LASIK outcomes following multifocal and monofocal intraocular lens implantation

EVALUATION AND MANAGEMENT OF POST-OPERATIVE COMPLICATIONS FOLLOWING CATARACT EXTRACTION AND INTRAOCULAR LENS PLACEMENT

THIS REVIEW EXPLORES POST-OPERATIVE CHALLENGES ARISING FROM CATARACT SURGERY, INCLUDING INTRAOCULAR LENS (IOL) DECENTRATION OR DISLOCATION, REFRACTIVE SURPRISES, DYSPHOTOPSIAS, AND IOL OPACIFICATIONS. IOL DECENTRATION OR DISLOCATION IS RARE, HIGHLIGHTING THE NEED FOR CAREFUL MANAGEMENT WITH MONITORING, SURGICAL REPOSITIONING OR LENS EXCHANGE TO ACHIEVE OPTIMAL VISUAL OUTCOMES. REFRACTIVE SURPRISES, ATTRIBUTED TO ERRORS IN IOL CALCULATION AND SELECTION, MAY BE MANAGED CONSERVATIVELY OR SURGICALLY, WITH THE MOST ACCURATE RESULTS ACHIEVED BY LASER VISION CORRECTION. POSITIVE AND NEGATIVE DYSPHOTOPSIAS MAY CONTINUE TO BE INTOLERABLE FOR PATIENTS, AND MAY REQUIRE LENS EXCHANGE AS WELL. IOL OPACIFICATIONS VARY BY IOL MATERIAL AND MAY BE VISUALLY SIGNIFICANT, REQUIRING LENS EXCHANGE. WE UNDERSCORE THE IMPORTANCE OF NUANCED MANAGEMENT AND PROVIDING OPTIMAL PATIENT CARE IN THE ABOVE POST-CATARACT SURGERY AND IOL IMPLANTATION COMPLICATIONS.

Comparative Analysis of the Visual, Refractive and Aberrometric Outcome with the Use of 2 Intraocular Refractive Segment Multifocal Lenses

To demonstrate the results of ray tracing higher- and lower-order aberrations in pseudophakic eyes with rotationally asymmetrical segment multifocal lenses, total high- and low-order aberrations, measured by root mean square value (RMS), refraction, uncorrected distance and uncorrected near visual acuity (UCDVA and UCNVA), and tear break-up time, were measured at scotopic size in 42 eyes of patients implanted with bifocal refractive Mplus15/Mplus30 IOL with +1.5 dpt near addition (42 eyes of patients implanted with Mplus15)/+3.0 dpt near addition (91 eyes of patients implanted with Mplus30), and 107 eyes of control group. No significant differences were noticed between the examined groups concerning UCDVA, UCNVA, and tear break-up time (p < 0.001). Coma and total high-order aberrations were significantly higher for the Mplus30 lens in comparison to the Mplus15 lens and the control group (Coma, Trefoil p < 0.001, Secondary Astigmatism p = 0.002). The spherical aberrations were significantly higher in the lower-addition lens (p = 0.016) in comparison to the control group and to the higher-addition lens group (p < 0.001). Both intraocular lens models were successful at reaching refractive aim, good distance, and near function with the lower higher-order aberrations for the low-addition lens.

Monofocal intraocular lens with enhanced intermediate function as substitute for multifocal intraocular lens in positive dysphotopsia

Purpose

To present a case of a 62-year-old patient implanted with multifocal intraocular lenses (IOLs) who underwent a bilateral IOL exchange due to positive dysphotopsia. In an attempt to reduce the symptoms and compensate for the loss of multifocality, we implanted an aspheric monofocal IOL with enhanced intermediate function in one eye and a spherical monofocal IOL in the other eye.

