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Visual acuity, patient satisfaction comparable for bilateral, unilateral multifocal IOLs
Patient selection is key when implanting unilateral or mix-and-match bilateral multifocal IOLs.
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Bilateral and unilateral implantation of multifocal IOLs yielded similar outcomes for vision, subjective patient satisfaction, spectacle independence and other visual symptoms, according to a study.
In the retrospective review, a patient lifestyle questionnaire determined the treatment for 23 patients with bilateral cataract. Thirty patients had unilateral cataract.
For patients with bilateral cataract who preferred to see near targets, such as at 33 cm, the study authors implanted a diffractive multifocal IOL (Tecnis ZM900, Abbott Medical Optics) in the dominant eye and a refractive multifocal IOL (ReZoom NXG1, AMO) in the nondominant eye.
“When a patient preferred to see intermediate targets, such as at 50 cm to 70 cm, more clearly, we reversed the lenses,” co-author Hungwon Tchah, MD, told Ocular Surgery News.
Hungwon Tchah
Patients with monocular cataract were implanted with the diffractive multifocal IOL in one eye only.
Patient satisfaction
“Nearly all patients from both the bilateral mix-and-match group and the unilateral group were satisfied with their results,” Tchah said. “Severe glare and halo was rare. Therefore, mix-and-match multifocal IOL implantation and even unilateral multifocal IOL can be recommended.”
Tchah and the other authors of the study, which appeared in the Journal of Cataract and Refractive Surgery, were surprised by how well the unilateral group fared.
“About 40% of these patients were very satisfied and about 50% satisfied,” Tchah said. “Moreover, about 60% of the group was able to read without spectacles.”
However, subjective patient satisfaction was slightly higher in the bilateral group.
“Bilateral patients had slightly better uncorrected distance visual acuity, uncorrected intermediate visual acuity and uncorrected near visual acuity,” Tchah said.
At 1 year, the mean values for the bilateral group and unilateral group, respectively, were uncorrected distance visual acuity of 0.10 logMAR and 0.10 logMAR; uncorrected intermediate visual acuity of 0.23 logMAR and 0.29 logMAR; and uncorrected near visual acuity of 0.25 logMAR and 0.27 logMAR.
There were no serious complications during the 1-year postoperative study period.
“Some patients complained about severe glare and halo,” Tchah said. “Glare seemed to disappear over time, but halo remained. Still, none of the patients wanted to have their IOL removed because of intractable visual symptoms.”
Patient selection
Tchah said patient selection is key to increase the efficacy and safety of multifocal IOL implantation.
“Patients with abnormal corneal topography and macular pathology should be avoided,” he said. “Accurate biometry is also very important. These patients expect not to wear glasses at all. If there is residual refractive error after surgery, the patient will not be satisfied.”
Tchah found that the patient who had a strong desire to rid himself of glasses for near vision was usually satisfied with multifocal IOLs.
“However, it is known that such a demanding person is not a good candidate,” he said.
Tchah said that he tells his patients to avoid comparing the two eyes to prevent compromising the neural adaptation.
“When neural adaption is working well in multifocal IOL patients, the mix-and-match method might be a good option or better option than the same multifocal lens in both eyes because the brain can select the clearer image from both eyes, thus hopefully maximizing the advantages and minimizing the disadvantages of each individual multifocal lens,” Tchah said.
Tchah predicted the use of multifocal IOLs will increase as efficacy continues to improve and complications decrease.
Tchah is currently evaluating the results of multifocal IOL implantation in patients who previously had a monofocal IOL in one eye. – by Bob Kronemyer