Effect of Multifocal Intraocular Lens on Contrast Sensitivity in Primary Angle-Closure Patients

Abstract

Introduction: Cataract surgery with intraocular lens (IOL) implantation in primary angle-closure glaucoma (PACG) has been reported to improve visual acuity, and to reduce postoperative intraocular pressure (IOP) and the number of required medications. Few studies have reported the use of multifocal IOL (MIOL) in PACG. Since both MIOL and glaucoma can decrease contrast sensitivity (CS), this study was to evaluate the effect of MIOL implantation on CS compared to monofocal IOL (mIOL) in primary angle-closure (PAC) or PACG.Methods: This prospective study included patients with PAC or PACG and visually significant cataract. Phacoemulsification with MIOL or mIOL (patient preference) was performed. Collected data included best-corrected distant visual acuity (BCVA), intraocular pressure (IOP), anterior chamber depth (ACD), and contrast sensitivity (CS) measured at spatial frequency 1.5, 3.0, 6.0, 12.0, and 18.0 cycles per degree (CPD) preoperatively, and at 2-6 months postoperatively. Preoperative and postoperative parameters were then compared. Results: Of the 45 eyes from 35 patients that were enrolled, 33 eyes (15 PAC, 18 PACG) from 26 patients completed the study. Fourteen eyes (11 patients) received diffractive MIOL, and 19 eyes (15 patients) received aspheric mIOL. Preoperative CS was not significantly different between groups. Postoperatively, BCVA, and CS at each spatial frequency were significantly improved in both groups (all p<0.001). Mean postoperative CS at spatial frequency 1.5, 3.0, 6.0, 12.0, and 18.0 CPD was 28.03, 42.63, 44.84, 10.82, and 2.86 in the MIOL group, and 29.55, 49.63, 46.20, 16.83, and 7.09 in the mIOL group, both respectively. Postoperative CS was not significant different between groups at any spatial frequencies. IOP was decreased (p=0.001) and ACD increased (p<0.001) postoperatively in both groups. Conclusion: No significant difference in contrast sensitivity was observed between MIOL and mIOL after cataract removal in PAC/PACG. Multifocal IOL can be considered in primary angle-closure eyes.

Effect of presbyopic correction lens on humphrey visual field testing in patients with multifocal intraocular lens

“…[ 17 ] Implantation of MIOL in glaucomatous patients may exacerbate the loss of contrast sensitivity. [ 18 – 20 ] Thus, patients with glaucoma who naturally have reduced contrast sensitivity should be well-informed about the application of MIOL. [ 18 , 21 , 22 ] Several studies have reported a depression of MD on HVF measurement with MIOL.…”