Observations

The patient presented with complaints of halo and glare, measured with a simulator, following the implantation of segmented multifocal IOLs two years earlier. The uncorrected distance visual acuity (UDVA) was 20/20 in both eyes. Before presentation at our clinic, a laser capsulotomy had been performed on the right eye. We proceeded with a bilateral IOL exchange. Because of capsular insufficiency in the right eye, we implanted a spherical monofocal three-piece IOL in the ciliary sulcus with optic capture. In the left eye, we used a monofocal IOL with an enhanced intermediate function. Two weeks postoperatively, UDVA (monocularly) was 20/20 in OD and OS, the uncorrected intermediate visual acuity (UIVA) was 20/32, and the uncorrected near visual acuity (UNVA) was 20/50. Binocularly, UDVA was 20/20, UIVA was 20/25 and UNVA was 20/25. The patient reported a marked decrease in halos and glare.

Conclusions and importance

When planning IOL exchange surgery, in cases of intolerance to multifocal IOLs, the clinician should consider the dilemma of loss of multifocality. Recent developments in monofocal IOL technology present new options to improve visual function in cases of multifocal IOL explantation.

The relationship between patient satisfaction and visual and optical outcome after bilateral implantation of an extended depth of focus multifocal intraocular lens

Purpose

To evaluate patient satisfaction after implantation of the Tecnis Symfony multifocal intraocular lens (MIOL).

Methods

120 eyes of 60 subjects with senile cataract were bilaterally implanted with the Tecnis Symfony IOL. Follow-up examination was performed 6 months postoperatively. Main outcome measures included uncorrected and corrected distance and near visual acuity, manifest refraction, and visual quality metrics. According to their subjective symptoms patient were divided in two groups: satisfied and unsatisfied.

Results

Uncorrected intermediate (0.15 ​± ​0.11 vs 0.18 ​± ​0.01, P ​= ​0.04) and near (0.26 ​± ​0.12 vs 0.31 ​± ​0.11, P ​= ​0.04) (UIVA, UNVA) log MAR visual acuity was significantly better, cylindrical error less (0.31 ​± ​0.36 vs 0.67 ​± ​0.29, P ​= ​0.05), axial length (AL) smaller (23.68 ​± ​1.3 vs 24.22 ​± ​1.6, P ​= ​0.05), Strehl ratio higher (0.08 ​± ​0.08 vs 0.05 ​± ​0.04, P ​= ​0.03) and mesopic pupil larger (4.3 ​± ​1.1 vs 3.7 ​± ​1.05, P ​= ​0.01) among satisfied patients.Residual cylinder, Strehl ratio, halos, mesopic pupil diameter and UNVA were significant predictors of patient satisfaction. Uncorrected distance visual acuity, higher order Strehl ratio and pupil diameter were significant predictors of halos. Near visual acuity significantly correlated (P ​= ​0.018, R ​= ​0.22) with axial length.

Conclusions

Uncorrected cylindrical error, poor reading quality, larger pupil and halos seem to be the most disturbing factors for patients implanted with the Tecnis Symfony IOL.

Multifocal Femto-PresbyLASIK in Pseudophakic Eyes

BACKGROUND

Presbyopia treatment in pseudophakic patients with a monofocal IOL is challenging. This study investigates the refractive results of femto-PresbyLASIK and analyzes presbyopia treatment in pseudophakic eyes.

METHODS

14 patients with 28 pseudophakic eyes were treated with femto-PresbyLASIK. The dominant eye was targeted at a distance and the non-dominant eye at -0.5 D. The presbyopic algorithm creates a steepness in the cornea center by using an excimer laser that leads to corneal multifocality.

RESULTS

6 months after surgery a refraction of -0.11 ± 0.13 D (p = 0.001), an uncorrected distance visual acuity of 0.05 ± 1.0 logMAR (p < 0.001) and an uncorrected near visual acuity of 0.15 ± 0.89 logMAR (p = 0.001) were achieved in the dominant eye. For the non-dominant eye, the refraction was -0.28 ± 0.22 D (p = 0.002), the uncorrected distance of visual acuity was 0.1 ± 1.49 logMAR, and the uncorrected near visual acuity was 0.11 ± 0.80 logMAR (p < 0.001). Spherical aberrations (Z400) were reduced by 0.21-0.3 µm in 32% of eyes, and by 0.31-0.4 µm in 26% of eyes.

