediate vision.

CONCLUSION

The Acrysof ReSTOR provides excellent uncorrected visual acuity for distance and near vision and the level of patient satisfaction achieved with it is good.

Status of accommodative intraocular lenses

PURPOSE OF REVIEW

This review examines the recent peer-reviewed literature of the past 18 months, with the goal of providing an overview of the pseudophakic lenses designed to provide accommodative action. Accommodative lenses take advantage of axial movement, refractive change and bag filling to provide their effect. Single and dual optic design, as well as unique technologies, were reviewed.

RECENT FINDINGS

An overview is presented of the various accommodative lenses available for investigation and use. There is positive evidence that current accommodative intraocular lenses provide superior potential for near vision compared with standard intraocular lenses.

SUMMARY

The available data suggest that accommodative amplitude and pseudoaccommodation are both important factors in the functional ability of accommodative intraocular lenses to provide a range of distance, intermediate and near vision.

Correlation of pupil size with visual acuity and contrast sensitivity after implantation of an apodized diffractive intraocular lens

PURPOSE

To determine whether pupil size is correlated with visual acuity and contrast sensitivity at all distances in eyes with an apodized diffractive intraocular lens (IOL).

SETTING

Private Clinic, Oviedo, Spain.

METHODS

Six months after surgery, the best corrected distance visual acuity, best distance-corrected near visual acuity, intermediate visual acuity, and distance contrast sensitivity under photopic (85 cd/m2) and mesopic (5 cd/m2) conditions were measured in 670 eyes of 335 consecutive patients who had implantation of the AcrySof ReSTOR Natural IOL (SN60D3, Alcon). Pupil diameters in distance vision were measured using a pupillometer.

RESULTS

The logMAR best corrected distance acuity was significantly better with larger pupils (r = 0.297; P = 1.36 x 10(-8)), whereas logMAR best distance-corrected near acuity was significantly worse with larger pupils (r = 0.276, P = 1.02 x 10(-7)). For all pupil diameters, intermediate visual acuity worsened significantly as the distance of the test increased (P<.01). Statistically significant differences in photopic and mesopic contrast sensitivity at all spatial frequencies were found between the small-pupil and large-pupil groups (P<.01). Distance photopic contrast sensitivity and mesopic contrast sensitivity were better in patients with large pupils than in patients with small pupils.

CONCLUSIONS

A larger pupil was correlated significantly with better distance visual acuity and with worse near visual acuity. For all pupil diameters, intermediate visual acuity worsened significantly as the distance of the test increased. Distance contrast sensitivity was better with larger pupils at all spatial frequencies in bright-light and dim-light conditions.

Opacification of Array SA40N silicone multifocal intraocular lens

We report opacification of 2 multifocal intraocular lenses (IOLs). Patients with these IOLs may be more likely to require IOL explantation than those with monofocal IOLs.

Quality of vision with the Acri.Twin asymmetric diffractive bifocal intraocular lens system

PURPOSE

To assess the quality of vision in patients who had implantation of asymmetric Acri. Twin bifocal diffractive intraocular lenses (IOLs) by evaluating distance and near visual acuities and photopic and mesopic contrast sensitivity under monocular and binocular conditions.

SETTING

Fernández-Vega Ophthalmological Institute, Oviedo, Spain.

METHODS

The study comprised 343 consecutive patients who had bilateral implantation of the Acri. Twin system: a distance-weighted 737D IOL and a near-weighted 733D IOL. Monocular and binocular best corrected distance visual acuities, best distance corrected near visual acuity, and distance contrast sensitivity under photopic (85 cd/m(2)) and mesopic (5 cd/m(2)) conditions were determined.

RESULTS

Eyes with the 737D IOL had better best corrected distance acuity than eyes with the 733D IOL (mean 0.036 +/- 0.061 logMAR versus 0.141 +/- 0.131 logMAR) (P<.0001). Eyes with the 733D IOL had better best distance corrected near acuity than eyes with the 737D IOL (mean 0.015 +/- 0.115 logMAR versus 0.059 +/- 0.091 logMAR) (P = .0027). Binocularly, the Acri. Twin system allowed good distance and near vision; the means were 0.031 +/- 0.059 logMAR and 0.005 +/- 0.024 logMAR, respectively. Contrast sensitivity with the Acri. Twin system was within normal limits under photopic and mesopic conditions. Contrast sensitivity was statistically significantly better with the Acri. Twin system, followed by the 737D IOL and the 733D IOL under both illumination levels.

CONCLUSIONS

Asymmetric bilateral implantation of the Acri. Twin IOL gave good simultaneous distance and near vision with improved contrast sensitivity under photopic and mesopic conditions. Differences between monocular and binocular visual acuity and contrast sensitivity were obtained because of the distance-/near-weighted light distribution of Acri. Twin IOLs.