Visual Outcomes After Cataract Surgery: Multifocal Versus Monofocal Intraocular Lenses

Abstract

ataract is a common, vision-altering condition that affects 36 million people in Western Europe and is projected to affect approximately 30 million people in the United States by the year 2020.1 Implantation of a monofocal intraocular lens (IOL) after surgical removal of cataract via phacoemulsification is the standard of care in the Western world.2 Although monofocal IOLs result in excellent distance acuity, patients usually require corrective spectacles C ABSTRACT PURPOSE: To evaluate visual outcomes, spectacle independence, and quality of life among nonastigmatic and astigmatic patients who received AcrySof IQ ReSTOR toric or nontoric multifocal intraocular lenses (IOLs) (Alcon Laboratories, Fort Worth, TX) compared with those who received commercially available nontoric monofocal IOLs after bilateral cataract removal. METHODS:This randomized, patient-and observertechnician-masked study was conducted at 20 sites in Europe. Patients were randomized to receive monofocal (nontoric only) or multifocal (nontoric or toric, as needed) IOLs. Primary efficacy endpoints included percentage of patients achieving binocular uncorrected distance and near acuity of 0.1 logMAR or better (20/25 Snellen), spectacle independence, and scores on the National Eye Institute Refractive Error and Quality of Life questionnaire domains. Safety endpoints included adverse events and refractive error within 0.5 and 1.0 diopters. RESULTS:In the multifocal group (n = 108) versus the monofocal group (n = 100), significantly more patients achieved uncorrected distance and near acuity of 0.1 logMAR or better (45.7% vs 2.1%; P < .0001) and spectacle independence (73.3% vs 25.3%; P < .0001) at 6 months. The percentage of patients who achieved uncorrected distance visual acuity of 20/40 or better at 6 months was 92% in the multifocal group and 97% in the monofocal group. National Eye Institute Refractive Error and Quality of Life scores were significantly better for dependence on correction in the multifocal group (P < .0001) and for glare in the monofocal group (P = .0157); other domain scores were similar between groups. No significant trends in study device-related adverse events were observed. CONCLUSIONS:Monofocal and multifocal IOLs provided good clinical outcomes. More patients receiving multifocal IOLs attained better uncorrected visual acuity at a range of distances and spectacle independence compared with patients who received monofocal IOLs. Monofocal IOLs were associated with better patientreported scores for glare compared with multifocal IOLs; however, scores for patient satisfaction were significantly better in the multifocal group.[J Refract Surg. 2015;31(10):658-664.]

Cataract Surgery in Patients with a Previous History of KAMRA Inlay Implantation: A Case Series

“…Regardless, our mean difference between target and achieved IOL power falls within the level of accuracy previously reported for cataract surgery in patients without a previous history of karma inlay implantation. Consistent with our outcomes, Shah et al reported that 77.7% (153 of 197) of eyes undergoing routine cataract surgery had a refractive outcome within 0.5 D of target refraction and 91.4% within 1.0 D without reporting any tendency toward hyperopic shift [11]. …”

Stability and visual outcomes yielded by three intraocular trifocal lenses with same optical zone design but differing material or toricity

“…It has been shown that a given refractive error results in a more pronounced drop in visual acuity and a worsening of visual quality for multifocal IOLs wearers than for those people implanted with monofocal IOLs. [5][6][7] Regarding visual acuity, the three IOLs under investigation-Micro F, POD F, and POD FT-showed similar performance levels, with no statistically significant differences between them. This lead us to conclude that the different materials they are made of was not as relevant a parameter as the fact that all three lenses relied on exactly the same optical zone design.…”

“…Furthermore, when the patient has multifocal IOLs implanted instead of monofocal ones, IOL decentration and malposition have an even greater impact upon visual acuity and quality of vision. [5][6][7] [AQ: 7] [AQ : 8] Theoretical simulations carried out by Holladay et al 2 demonstrated that aspheric lenses may undergo a decentration of up to 0.4 mm and a tilt of up to 7° before they start to show a lower performance than their spherical counterpart. Piers et al's 3 studies revealed an even higher tolerance to malposition, the resulting threshold values being 0.8 mm of decentration and 10° of tilt.…”

Modern Aspects of Multifocal Intraocular Correction: A Review

“…В этом вопросе интерес вызывает исследование S. Shah с соавт. [17], в котором оценивались данные послеоперационной остроты зрения у 100 пациентов на фоне имплантации мультифокальных ИОЛ и 108 пациентов с монофокальной интраокулярной коррекцией. В результате сравнения оказалось, что значение остроты зрения без коррекции как вдаль, так и на близком расстоянии 0,10 logMAR и выше было достигнуто в 45,7% случаев при использовании мультифокальной коррекции и в 2,1% при выборе в пользу монофокальной коррекции.…”