CONCLUSION

By steepening the central cornea while maintaining spherical aberrations within acceptable limits, PresbyLASIK created a corneal multifocality that safely improved near vision in both eyes. Thus, femto-PresbyLASIK can be used to treat presbyopia in pseudophakic eyes without performing intraocular surgery.

Transepithelial Photorefractive Keratektomy after a Clear Lens Exchange

PURPOSE

We evaluated the refractive visual outcomes and efficacy of Transepithelial Photorefractive Keratectomy (TransPRK) using Smart Pulse Technology with static and dynamic cyclotorsion and the AMARIS 1050 Hz RS laser platform from Schwind in the eyes after a refractive lens exchange. Setting/Venue: Aurelios Augenlaserzentrum, Recklinghausen.

METHODS

We retrospectively evaluated the data of 552 consecutive eyes treated with refractive lens exchange between 2016 and 2019. A total of 47 eyes (8.5%) required a touch up after the clear lens exchange. From 43 eyes of 43 patients, we obtained a minimum follow up of 3 months. In all cases, we performed a TransPRK with a minimum optical zone of 7.2 mm, centering the ablation on the vertex of the cornea.

RESULTS

The average age of the treated eyes was 57 years old, with a range between 48 and 68 years. The mean treated sphere was 0.42 diopters (D), with a range between -1.0 and +1.75 D. The mean astigmatism was 1.06 D. Postoperatively, after laser vision correction, we reduced the sphere to a mean of 0.11 D (range -0.5 to +0.75 D), and, postoperatively, the mean astigmatism was 0.25 D (range -0.75 to 0 D). The predictability for a spheric equivalent (SEQ) of 0.5 D was 91%, and for 1 D it was 100% of the cases. No eye lost more than one Snellen line.

CONCLUSIONS

TransPRK with smart pulse was predictable for correcting ametropia after Clear Lens Surgery.

Refractive enhancements for residual refractive error after cataract surgery

PURPOSE OF REVIEW

Advances in cataract surgery have allowed surgeons to achieve superior refractive outcomes but have also led to higher patient expectations. Despite ever-evolving technology, residual refractive errors still occur. Postcataract refractive enhancements may be required to deliver satisfactory visual outcomes. This review aims to discuss the potential causes of residual refractive errors and the various enhancement modalities to correct them.

RECENT FINDINGS

A thorough preoperative workup to detect and address underlying pathologic causes of impaired vision should be performed prior to enhancement or corrective procedures. Corneal-based procedures are the safest and most accurate methods of correcting mild cases of residual refractive error. Hyperopic, high myopic, and high astigmatic errors are best managed with lens-based enhancements. Piggyback intraocular lenses (IOLs) are safer and more effective compared with IOL exchange. Toric IOL rotation and IOL exchange are ideally performed in the early postoperative period.

SUMMARY

A multitude of options exist for effective correction of residual refractive errors. The choice on how to best manage these patients depends on many factors such as the cause of refractive error, type of IOL used, ocular comorbidities, and patient preference.

Comparison of Outcomes after Phacoemulsification with Two Different Corneal Incision Distances Anterior to the Limbus

Purpose

To compare visual performance and visual quality outcomes after phacoemulsification with two different clear corneal incision (CCI) distances anterior to the limbus in senile cataract patients.

Methods

Retrospective case series. Patients who had undergone phacoemulsification were divided into two groups according to the CCI distances anterior to the limbus. The CCI distances in group A range from 1 mm to 1.5 mm, while those in group B range from 0.5 mm to 1 mm. The visual acuity, refraction, surgically induced astigmatism (SIA), corneal aberrations, anterior segment parameters, and subjective vision quality were evaluated.

