Visual function and subjective perception of vision after bilateral implantation of monofocal and multifocal IOLs: a randomized controlled trial

Abstract

Following implantation with Multifocal intraocular lenses (MIOLs) or monofocal intraocular lenses (IOLs), the study examines monocular and binocular visual function and patient reporting outcomes using a rigorous series of clinical assessments. Setting: BMI Southend Hospital, UK DESIGN: Prospective, randomised, double-masked clinical trial. METHODS: 100 subjects were randomised for bilateral implantation of either Bi-Flex 677MY MIOL or Bi-Flex 677AB IOL and were assessed at 3-6 months (V1) and 12-18 months (V2). Primary outcomes included distance, intermediate and near LogMAR visual acuities (VA) and defocus curve profile assessment. Secondary outcomes included reading speed, contrast sensitivity (CS) and the subjective perception of quality-of-vision. RESULTS: Uncorrected (MIOL 0.10±0.09LogMAR; IOL 0.09±0.11LogMAR) and best distancecorrected VA (MIOL 0.04±0.06LogMAR; IOL 0.01±0.07LogMAR) were comparable (p>0.05). Unaided near VA (UNVA p<0.001: MIOL 0.23±0.13LogMAR; IOL 0.55±0.20LogMAR) and distancecorrected near VA (DCNVA p<0.001: MIOL 0.24±0.13LogMAR; IOL 0.54±0.17LogMAR) were significantly improved with MIOLs. There was no significant difference in distance-corrected intermediate VA (DCIVA p=0.431: MIOL 0.38±0.13; IOL 0.39±0.13).Defocus curves demonstrated an increased range-of-focus amongst MIOLs (MIOL 4.14±1.10D; IOL 2.57±0.77D). Pelli-Robson CS was different at V1 (p<0.001) but similar by V2 (p=0.059).Overall satisfaction was high (>90%) in both groups for distance tasks whereas significantly different for near (MIOL 18.45±16.53LogUnits; MIOL 55.59±22.52LogUnits). CONCLUSIONS:Unaided near visual acuity is demonstrably better with MIOLs and there was greater subjective satisfaction with their quality-of-near-vision. Halos reported by the MIOL group was significant compared to the IOL group, but did not show an adverse effect on overall satisfaction.Multifocal intraocular lenses (MIOLs) are widely considered the most reliable method of achieving spectacle independence following cataract surgery. [1][2][3] MIOLs distribute the light between distant and near focal points whereby the vergence of the incident light dictates which focal point is conjugate to the retinal plane.The separation of these multiple focal points is determined by the addition power of the MIOL and to a lesser extent the biometry of the eye. High addition MIOLs (+4.00D or higher) are the zeitgeist of the designs used in the late 90s-early 2000s. Disadvantages of these early lenses included a close working distance and reduced intermediate vision. Moreover, the size of the dysphotopic phenomenon (commonly described as halo), associated with MIOLs, increases according to the addition power; these higher addition lenses generate larger haloes. 4,5 The light energy distribution between the retinal focal points created by a MIOL influences the overall quality of vision at different viewing distances. MIOLs that split light equally, create two focal points of comparative image quality. In contrast, distance dominant MIOLs allocate a higher per...

Comparison of Clinical Outcomes, Visual Quality and Visual Function of Two Presbyopia-Correcting Intraocular Lenses Made from the Same Material, but with Different Design and Optics

“…Because all surgeries were performed by the same experienced surgeon using the same surgical protocol with the utmost caution, we believe that the differences in frequency and severity of PCO are likely explained by differences in IOL design [16,46]. We acknowledge that our reported 1-year rates for PCO and Nd:YAG capsulotomy are higher than those reported in other studies [29,[47][48][49]. The definition of PCO and the criteria for performing Nd:YAG capsulotomy, however, may differ between centers.…”

Distribution of angle α and angle κ in a population with cataract in Shanghai

“…However, disturbing photic phenomena, such as glare and haloes, are some of the main complaints in patients who have undergone multifocal IOL implantation, influencing their daily quality of life and overall satisfaction with the surgery. 1,2 Previous studies have shown that abnormal deviations between the optical axis and the visual axis (angle a) or between the pupillary axis and the visual axis (angle k) can lead to increased higher-order aberrations and consequent photic phenomena, causing impaired visual quality in patients after multifocal IOL implantation. [3][4][5] Therefore, angle k and angle a have been gradually taken into consideration in the surgical planning of functional IOLs.…”

“…However, disturbing photic phenomena, such as glare and haloes, are some of the main complaints in patients who have undergone multifocal IOL implantation, influencing their daily quality of life and overall satisfaction with the surgery. 1,2…”

One-year follow-up of a multifocal intraocular lens with optimized elevated phase shift

“…For instance, spectacle independence at near has been reported for the 677MY to be between 75% and 100% and between 93% and 100% for intermediate, but these percentages were not collected with the PRSIQ. 10,11,21…”

“…6 Clinical results with the EPS technology have been widely reported for the Liberty 677MY (EPS 1.0), but a new optimized EPS version for increasing light intensity distribution at intermediate distance has been designed (EPS 2.0), decreasing far and near light intensity, in such a low degree, that this optimization could have a clinically negligible decrease on far and near distance visual acuities but a clinically relevant increase at intermediate visual acuity (VA). [7][8][9][10][11] The aim of this study was to evaluate the safety, predictability, and efficacy of the implantation of a mIOL with this optimized EPS. The secondary aim was to assess the defocus curves (DCs) and patient-reported outcomes at 1 year postoperatively.…”