Multifocal IOL may maintain near vision without reducing distance vision in eyes with AMD

J Cataract Refract Surg. 2012;38(3):415-418.

  • Ocular Surgery News U.S. Edition, May 10, 2012

Implantation of a myopia-targeted multifocal IOL improved or maintained near vision without significantly diminishing distance vision in cataractous eyes with concomitant age-related macular degeneration, according to a study.

“The preliminary results in this study suggest this multifocal-magnification strategy holds promise for visual rehabilitation of AMD patients with cataract and may be useful in guiding researchers and manufacturers in the design of high-magnification IOLs for AMD patients,” the study authors said.

The analysis included 20 eyes of 13 patients with concurrent cataract and dry AMD or AMD associated with disciform scarring. All eyes received an AcrySof ReSTOR SN60D3 spherical multifocal IOL (Alcon).

Visual and refractive outcomes were evaluated at 1 week, 4 weeks and 6 months. The Visual Function Questionnaire (VFQ-25) was administered at 6 months.

Study results showed that uncorrected near visual acuity improved in 18 eyes and was unchanged in two eyes. Improvements were one to three lines in 10 eyes, four to seven lines in four eyes and more than seven lines in four eyes. No eyes lost lines of uncorrected near visual acuity.

Corrected near visual acuity improved in 17 eyes, was unchanged in one eye and diminished in two eyes.

Uncorrected distance visual acuity improved one to three lines in four eyes, was unchanged in eight eyes and decreased in eight eyes. 

Patients reported significant improvement in general vision, mental health symptoms tied to vision, role difficulties linked to vision, limitations with peripheral vision and overall scores (P < .05), the authors said.

Perspective

  • Like all cataract surgeons with a specialty interest in macular disease, I strive to improve life quality for patients with AMD and the take-home message of this paper is clear: There are a number of considerations which are relevant in surgical selection and planning, including IOL implant choice for individuals with co-existing AMD, and this paper makes a useful contribution. Specifically it addresses one option in meeting the needs of assisting activities requiring additional magnification using the ReSTOR SN60D3 multifocal IOL. While more work needs to be done to define its place in our surgical armamentarium, it does add to the discussion, which is of interest to the cataract surgical community. Assessing individual needs related to near and distance vision activities in AMD is useful to define both the patient’s postoperative expectations and the post-surgical refractive aim. The desire for a particular activity or “personal project” can be used to determine success of surgery and is arguably of more importance than a visual acuity outcome alone. As Dr. Gayton states in his article, more work is needed in achieving a bespoke approach to maximizing visual function and life quality for patients with AMD. Existing devices and novel approaches with intraocular implants or externally located tools need to be tested in a rigorous manner incorporating three key elements: anatomical descriptors (included cataract and macular morphology), psychophysical tests (including contract sensitivity) and quality of life evaluation as outcome measures, in order that we do the best for our increasingly large population of patients with both cataract and AMD.

    • Baljean Dhillon, BMedSci (Hons), BM BS FRCPS (Glasg), FRCS (Edin) FRCOphth
    • Consultant Ophthalmic Surgeon, Princess Alexandra Eye Pavilion,Edinburgh
      Professor of Visual Impairment Studies,Heriot Watt University, Edinburgh
      Hon Professor of Ophthalmology,University of Edinburgh
  • Disclosures: Dr. Dhillon has no relevant financial disclosures.

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