Results

This study enrolled 54 eyes, with 27 eyes per group. Both groups had significant improvement in postoperative uncorrected visual acuity (UCVA) and corrected distance visual acuity (CDVA) (P < 0.05). There were no statistically significant between-group differences in postoperative UDVA, CDVA, SIA, corneal aberrations, anterior segment parameters, or VF-QOL questionnaire performance (P > 0.05).

Conclusions

The phacoemulsification with CCI distances ranging from 0.5 mm to 1.5 mm is an effective and safe therapy to senile cataract. The CCI distance anterior to the limbus that ranges from 0.5 mm to 1.5 mm is recommended for routine phacoemulsification.

Multifocal Intraocular Lenses Implantation in Presbyopia Correction. Literature Review

Reduced dependence on glasses is an increasingly common expectation among those who want to take advantage of new surgical opportunities, especially for patients who lead an active lifestyle. Currently, due to the increase in the duration of active life in people over 40, there is a need for effective correction of presbyopia. Multifocal intraocular lenses are increasingly used in the treatment of presbyopia. After implantation of multifocal intraocular lenses most patients have no need for spectacle or contact vision. However, complications can affect the patient’s quality of life and level of satisfaction. The most common complications of multifocal correction are blurred vision and the presence of optical phenomena (“halo” and “glare”), associated with residual ametropia, clouding of the posterior capsule, large pupil size, anomalies of the wave front, dry eye and lens decentration. The main reasons for this are the failure to attempt to neuroadapt a patient, the dislocation of the lens, the residual refractive error and the clouding of the lens. The review presents the main features of various models of multifocal intraocular lenses, their implantation techniques, associated complications and methods for their correction. The development of multifocal correction of presbyopia and ametropia seems to be a promising direction in ophthalmic surgery.

Bioptics for high hyperopia with combined multifocal intraocular lens implantation and excimer ablation in young patients

PURPOSE

To analyze the visual and refractive outcome of the bioptics procedure combining multifocal intraocular lens implantation and excimer laser surgery in young patients with high hyperopic eyes not suitable for a single surgical procedure.

METHODS

This retrospective case series included 10 eyes of five patients (age range 18-30 years) with high hyperopia (spherical equivalent +8.51 ± 0.85 diopters (D)). They had been treated with serial multifocal intraocular lens implantation followed 6 weeks later by laser in situ keratomileusis for residual hyperopia. Uncorrected distance visual acuity, uncorrected near visual acuity, corrected distance visual acuity, corrected near visual acuity, and manifest refraction were evaluated before surgeries, after multifocal intraocular lens implantation, and 3 months post laser in situ keratomileusis.

RESULTS

No patients were lost to follow-up (6 months). The mean spherical equivalent decreased to +2.05 ± 1.33 D after multifocal intraocular lens implantation and to -0.10 ± 0.58 D after the laser in situ keratomileusis procedure. Success of the procedures was determined by uncorrected visual acuity. LogMAR uncorrected distance visual acuity improved by a total of more than six lines from 1.05 ± 0.18 LogMAR to 0.46 ± 0.12 LogMAR post multifocal intraocular lens implantation and to 0.15 ± 0.06 LogMAR after both surgeries. The LogMAR uncorrected near visual acuity increased by 0.81 ± 0.82 LogMAR after lens implantation due to loss of accommodation, and all eyes reached a LogMAR of 0 at 1 month postoperatively following laser in situ keratomileusis.

CONCLUSIONS

A bioptics approach involving multifocal intraocular lens followed 6 weeks later by a laser in situ keratomileusis procedure for the correction of very high hyperopia enabled the resolution of the residual refractive error in young very high hyperopic patients.

Predictability and Vector Analysis of Laser In Situ Keratomileusis for Residual Errors in Eyes Implanted With Different Multifocal Intraocular Lenses

PURPOSE

To investigate potential differences in predictability, efficacy, and safety of corneal excimer laser to correct residual myopia, hyperopia, and astigmatism in eyes previously implanted with multifocal intraocular lenses using distinct optical surfaces and platforms for multifocality.

