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Multifocal IOL provides good near, distance vision for hyperopic presbyopes
Hyperopic patients reported good visual acuity after refractive lens exchange with the Tecnis Multifocal IOL.
SAN FRANCISCO — With careful patient selection, the Advanced Medical Optics Tecnis ZM900 Multifocal IOL provides excellent postoperative vision at all distances for presbyopic hyperopic patients, according to Frank J. Goes, MD.
Dr. Goes spoke at the American Society of Cataract and Refractive Surgery in San Francisco in March about the use of the Tecnis multifocal IOL in presbyopic hyperopes. He discussed 3-month postoperative results in 84 eyes of 42 patients who underwent refractive lens exchange at his practice in Antwerp, Belgium. The presbyopic patients had hyperopia ranging from +1.5 D to +8 D. The mean age of patients was 55 years, and the surgery was performed in one session on both eyes, with topical anesthesia.
The AMO Tecnis Multifocal, which is not approved for use in the United States but is in use in Europe, has a modified aspheric prolate surface that compensates for spherical aberrations in the cornea, Dr. Goes said. The reduction in spherical aberration improves functional vision, he said.
“It eliminated spectacle dependency across a range of distances,” Dr. Goes said of the lens. “It’s indicated for visual correction of aphakia in cataract surgery and in refractive lens exchange and presbyopia treatment.”
He said the lack of patient complaints, excellent uncorrected visual acuity and large percentage of patients who did not require glasses after surgery demonstrated the lens’ effectiveness.
Working distances
Of 42 patients in the study, 40 went without glasses 100% of the time following bilateral implantation of the Tecnis Multifocal, Dr. Goes said. Two patients needed glasses for specific activities but spent 80% of their time without spectacles. Fourteen out of 84 eyes needed LASIK “touch-up” to correct residual refractive error after IOL implantation, he said.
Dr. Goes said he tested his employees and himself to determine mean intermediate computer working distance using Jaeger card testing. He determined that it was 48 cm. He then checked the patients in the study and found that more than 90% of patients could see binocularly J3 or better at 50 cm for computer work with distance correction in place; 40% could see J2 or better.
“Those results were extremely good” for intermediate vision with the dual-focus IOL, he said.
Near vision results were as good as distance results with the lens, Dr. Goes said. With distance correction, almost 100% of patients could see J1 at near; uncorrected 93% could see J1 at near, he said.
The manifest refraction spherical equivalent preoperatively was +4.21 D, and postoperatively +0.24 D.
Visual disturbances
According to Dr. Goes, only two patients of the 42 reported night vision driving problems. All patients said they would recommend the lens to others, and none considered explantation.
He said that, when asked, 16% of patients had minor complaints about the lens. About 7% had major complaints. The remaining patients had no complaints. None required YAG laser at 3-month follow-up.
Dr. Goes said a method is needed to anticipate patient complaints before surgery, through careful preoperative counseling.
“There should be a way to detect these patients who will develop important subjective complaints before we do surgery,” he said.
There were no major intraoperative complications, and the surgery is no more challenging than standard cataract surgery, Dr. Goes said.
Potential long-term complications of refractive lens exchange included retinal detachment, Dr. Goes acknowledged, but he said he has never seen a retinal detachment in a high hyperope after refractive lens exchange.
“I will give a box of champagne to anyone who has seen a retinal detachment after uncomplicated lens surgery in high hyperopia,” he said at the meeting.
For more information:
- Frank J. Goes, MD, can be reached at W. Klooslaan 6 B2050 Antwerp, Belgium; 32-321-939-25; fax: 32-321-966-67; e-mail: frank@goes.be.
- Advanced Medical Optics, maker of the Tecnis ZM900, can be reached at 1700 E. St. Andrew Place, Santa Ana, CA 92799; 714-247-8200; fax: 866-872-5635; Web site: www.amo-inc.com.
- Erin L. Boyle is an OSN Staff Writer who covers all aspects of ophthalmology.