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Patients with multifocal IOL may require 6-month neuroadaptation period
Eur J Ophthalmol. 2009;19:762-768.
Most cataract patients experienced a 6-month neuroadaptation period before benefiting fully from implantation of a multifocal IOL, according to a study.
The Tecnis multifocal IOL (Abbott Medical Optics) yielded positive near and distance vision after the acclimation period, the study authors said.
The prospective study included 250 eyes of 137 patients with a mean age of 68.5 years. Investigators assessed monocular uncorrected and corrected near visual acuity and distance visual acuity, visual symptoms and patient satisfaction at 1 to 3 days, 30 to 90 days and 150 to 210 days after cataract surgery.
Investigators also evaluated posterior capsular opacification and contrast sensitivity in photopic conditions.
Study data showed mean uncorrected near visual acuity of 0.215 and corrected near visual acuity of 0.189 at final follow-up. Most eyes (96.8%) were able to read J2 without correction; 83.2% were able to read at J1. The majority of eyes (95.6%) were able to read J1 with best distance correction.
Mean uncorrected distance visual acuity was 0.144, with 77.6% of eyes seeing 20/30 or better. Mean corrected distance visual acuity was 0.09, with 98.4% of eyes seeing 20/30 or better.
More than 90% of patients ranked near, distance and global vision as good or excellent; 88.4% of patients achieved spectacle independence. The rate of grade 1 PCO was 4.4%, and mean monocular contrast sensitivity was 1.44 at final follow-up, the authors said.
Bautista et al show excellent 6 months’ results with the Tecnis multifocal IOL for both distance and near uncorrected visual acuity. Because all diffractive IOLs are bifocal lenses, intermediate vision is always a concern; however, satisfaction seemed to be very good. These are the kind of results that are generally expected today with any top-quality diffractive IOL. They also document that success is a learned function with 6 months necessary to fully adapt to this new way of seeing. So patients better be prepared for a learning curve and have some patience for this adaptation process.
The take-home message from this study is that good near and distance uncorrected vision is the norm with this IOL. The unanswered questions of visual quality and intermediate vision issues are not resolved with this study; however, satisfaction was very good. Are people in the U.S. a tougher sell? Are European patients less likely to complain? Rigorous studies focusing on visual quality, patient satisfaction and intermediate vision for those who use it a lot are still badly needed in the literature. There will be skeptics until we see such great results in a U.S. cohort.
– Randall J. Olson, MD
OSN Cataract
Surgery Board Member