Clinical evaluation of two multifocal intraocular lens implantation patterns

Bilateral Implantation of a New Refractive Multi-Segmented Multifocal Intraocular Lens in Cataract or Refractive Lens Exchange Patients

Purpose

To evaluate the safety and efficacy of a new multi-segmented refractive multifocal intraocular lens (IOL) after phacoemulsification and refractive lens exchange (RLE).

Patients and Methods

In this prospective, multicenter clinical trial, 63 presbyopic subjects who had cataract or where RLE candidates were bilaterally implanted with the Precizon Presbyopia IOL (Ophtec BV, Groningen, the Netherlands) after phacoemulsification. The study was conducted at 6 clinical centers in Germany, the Netherlands, Belgium, Turkey and Spain. Subjects were evaluated at baseline and at 1 day, 1 week, 1 and 3 months postoperatively for monocular and binocular uncorrected (UDVA) and corrected distance visual acuity (CDVA), uncorrected (UIVA) and distance-corrected intermediate visual acuity (DCIVA), uncorrected (UNVA), corrected (CNVA) and distance-corrected near visual acuity (DCNVA), contrast sensitivity and quality of vision.

Results

Three months postoperatively, binocular UDVA and CDVA of ≥20/40 was achieved in 98.4% (60/61) and 100%, respectively. Binocular UIVA and DCIVA of ≥20/40 was achieved in 96.7% (59/61) and 93.4% (57/61) respectively. Binocular UNVA, CNVA and DCNVA of ≥20/40 was achieved in 93.4% (57/61), 98.4% (60/61) and 95% (57/60) subjects, respectively. Complete spectacle independence was achieved in 80% (49/61) patients; 93% of patients reported that they were quite or very satisfied with the outcomes of the procedure.

Conclusion

Precizon Presbyopia IOL implantation is a safe and effective method to provide good visual acuity at all distances in presbyopic and cataract patients.

Visual function and higher order aberration after implantation of aspheric and spherical multifocal intraocular lenses: a meta-analysis

AIM

To assess the visual outcomes of aspheric multifocal intraocular lenses (IOLs) compared with spherical multifocal IOL after cataract surgery.

METHODS

Potential prospective controlled trials that comparing aspheric multifocal IOL implantation with spherical multifocal IOL group were extracted from the computer database. The statistical analysis was carried out using Stata 10 software. Standardized mean differences with 95% confidence intervals (CIs) were calculated for continuous variables. The pooled estimates were computed in the use of a random-effects model.

RESULTS

A systematic review identified five prospective nonrandomized controlled trials, including 178 aspheric multifocal IOL and 164 spherical multifocal IOL. There was no significant difference in uncorrected distance visual acuity (95%CI, -0.248 to 0.152;P=0.641) and uncorrected near visual acuity (95%CI, -0.210 to 0.428;P=0.504) between aspheric multifocal IOL and spherical multifocal IOL. Statistically significant differences were detected less spherical aberration in aspheric multifocal IOL (95%CI, -1.111 to -0.472; P<0.001) when compared to spherical multifocal IOL. Spherical multifocal IOL showed a greater higher order aberration compared to the aspheric multifocal IOL (95%CI, -1.024 to-0.293; P<0.001). Sensitivity analysis suggested that the results were relatively reliable.

CONCLUSION

The overall findings indicated that aspheric multifocal IOL and spherical multifocal IOL provided similar visual acuity at near and distance. Patients implanted with aspheric multifocal IOL had less spherical aberration and higher order aberration than patients with spherical multifocal IOL. Further well-organized, prospective controlled trials involving larger patient numbers are needed.

Psychometric properties of the national eye institute refractive error correction quality-of-life questionnaire among Iranian patients

BACKGROUND AND AIM

To evaluate the psychometric properties of the national Eye Institute refractive error correction quality of life questionnaire (NEI-RQL-42) among Iranian patients with refractive errors.

MATERIALS AND METHODS

Two samples of patients (n1 = 296, n2 = 95) were consecutively selected from the eye clinic of the Boo-Ali Hospital, Qazvin. A forward-backward procedure was conducted to translate and cross-culturally adapt the Iranian version of the NEI-RQL-42. A homogeneity, stability, and reliability test was conducted for the first sample after a two-week interval. Convergent validity was computed using the correlation between the NEI-RQL-42 subscale scores, National Eye Institute-Visual Functioning Questionnaire (NEI-VFQ-25), and the Short Form-36 (SF-36). Furthermore, Known-group analysis was performed, to determine the discriminant validity between the subgroups of patients with hyperopia, emmetropia, and myopia. Responsiveness to clinical change was tested by administering NEI-RQL-42 on the second sample that was scheduled for surgery.

RESULTS

Homogeneity was satisfactory with the Cronbach's alpha coefficients ranging between 0.70 and 0.92. The 13 subscales of the NEI-RQL-42 showed a considerable stability in intra-class-correlation (ICC) ranging between 0.70 and 0.89. Positive correlation coefficients were found among all subscales of the NEI-RQL-42 and the other quality-of-life instruments (NEI-VFQ-25 and SF-36). The NEI-VFQ-25 displayed excellent discriminant validity to differentiate the subgroups of patients, and was found to be responsive to change after the surgical correction at three months.

CONCLUSIONS

The Iranian version of the NEI-RQL-42 is a valid and reliable instrument to assess refractive error correction quality-of-life in Iranian patients. Moreover this questionnaire can be used to evaluate the effectiveness of interventions in patients with refractive errors.