METHODS

This prospective comparative study included 37 eyes submitted to laser in situ keratomileusis correction for residual errors after implantation of either an apodized diffractive-refractive (Restor) or a full-diffractive (Tecnis) multifocal intraocular lens. Data analysis included investigation of predictability, efficacy, and safety of excimer laser surgery to correct residual errors. A double-angle plot, using vector analysis, was also created to evaluate predictability of astigmatism correction.

RESULTS

At 6-month follow-up, statistical analyses revealed a significant improvement when comparing preoperative (0.51 ± 0.25 and 0.44 ± 0.18) and postoperative values (0.17 ± 0.10 and 0.09 ± 0.07) of uncorrected distance visual acuity (P < 0.0001 and <0.0001), preoperative (0.92 ± 0.61 and 1.02 ± 0.45) and postoperative values (0.33 ± 0.23 and 0.19 ± 0.17) of manifest refractive spherical equivalent (P = 0.0006 and <0.0001), and preoperative (-1.08 ± 0.70 and -0.65 ± 0.42) and postoperative values (-0.25 ± 0.28 and -0.14 ± 0.21) of astigmatism (P < 0.0001 and <0.0001) in eyes implanted with Restor and Tecnis, respectively. Vector analysis revealed a predictable correction of astigmatism in all groups. Ninety-two percent of total eyes achieved a manifest refractive spherical equivalent within ±0.5 of emmetropia.

CONCLUSIONS

Corneal excimer laser refractive surgery seems to be equally effective to correct different residual errors, including astigmatism, in eyes implanted with intraocular lenses with various platforms for multifocality.

Outcomes of excimer laser enhancements in pseudophakic patients with multifocal intraocular lens

Purpose

The aim of this study was to assess visual and refractive outcomes of laser vision correction (LVC) to correct residual refraction after multifocal intraocular lens (IOL) implantation.

Patients and methods

In this retrospective study, 782 eyes that underwent LVC to correct unintended ametropia after multifocal IOL implantation were evaluated. Of all multifocal lenses implanted during primary procedure, 98.7% were refractive and 1.3% had a diffractive design. All eyes were treated with VISX STAR S4 IR excimer laser using a convectional ablation profile. Refractive outcomes, visual acuities, patient satisfaction, and quality of life were evaluated at the last available visit.

Results

The mean time between enhancement and last visit was 6.3±4.4 months. Manifest spherical equivalent changed from −0.02±0.83 D (−3.38 D to +2.25 D) pre-enhancement to 0.00±0.34 D (−1.38 D to +1.25 D) post-enhancement. At the last follow-up, the percentage of eyes within 0.50 D and 1.00 D of emmetropia was 90.4% and 99.5%, respectively. Of all eyes, 74.9% achieved monocular uncorrected distance visual acuity 20/20 or better. The mean corrected distance visual acuity remained the same before (−0.04±0.06 logMAR [logarithm of the minimum angle of resolution]) and after LVC procedure (−0.04±0.07 logMAR; P=0.70). There was a slight improvement in visual phenomena (starburst, halo, glare, ghosting/double vision) following the enhancement. No sight-threatening complications related to LVC occurred in this study.

Conclusion

LVC in pseudophakic patients with multifocal IOL was safe, effective, and predictable in a large cohort of patients.

Retinal Image Simulation of Subjective Refraction Techniques

Refraction techniques make it possible to determine the most appropriate sphero-cylindrical lens prescription to achieve the best possible visual quality. Among these techniques, subjective refraction (i.e., patient's response-guided refraction) is the most commonly used approach. In this context, this paper's main goal is to present a simulation software that implements in a virtual manner various subjective-refraction techniques--including Jackson's Cross-Cylinder test (JCC)--relying all on the observation of computer-generated retinal images. This software has also been used to evaluate visual quality when the JCC test is performed in multifocal-contact-lens wearers. The results reveal this software's usefulness to simulate the retinal image quality that a particular visual compensation provides. Moreover, it can help to gain a deeper insight and to improve existing refraction techniques and it can be used for simulated training.

