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Multifocal IOL yields better visual outcomes in low hyperopes than in high hyperopes

Eur J Ophthalmol. 2009;19:748-753.

Issue: October 25, 2009

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Low hyperopes had markedly better visual acuity and contrast sensitivity than high hyperopes after implantation of a multifocal IOL, according to a study.

"The visual acuity and [contrast sensitivity] for both distance and near, with and without distance correction, were statistically better in eyes with low hyperopia compared to those obtained in eyes with high levels of hyperopia," the study authors said.

The prospective study included 172 hyperopic eyes implanted with the AcrySof ReSTOR Natural IOL (Alcon). The group included 86 high hyperopic eyes and 86 low hyperopic eyes. Investigators assessed monocular logMAR visual acuity for distance and near, with and without distance correction, and photopic and mesopic contrast sensitivity at 6 months postoperatively.

Study data showed low hyperopes had a mean monocular best distance-corrected visual acuity of 0.01. High hyperopes had a mean monocular best distance-corrected visual acuity of 0.04. Low hyperopes had mean monocular best distance-corrected near visual acuity of 0.02. High hyperopes had mean monocular best distance-corrected near visual acuity of 0.05.

High hyperopes had lower contrast sensitivity under photopic conditions than low hyperopes, especially at high spatial frequencies. High hyperopes had lower contrast sensitivity values than low hyperopes under mesopic conditions at all spatial frequencies, the authors said.

This paper reports better contrast sensitivity following implantation of a ReSTOR Natural Multifocal IOL in eyes with low hyperopia when compared to those with higher levels of hyperopia. This finding may be partly secondary to the optics of the IOLs, because lenses with very high plus powers do generate a slightly inferior quality image. The most likely primary cause is secondary to the optics of the eye receiving the implant. Eyes with high hyperopia often demonstrate more higher order aberrations in the cornea than those with lower levels of hyperopia. These corneal higher-order aberrations reduce contrast sensitivity. Finally, some eyes with extreme refractive errors have a relative amblyopia, with a reduced maximum visual acuity and contrast sensitivity. The contrast sensitivity differences are to me subclinical and the visual handicap of high hyperopia is significant. Therefore, these findings should not discourage those who favor this lens implant from using it in high hyperopes.

– Richard L. Lindstrom, MD
OSN Chief Medical Editor