Evolution of Visual Performance in 250 Eyes Implanted with the Tecnis ZM900 Multifocal IOL

Abstract

Purpose To evaluate visual performance in relation to time after implantation of the multifocal Tecnis intraocular lens (IOL) in patients with cataract. Methods This prospective case series involved 250 eyes of 137 patients with cataract aged 68.5±9.9 years. Monocular uncorrected and corrected near visual acuity (NVA and DCNVA) and distance visual acuity (UCVA and BCVA), occurrence of visual symptoms, and patient satisfaction were evaluated at 1–3 days, 30–90 days, and 150–210 days after surgery. Posterior capsule opacification and contrast sensitivity under photopic conditions were also assessed. Results At the last follow-up visit, mean NVA and DCNVA was 0.215±0.082 and 0.189±0.045 log-MAR, respectively. The majority of eyes (96.8%) could read J2 without correction, including 83.2% reading J1. With best distance correction, 95.6% of eyes were able to read J1. Mean UCVA and BCVA was 0.144±0.101 and 0.09±0.03 logMAR, including 77.6% and 98.4% of eyes that achieved 20/30 or better, respectively. The majority of patients (>90%) ranked their near, distance, and global vision as good or excellent and 88.4% were free from spectacles. A significant improvement of uncorrected and corrected distance and near VA as well as a decrease in the intensity of subjective photic phenomena was observed over time. At the last follow-up visit, the rate of posterior capsule opacification (grade 1) was 4.4% and mean monocular contrast sensitivity was 1.44±0.26. Conclusions The multifocal Tecnis IOL provides excellent near vision and good distance vision in patients with cataract. However, most patients required a neuroadaptation period of approximately 6 months to experience full visual benefits of the lens. (Eur J Ophthalmol 2009; 19: 762–8)

Objective and subjective visual quality after implantation of all optic zone diffractive multifocal intraocular lenses: a prospective, case-control observational study

“…The all optic zone diffractive rings of ZMB00 can induce more positive dysphotopsias than monofocal IOLs 22. In this study, the glare incidence rate was slightly higher in the multifocal group (14/25, 56.0%) than in the monofocal group (11/25, 44.0%), which fits in the previous study range 10 22 38 39. Our objective optical quality results suggested OSI in the monofocal group was significant better than in the multifocal group, and the results were consistent with the subjective results, which showed that moderate glare or halo was reported only in the multifocal group.…”

“…Dysphotopsias can be caused by either multifocal or monofocal IOLs, and it includes both positive and negative dysphotopsias 10 22 38 39. The all optic zone diffractive rings of ZMB00 can induce more positive dysphotopsias than monofocal IOLs 22.…”

“…The glare incidence rate between two groups had no statistical significance, and neither group reported severe, intolerable glare. Pupil miosis and neural adaption post cataract surgery might contribute to it 38 40. So even though multifocal IOLs have more scattered light, patients who were implanted with it did not complain of severe glare.…”

Clinical outcomes after cataract surgery with implantation of the Tecnis ZMB00 multifocal intraocular lens

“…In the current series, a low level of halo perception was reported in 60% of patients at 6 months postoperatively, with no severe complaints of halos. Future studies should confirm if this subjective symptomatology disappears with time, as suggested by many authors based on the short- and medium-term outcomes [15] and according to the significant reduction of the intensity of photic phenomena with time observed in the current series.…”

“…Several factors may have contributed to this finding, but patient neuroadaptation to the multifocality induced by the IOL optics seems to have played a major role. Indeed, a similar finding has been reported with other diffractive multifocal IOLs [14,15] and it has even been demonstrated that visual performance after multifocal IOL implantation can be significantly accelerated by training programs [16]. Via the neuroadaptation process (synaptogenesis, neurogenesis) [17], the brain has the ability to select an image related to the object that is being looked at, suppressing other images.…”