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Con: Bilateral implantation of same model presbyopia-correcting IOL
Implanting the same technology in both eyes has been shown in clinical trials to produce good visual results, investigator asserts.
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Implanting the same presbyopia-correcting IOL technology in both eyes of a patient creates a “summation effect” that allows the lens to function more effectively than if different technologies are combined, according to Robert P. Lehmann, MD.
![Robert P. Lehmann, MD [photo]](/images/osn/200601a/lehman.jpg) Robert P. Lehmann |
The Alcon AcrySof ReSTOR apodized diffractive IOL, which Dr. Lehmann uses for presbyopia correction, provides patients with the best quality vision after the second lens has been implanted, he said.
He said the apodized diffractive optics of the ReSTOR and the zonal refractive optics of the Advanced Medical Optics ReZoom IOL are vastly different and are not designed to work together.
“The optics are different enough that, in a number of patients, far from being complementary, they may be somewhat conflicting. I’m concerned that we’ll see patients that will compare one with the other and be unhappy,” Dr. Lehmann said.
Dr. Lehmann has long-term experience with the ReSTOR IOL, having implanted the first one in the United States in 2001 at the beginning of the clinical trial for Food and Drug Administration approval. The clinical trial allowed investigators to examine patient characteristics such as nighttime vision, driving ability, contrast sensitivity and overall satisfaction, he said.
Since its premarket approval in March, Dr. Lehmann said he has implanted the ReSTOR in more than 350 eyes, and most of these implantations have been bilateral. He said he has found that using the same lens in both eyes enhances patient satisfaction because the two IOLs work in tandem.
“There is absolutely no need to mix these lenses,” Dr. Lehmann said. “The clinical science and studies have been done with bilateral implantation. I’m familiar with the results of the ReSTOR lens when bilaterally implanted, and the results are pretty much second to none. It concerns me gravely to hear the idea that maybe we’re going to see some sort of synergy and improvement by mixing lenses. This is based pretty much right now on speculation rather than any kind of carefully controlled clinical study.”
Second lens enhances results
According to Dr. Lehmann, after he implants the ReSTOR lens in a patient’s first eye, most patients are pleased with the result, as they are able to read and still have good distance vision. About 1 to 2 weeks after the first surgery, when he implants the same lens model in the second eye, the patients’ enthusiasm levels increase, Dr. Lehmann said.
“The majority of these patients are just overwhelmingly enthusiastic with the overall visual function improvement that they have,” Dr. Lehmann said. “They regain excellent distance vision, have good nighttime vision and excellent reading function. I have found that in that process of bilateral implantation, with implantation of the second eye, I get an acceleration of the satisfaction level.”
A small percentage of patients may not be satisfied with their vision after the first lens is implanted, Dr. Lehmann said. In 99% of those cases, he said, implanting the same IOL model in the second eye corrects the problem.
Dr. Lehmann said it is unclear whether the dissatisfaction in a small number of patients after the first implantation is caused by the process of neural adaptation or some other reason. If there is an observable cause, it is usually another issue rather than the IOL, he said, such as dry eye, anterior basement membrane dystrophy, residual astigmatism or mild, subclinical macular edema. He said in those cases, he feels it is best to use the same lens style in the second eye and not risk further complications by implanting a different model.
Dr. Lehmann said part of the success of multifocal IOLs depends on thorough patient education and informed consent. While implanting the ReSTOR in both eyes brings good visual results, patients must be informed about the possibility of unwanted visual effects such as glare, halos and night vision problems.
“If you look at the FDA clinical results, there’s really very little that compares with bilateral implantation. I have a number of patients that have been refractive lens exchanges, and they’re very satisfied,” he said.
For Your Information:
- Robert P. Lehmann, MD, can be reached at 5300 North St., Nacogdoches, TX, 75965; 936-569-8278; fax: 936-569-0275; e-mail: Lehmanneyecenter@cox-internet.com. Ocular Surgery News was unable to confirm whether Dr. Lehmann has a direct financial interest in the products mentioned in this article or is a paid consultant for any companies mentioned.
- Alcon, maker of the AcrySof ReSTOR IOL, can be reached at 6201 South Freeway, Fort Worth, TX 76134; 817-293-0450; fax: 817- 568-6142; Web site: www.alconlabs.com.
- Erin L. Boyle is an OSN Staff Writer who covers all aspects of ophthalmology.