Lifestyle survey of diffractive multifocal IOL patients shows high satisfaction

Spectacle dependence was greatly reduced, and almost all patients surveyed said they would recommend the lens.

ByMichela Cimberle

Richard B. Packard

ROME — A survey evaluating the effects on lifestyle of bilaterally implanted Alcon AcrySof ReSTOR IOLs showed a high level of appreciation by patients for this type of implant.

“The vast majority of patients are able to read without glasses, and only a few need them for intermediate tasks. Night vision disturbances are minimal and, above all, almost all of these patients would recommend this lens to friends and relatives,” Richard B. Packard, MD, FRCS, said at the Annual Joint Meeting of the Italian Society of Ophthalmology and Ocular Surgery News.

Dr. Packard was the first to implant an Alcon AcrySof IOL in a human, in December 1990. After more than 15 years, that patient’s capsule is still perfectly clear, he said.

Since October 2003, he has been implanting the ReSTOR multifocal IOL.

Clinical data

“This IOL incorporates the concepts of diffraction and refraction to gain the advantages of both technologies,” he said. “It offers a good near and distance vision. Intermediate vision, due to the nature of the diffractive optic, is not equally sharp, but in the majority of cases is perfectly functional.”

He has implanted the ReSTOR in 248 patients, bilaterally and simultaneously. Of these procedures, 183 were cataract and 65 were refractive lens exchange (RLE).

The mean age of the patients was 58, “lower than the normal average for cataract surgery, because a number of these patients have had RLE,” he said.

The range of correction achieved was between –10 D and +16 D, with astigmatism up to –2.5 D. “Obviously, the +16 D required piggybacking,” he said. “The greatest number of these patients were hyperopes, a lot were myopes, and the ones that were close to emmetropia were cataract patients. I haven’t implanted any of these lenses in RLE in emmetropic patients.”

Dr. Packard said visual results at 18 months were good. Distance uncorrected vision of 20/30 or better was achieved in 100% of the patients, and the majority were 20/25 or better. At near, 99% of the patients could see J2 or better. Of the two patients who achieved only J4, one had residual astigmatism and the other had macular changes undetected before cataract surgery.

Binocular UCVA at distance and near [n = 18]

Distance uncorrected vision of 20/30 or better was achieved in 100% of the patients, and the majority were 20/25 or better. At near, 99% of the patients could see J2 or better. Of the two patients who achieved only J4, one had residual astigmatism and the other had macular changes undetected before cataract surgery.

Binocular UCVA at distance and near [n = 18] chart

Source: Packard RB

Spectacle independence

The effect of this IOL on the activities of daily living was assessed with a questionnaire. Of 50 patients who had follow-up data for more than 1 year, 40 of them filled in the form completely, and their data were analyzed.

Patients were asked to rate their visual comfort in a series of activities, such as reading, working with the computer, playing cards and driving, on a scale from 1 (very poor) to 7 (very good), in bright light and in dim light or at night. They were also asked if they used spectacles in any of these situations. Finally, they were asked if they would or would not recommend the same lens to friends and relatives. Thirty-five out of the 40 patients scored a 6 or 7 to the latter, with no patient marking less than a 4.

“The results for both distance and near vision approached 7 in bright light and were also acceptable, in the good range, for dim light,” Dr. Packard said.

The number of patients using reading glasses was slightly greater than one might expect, because “some of the patients (3/40) wear glasses to move their reading distance vision away, although they’re perfectly capable of reading J2 if they want to. All three of them said that if they didn’t have glasses they could manage very well anyway,” he said.

“As far as computer work was concerned, I was surprised that 30 out of 40 patients use the computer frequently. This confirms the data of a recent survey, showing that a high percentage of people who are 50 or older make regular use of the computer. Out of those 30 patients, five felt the need to use glasses for their computer work but didn’t use them at any other time,” Dr. Packard said.

Most of the patients who play cards – and they were the majority in the group – found that they had no problem doing so without spectacles, he said.

He added that patients were generally happy with their driving vision in good light and at night. All patients but one drive regularly, and the majority felt they had no significant problems, but only a slight disturbance, with glare and halos.

“Only a few patients had more severe complaints, which, however, didn’t stop them from driving at night. We should remember that a lot of cataract patients implanted with monofocal IOLs also complain of glare at night,” Dr. Packard said.

“In conclusion, long-term data indicate that bilaterally implanted AcrySof ReSTOR lenses are a good option for patients who are motivated to gain spectacle independence in a wide range of daily activities,” he said.

For more information:

Richard B. Packard, MD, FRCS, can be reached at Arnott Eye Associates, 22A Harley St., London W1G 9BP England; +44-207-580-1074/8792; fax: +4-207-255-1524; e-mail: post@arnotteye.com. Dr. Packard has no financial interest in this product.

Michela Cimberle is an OSN Correspondent based in Treviso, Italy, who covers all aspects of ophthalmology. She focuses geographically on Europe.