Prospectively randomized trial comparing the pseudoaccommodation of the AMO ARRAY multifocal lens and a monofocal lens

Abstract

A prospective trial was set up to compare pseudoaccommodation. Fifty patients were randomized into two groups. Group 1 comprised 25 patients who had a monofocal implant and a postoperative refractive aim of -0.3 to -1.3 diopter (D) spherical equivalent and an astigmatic component between 1.0 and 1.75 D cylinder. Group 2 comprised 25 patients who had a new multizone refraction style multifocal implant and a postoperative refractive aim of -0.5 to +0.5 D spherical equivalent and an astigmatic component of less than 1.0 D cylinder. Eighty percent of postoperative refractions in Group 1 and 88% in Group 2 were within 0.5 D either side of the refractive aim. Forty-eight percent of Group 1 and 72% of Group 2 could see both 20/40 and J3 unaided. Four percent of Group 1 and 84% of Group 2 could read J2 with the distance correction. Sixteen percent of Group 1 and 48% of Group 2 could read J2 at 25 cm unaided (P = .03). Sixty-four percent of Group 1 and 88% of Group 2 stated they could manage daily activities without glasses. However, 88% of Group 1 and 52% of Group 2 requested reading glasses to improve clarity of the smallest print.

Quality of vision after AMO Array multifocal intraocular lens implantation

“…This is consistent with the design and function of the zonal progressive multifocal lens and with earlier findings that multifocal IOLs help most patients read without spectacles. [11][12][13][14][15][16][17][18] Our study also demonstrated significantly better best corrected distance acuity with the multifocal IOL. This contradicts previous reports that showed better near vision with multifocal IOLs but only equally good distance Snellen acuity.…”

“…[13][14][15]17,18 The difference was, however, mild and not significant clinically. The decrease in contrast sensitivity reported in our study and others 25 appears to be an acceptable compromise to enhanced near and functional vision.…”

“…This contradicts previous reports that showed better near vision with multifocal IOLs but only equally good distance Snellen acuity. [13][14][15] Our better results can be explained by careful selection of the patients for the study. The design of the multifocal IOL (ie, 2 central zones for distance vision) can help the eye focus light from distance better than eyes with a monofocal IOL.…”

“…The Array Ò SA40N (AMO) is the first multifocal IOL approved by the U.S. Food and Drug Administration and is reported to offer better outcomes, as demonstrated by reduced dependence on glasses, increased range of vision from near to far, and probably enhanced quality of life. [13][14][15][16][17][18] This lens is distance dominant, with the central zone for distance and series of refractive zones on the anterior surface. The distribution of incoming light to more than 1 focus from these zones theoretically 10,19 and clinically [20][21][22][23][24] decreases contrast sensitivity and increases glare disability because the image of a distinct focus is always overlapped by out-of-focus images generated by the multifocal principle.…”

Accommodating intraocular lenses: a review of design concepts, usage and assessment methods

“…36,37 Zonal photorefractive keratectomy, 38 decentred laser in situ keratomileusis 39 and implantation of corneal inlays 40 represent more experimental methods targeted at the cornea. Multifocal IOLs based on either diffractive optics or zones of varying refractive power, divide incoming light into two or more focal points and allow up to 50 per cent of patients to attain spectacle independence, 41 however, due to their design, multifocal implants are frequently associated with poorer contrast sensitivity than monofocal IOLs [42][43][44] and an increased incidence of troublesome visual phenomena including glare and halos. 45,46 To avoid such disturbing visual effects and restore natural accommodative function, the ultimate goal in ongoing AIOL and presbyopia research is to refill the capsular bag with a substance able to mimic the behaviour of the youthful lens mass.…”