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Bilateral, contralateral multifocal IOLs yield similar intermediate, distance visual acuity
Bilateral implantation of a multifocal IOL was non-inferior to contralateral implantation of different multifocal IOLs in terms of intermediate and distance visual acuity, according to a study. However, bilateral implantation did not yield comparable near vision.
“These results suggest that contralateral implantation might have a higher likelihood than bilateral implantation of patients attaining spectacle independence over a wide range of distances,” the study authors said.
The prospective study included 206 eyes of 103 patients who underwent bilateral cataract extraction. Fifty-three patients underwent bilateral implantation of an AcrySof IQ ReSTOR +2.5 D multifocal IOL (Alcon) in the dominant and fellow eye. Fifty patients underwent implantation of an AcrySof IQ ReSTOR +2.5 D multifocal IOL in the dominant eye and an AcrySof IQ ReSTOR +3.0 D multifocal IOL in the fellow eye.
Mean logMAR corrected intermediate visual acuity at 60 cm at 3 months was 0.13 in the bilateral group and 0.10 in the contralateral group. Bilateral implantation was non-inferior to contralateral implantation.
Mean binocular logMAR corrected near visual acuity at 40 cm at 3 months was 0.26 in the bilateral group and 0.11 in the contralateral group. Bilateral implantation did not achieve non-inferiority to contralateral implantation.
Uncorrected distance visual acuity was similar between the groups. Mean binocular corrected distance visual acuity was better in the contralateral group.
Binocular photopic contrast sensitivity was similar in both groups, with and without glare. – by Matt Hasson
Disclosure: Nuijts reports he has received non-remunerative research grants from AcuFocus, Alcon Research, Bausch + Lomb, HumanOptics, Ophtec and PhysIOL and consultant fees from Laboratoires Thea. See the full study for all other authors’ relevant financial disclosures.
Perspective
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Its always valuable to see a study that corroborates our own clinical impressions. This study, performed at eight centers on about 100 patients, examines performance for intermediate and near vision among patients with bilateral ReSTOR +2.5 D add lenses vs. those with a +2.5 D add ReSTOR in one eye and a +3.0 D add lens in the other, with the higher add in the non-dominant eye. Not surprisingly, the study shows improved near performance in patients receiving the +3.0 D add lens in one eye. It also shows actually fewer issues with glare and halos at 3 months in the group with mixed IOLs. This matches with my own clinical impressions with this lens, where I routinely use this +2.5 D and +3.0 D add approach for the dominant and non-dominant eyes, respectively.
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Nuijts RMMA, et al. J Cataract Refract Surg. 2016;doi:10.1016/j.jcrs.2016.02.009.