Prospective randomised double-masked trial of bilateral multifocal, bifocal or monofocal intraocular lenses

Abstract

Aims To evaluate the functional effect of bilateral implantation of two different multifocal intraocular lenses (IOL) compared with the standard monofocal IOL. Methods Sixty-nine patients were recruited into a prospective, double-masked, randomised, controlled trial at a single hospital in the United Kingdom. Sixty completed follow-up; 16 implanted with monofocal IOLs, 29 with AMO 'ARRAY' multifocal IOLs and 15 with Storz 'TRUEVISTA' bifocal IOLs. Phacoemulsification and IOL implantation was performed to a standardised technique in both eyes within a 2-month period. The main outcome measures were distance and near visual acuity, depth of field and validated assessment of subjective function (TyPE questionnaire). Results Unaided distance acuity was good, and equivalent across the three groups. Corrected distance acuity was significantly lower in the bifocal group. Patients with multifocal and bifocal IOLs could read smaller absolute print size than those in the monofocal group (P = 0.05), but at a closer reading distance such that mean unaided near acuity was equal in the three groups. Corrected near acuity was significantly higher in the monofocal control group (P Ͻ 0.05). Depth of field was increased in multifocal (P = 0.06) and bifocal (P = 0.004) groups. Overall visual satisfaction was equal in the three groups, while near visual satisfaction was higher in the multifocal group than the monofocal (P = 0.04). Spectacle independence was not seen in the monofocal group, but was achieved in 28% of multifocal IOL patients and 33% of bifocal patients (P Ͻ 0.001). Adverse symptoms such as glare and haloes were significantly more bothersome with multifocal (not bifocal) IOLs than monofocals (P = 0.01). Conclusions Multifocal and bifocal IOLs improved unaided near vision performance, with around one in three patients becoming spectacle-independent. The main adverse effect was an increased incidence of subjective glare and haloes in the multifocal IOL group.

Lente intraocular multifocal refrativa: a performance visual e qualidade de vida em implantes bilaterais versus unilaterais

“…Tendo em vista tais expectativas, o objetivo do presente estudo foi avaliar e comparar a performance visual e a qualidade de vida de pacientes submetidos a implantes unilaterais e bilaterais de lentes intraoculares multifocais refrativas (2,3) .…”

Effect of illumination on visual function after monofocal and multifocal intraocular lens implantation

“…[1][2][3][4][5] However, they are known to reduce contrast sensitivity (CS) under low-contrast 6,7 and mesopic conditions, 8 and to induce photic phenomena such as glare and halo with bright light. 5,6,9 In daily life, exposure to different levels of illumination is unavoidable and, although visual acuity is known to improve with increasing illumination, 10 it has not been reported before if, in patients with multifocal IOLs, visual acuity and CS are affected by changing the level of illumination.…”

Elaboração e validação do questionário de satisfação dos pacientes pseudofácicos em português

“…The modified TyPE questionnaire (Appendix 1) was developed specifically to assess quality of life after cataract surgery. It assesses 10 functional status items using 18 questions (17,18) .…”

“…We applied the TyPE questionnaire, a satisfaction questionnaire developed to assess quality of life after multifocal IOL implantation, not available in this study. This is an important method to assess and compare the satisfaction of subjects included in the four groups (17,18) . It is also in agreement with the idea that hyperopic patients would have milder symptoms than myopic patients, although this comparison was not done in this study (19) .…”

“…The modified TyPE questionnaire (Appendix 1) was developed specifically to assess quality of life after cataract surgery. It assesses 10 functional status items using 18 questions (17,18) .A significance level of 5% was adopted, using comparison tests such as the Tukey, Kruskal-Wallis, Mann-Whitney, and Chisquare (two-tailed) tests and adjusting the significance level when needed. …”