Error induced by the estimation of the corneal power and the effective lens position with a rotationally asymmetric refractive multifocal intraocular lens

AIM

To evaluate the prediction error in intraocular lens (IOL) power calculation for a rotationally asymmetric refractive multifocal IOL and the impact on this error of the optimization of the keratometric estimation of the corneal power and the prediction of the effective lens position (ELP).

METHODS

Retrospective study including a total of 25 eyes of 13 patients (age, 50 to 83y) with previous cataract surgery with implantation of the Lentis Mplus LS-312 IOL (Oculentis GmbH, Germany). In all cases, an adjusted IOL power (PIOLadj) was calculated based on Gaussian optics using a variable keratometric index value (nkadj) for the estimation of the corneal power (Pkadj) and on a new value for ELP (ELPadj) obtained by multiple regression analysis. This PIOLadj was compared with the IOL power implanted (PIOLReal) and the value proposed by three conventional formulas (Haigis, Hoffer Q and Holladay I).

RESULTS

PIOLReal was not significantly different than PIOLadj and Holladay IOL power (P>0.05). In the Bland and Altman analysis, PIOLadj showed lower mean difference (-0.07 D) and limits of agreement (of 1.47 and -1.61 D) when compared to PIOLReal than the IOL power value obtained with the Holladay formula. Furthermore, ELPadj was significantly lower than ELP calculated with other conventional formulas (P<0.01) and was found to be dependent on axial length, anterior chamber depth and Pkadj.

CONCLUSION

Refractive outcomes after cataract surgery with implantation of the multifocal IOL Lentis Mplus LS-312 can be optimized by minimizing the keratometric error and by estimating ELP using a mathematical expression dependent on anatomical factors.

Surgical options for correction of refractive error following cataract surgery

Refractive errors are frequently found following cataract surgery and refractive lens exchange. Accurate biometric analysis, selection and calculation of the adequate intraocular lens (IOL) and modern techniques for cataract surgery all contribute to achieving the goal of cataract surgery as a refractive procedure with no refractive error. However, in spite of all these advances, residual refractive error still occasionally occurs after cataract surgery and laser in situ keratomileusis (LASIK) can be considered the most accurate method for its correction. Lens-based procedures, such as IOL exchange or piggyback lens implantation are also possible alternatives especially in cases with extreme ametropia, corneal abnormalities, or in situations where excimer laser is unavailable. In our review, we have found that piggyback IOL is safer and more accurate than IOL exchange. Our aim is to provide a review of the recent literature regarding target refraction and residual refractive error in cataract surgery.

Corrective Techniques and Future Directions for Treatment of Residual Refractive Error Following Cataract Surgery

Postoperative residual refractive error following cataract surgery is not an uncommon occurrence for a large proportion of modern-day patients. Residual refractive errors can be broadly classified into 3 main categories: myopic, hyperopic, and astigmatic. The degree to which a residual refractive error adversely affects a patient is dependent on the magnitude of the error, as well as the specific type of intraocular lens the patient possesses. There are a variety of strategies for resolving residual refractive errors that must be individualized for each specific patient scenario. In this review, the authors discuss contemporary methods for rectification of residual refractive error, along with their respective indications/contraindications, and efficacies.

Management of residual refractive error after cataract surgery

PURPOSE OF REVIEW

To provide a review of the recent literature on the management of residual refractive error after cataract surgery.

RECENT FINDINGS

Laser in-situ keratomileusis (LASIK) is the most accurate procedure to correct residual refractive error after cataract surgery. Lens-based procedures, such as intraocular lens (IOL) exchange or piggyback lens implantation, are also possible alternatives in cases with extreme ametropia, corneal abnormalities, or in situations where excimer laser is not available. In this review, we found that Piggyback IOL were safer and more accurate than IOL exchange.

