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Bilateral, contralateral multifocal IOLs yield similar distance, intermediate visual acuity
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Bilateral implantation of one multifocal IOL power was non-inferior to contralateral implantation of different multifocal IOL powers in improving distance and intermediate visual acuity, according to a study. However, contralateral implantation yielded superior near vision.
“Contralateral implantation might be more beneficial for reading than bilateral implantation. Thus, patients demanding spectacle independence when reading would benefit from contralateral implantation,” corresponding author Soraya M.R. Jonker, MD, and colleagues said in the study, published in the Journal of Cataract and Refractive Surgery.
Study design
The prospective study included 206 eyes of 103 patients who underwent bilateral cataract extraction. Fifty-three patients underwent bilateral implantation of an Alcon AcrySof IQ ReSTOR +2.5 D multifocal IOL (bilateral group); 50 patients underwent implantation of the +2.5 D IOL in the dominant eye and an Alcon AcrySof IQ ReSTOR +3 D multifocal IOL in the fellow eye (contralateral group).
All eyes were targeted for emmetropia. The primary endpoint was logMAR corrected intermediate visual acuity at 60 cm. The secondary endpoint was corrected near visual acuity at 40 cm. The non-inferiority margin was 0.1. All endpoints were measured 3 months after implantation.
Results
Mean binocular corrected intermediate visual acuity 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 corrected near visual acuity at 3 months was 0.26 in the bilateral group and 0.11 in the contralateral group. Bilateral implantation did not achieve non-inferiority with contralateral implantation.
“Binocular defocus curves suggested similar performance in distance vision between the two groups,” the study authors said.
Reading speed was similar between the groups. Binocular photopic contrast sensitivity was similar in both groups, with and without glare.
Adverse events
There were no significant differences in treatment-related emergent ocular adverse events rates. Three device-related adverse events were reported in the bilateral group, and two were reported in the contralateral group.
“In contrast to results in some bilateral studies, in which straylight was an issue, bilateral implantation and contralateral implantation appeared to be similar in regard to photic phenomena and visual problems 3 months after implantation,” the authors said in the study. “In other studies, unlike what we observed in this study, this difference in the quality of vision with multifocal IOLs was believed to result from the adjustment of the apodization pattern within the IOLs because the +2.5 D IOL had fewer rings of progressively decreasing diffractive step height from the center to the periphery than the +3 D IOL and hence was potentially responsible for fewer halos. ... These unwanted visual phenomena have been shown to have a large impact on postoperative patient satisfaction.”
Further study is ongoing, Jonker said.
“At the Maastricht University Eye Clinic, we are currently implanting mostly trifocal multifocal IOLs to deliver a good visual acuity at intermediate and near distance. We used the FineVision Micro F multifocal IOL (PhysIOL) and are currently participating in a trial with the AcrySof IQ PanOptix multifocal IOL,” she said. – by Matt Hasson
- Reference:
- Nuijts RM, et al. J Cataract Refract Surg. 2016;doi:10.1016/j.jcrs.2016.02.009.
- For more information:
- Soraya M.R. Jonker, MD, can be reached at Department of Ophthalmology, Maastricht University Medical Center, University Eye Clinic, Maastricht, the Netherlands; email: soraya.jonker@mumc.nl.
Disclosure: Jonker reports no relevant financial disclosures.