Bilateral multifocal IOL implantation yields best visual outcomes, patient satisfaction

J Cataract Refract Surg. 2009;35(6):1033-1039.

Bilateral implantation of an apodized diffractive multifocal IOL yielded better visual outcomes than unilateral implantation, according to a recent study.

"Although unilateral implantation of a multifocal IOL provided patients with high levels of spectacle freedom and good visual acuity without compromising contrast sensitivity, overall clinical results favored bilateral implantation," the study authors said.

The study included patients who required cataract surgery in one eye. AcrySof ReSTOR IOLs (Alcon) were implanted in one eye of patients with contralateral phakic eyes and contralateral eyes implanted with monofocal IOLs or the same multifocal IOL. At 6 months postop, primary outcome measures were visual acuity, contrast sensitivity and stereopsis. Visual disturbances and lifestyle visual quality were also assessed.

Seventy-five percent of unilateral multifocal IOL recipients were satisfied with their vision; 56% of multifocal-phakic patients and 65% of multifocal-monofocal patients attained spectacle independence. Bilateral multifocal IOL recipients were slightly more satisfied (92%) and more had reached spectacle independence (77%). However, the difference was not statistically significant, the authors said.

Bilateral multifocal IOL recipients had a mean patient satisfaction score of 8.9, and unilateral multifocal IOL patients had a mean satisfaction score of 7.3; the difference was statistically significant. Bilateral implantation showed significantly better results for stereopsis, uncorrected near visual acuity, best corrected near visual acuity and best corrected intermediate visual acuity.

"Contrast sensitivity was similar between groups in most cases," the authors said. "The incidence of halos was lower in unilateral patients (57%) than in bilateral patients (77%), although the difference did not reach statistical significance."