Multifocal versus monofocal intraocular lenses after cataract extraction

Abstract

BACKGROUND: Good unaided distance visual acuity is now a realistic expectation following cataract surgery and intraocular lens (IOL) implantation. Near vision, however, still requires additional refractive power, usually in the form of reading glasses. Multiple optic (multifocal) IOLs are available which claim to allow good vision at a range of distances. It is unclear whether this benefit outweighs the optical compromises inherent in multifocal IOLs. OBJECTIVES: The objective of this review was to assess the effects of multifocal IOLs, including effects on visual acuity, subjective visual satisfaction, spectacle dependence, glare and contrast sensitivity, compared to standard monofocal lenses in people undergoing cataract surgery. METHODS: Search methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register), The Cochrane Library 2012, Issue 2, MEDLINE (January 1946 to March 2012), EMBASE (January 1980 to March 2012), the metaRegister of Controlled Trials (mRCT) (www. controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who. int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 6 March 2012. We searched the reference lists of relevant articles and contacted investigators of included studies and manufacturers of multifocal IOLs for information about additional published and unpublished studies. Selection criteria: All randomised controlled trials comparing a multifocal IOL of any type with a monofocal IOL as control were included. Both unilateral and bilateral implantation trials were included. Data collection and analysis: Two authors collected data and assessed trial quality. Where possible, we pooled data from the individual studies using a random-effects model, otherwise we tabulated data. MAIN RESULTS: Sixteen completed trials (1608 participants) and two ongoing trials were identified. All included trials compared multifocal and monofocal lenses but there was considerable variety in the make and model of lenses implanted. Overall we considered the trials at risk of performance and detection bias because it was difficult to mask patients and outcome assessors. It was also difficult to assess the role of reporting bias. There was moderate quality evidence that similar distance acuity is achieved with both types of lenses (pooled risk ratio, RR for unaided visual acuity worse than 6/6: 0.98, 95% confidence interval, CI 0.91 to 1.05). There was also evidence that people with multifocal lenses had better near vision but methodological and statistical heterogeneity meant that we did not calculate a pooled estimate for effect on near vision. Total freedom from use of glasses was achieved more frequently with multifocal than monofocal IOLs.

Multifocal and Accommodative Intraocular Lenses

“…By analyzing the published literature, the Coch rane review prepared by Calladine et al [23] found only 16 papers reporting wellorganized and conducted studies, with 1,608 participants. The emerging evidence is that multifocal IOLs provide the same uncorrected and corrected dis tance vision as monofocal IOLs, but definitely better near vision.…”

Cost-Effectiveness Comparison Between Monofocal and Multifocal Intraocular Lens Implantation for Cataract Patients in Taiwan

“…This finding was also consistent with previous studies, suggesting that multifocal IOLs were worthy of being more favored than monofocal IOLs. 15,[25][26][27] For the binocular distance vision of naked eyes and BCVA, no significant difference was observed in the effectiveness between multifocal and monofocal IOLs, as the ICERs indicated that multifocal IOLs were either too costly or were associated with a negative value. In addition, the ICERs of intermediate distance vision were in the second quadrant (dominant), suggesting that the multifocal IOL group was not better than the monofocal IOL group and an in-depth comparison was not necessary.…”

Clinical outcomes and surgeon assessment after implantation of a new diffractive multifocal toric intraocular lens

“…They found that night driving was the only exception to total subjective satisfaction when postoperative quality of life was assessed. Although some authors have reported good clinical results with multifocal IOLs,14 15 many practitioners have still some concerns about the performance of this IOL modality due to the significant rates of postoperative halos and glare perception associated with some of these implants16 that may affect daily tasks and quality of life 17. Likewise, visual alterations induced by non-centred IOLs18 and the low tolerance to mild residual refractive errors that may yield to a significant reduction of UDVA19 are other concerns related to multifocal IOLs.…”