SUMMARY

Emmetropia is our main target today in modern cataract surgery. Accurate biometric analysis, selection and calculation of the adequate IOL, and modern techniques for cataract surgery all help surgeons to move toward the goal of cataract surgery as a refractive procedure free from refractive error. However, in spite of all these inputs, residual refractive error still occasionally occurs after cataract surgery and LASIK seems to be the most accurate method for its correction.

Laser in situ keratomileusis in 2012: a review

Laser in situ keratomileusis (LASIK) is a safe and effective treatment for refractive error. A combination of technological advances and increasing surgeon experience has served to further refine refractive outcomes and reduce complication rates. In this article, we review LASIK as it stands in late 2012: the procedure, indications, technology, complications and refractive outcomes.

Visual performance after bilateral implantation of a new diffractive aspheric multifocal intraocular lens with a 3.5 D addition

PURPOSE

To evaluate visual performance after implantation of a new diffractive aspheric multifocal intraocular lens (MIOL) with a +3.50 D addition power.

METHODS

A total of 24 cataract patients were bilaterally implanted with the Diffractiva-aA MIOL in 2 ophthalmologic centers and followed for 6 months. Postoperative evaluations included visual acuities (VA) at various distances, defocus testing, contrast sensitivity (CS) measurements, and patient satisfaction questionnaire.

RESULTS

Six months postoperatively, binocular uncorrected VA (mean ± SD; logMAR) was 0.00 ± 0.05 (≈ 20/20) for distance, 0.06 ± 0.13 (≈ 20/23) for intermediate (1 m), and 0.00 ± 0.05 (≈ 20/20) for near (40 cm). All patients achieved uncorrected VA of 20/25 or better for distance and near, and 20/40 or better at 1 m. Monocular and binocular defocus curves showed 2 peaks of maximum VA at the distance focus (0.0 D) and the near focus (-2.5 D) and a good range of intermediate vision with the lowest mean acuity being at -1.5 D defocus. Photopic and mesopic CS were within the standard normal range. The majority of patients (n = 22; 91.7%) were spectacle independent; 8.3% (n = 2) reported wearing glasses occasionally for very small print (1 patient) or for watching television (1 patient). Overall, all patients were "very satisfied" (n = 22; 91.7%) or "satisfied" (n = 2; 8.3%) with the procedure.

CONCLUSIONS

The new Diffractiva-aA MIOL provided a full range of vision from near to far generating highly satisfied, spectacle independent patients with only minimal visual disturbances at night.

Quality of life evaluation after implantation of 2 multifocal intraocular lens models and a monofocal model

PURPOSE

To compare vision-related quality of life using the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) in patients with 1 of 3 types of intraocular lenses (IOLs) and to correlate it with postoperative visual outcomes.

SETTING

Vissum Corporation-Instituto Oftalmológico de Alicante, Alicante, Spain.

DESIGN

Comparative case series.

METHODS

This study comprised eyes having cataract surgery with bilateral implantation of a monofocal IOL (Group A), apodized multifocal IOL (Group B), or full diffractive multifocal IOL (Group C). Distance and near visual acuities, contrast sensitivity, and quality of life were evaluated preoperatively and postoperatively.

RESULTS

The study enrolled 106 eyes (53 patients; age range 49 to 80 years). All groups had significant improvement in uncorrected and corrected distance visual acuities postoperatively (P ≤.05). Near vision outcomes were significantly better in Groups B and C (P ≤.01). Groups B and C had significantly less difficulty in some near tasks, such as reading the newspaper (A-B, P=.02; A-C, P=.02) or reading bills (A-B, P=.04; A-C, P=.004). Group C also had significantly less difficulty driving at night than Group B (P<.01). Near visual acuity and contrast sensitivity were significantly correlated with difficulty in near visual tasks in Groups B and C. Night-driving difficulty correlated significantly with contrast sensitivity in Group B.

CONCLUSIONS

Patients with multifocal IOLs could perform several daily tasks at near and intermediate distances, with less night-driving limitation with the full diffractive IOL than with apodized multifocal and monofocal IOLs.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

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.