Journal of Refractive Surgery

Original Article Supplemental Data

Visual Performance in the Long Term With Secondary Add-on Versus Primary Capsular Bag Multifocal Intraocular Lenses

Jens Schrecker, MD; Achim Langenbucher, PhD

Abstract

PURPOSE:

To compare the long-term results of a secondary sulcus-placed, multifocal add-on intraocular lens (IOL) with those of a multifocal IOL implanted in the capsular bag.

METHODS:

In this prospective clinical trial, 30 pseudophakic eyes were treated with a multifocal add-on IOL and 30 cataractous eyes with a standard multifocal IOL. The main outcome measures comprised manifest refraction, visual acuity, defocus curves, and contrast sensitivity. Patients who had bilateral implantation of the same lens type were asked to complete a questionnaire.

RESULTS:

One year postoperatively, all eyes from the multifocal add-on IOL group (add-on group) and 97% from the standard multifocal IOL group (standard group) were within ±0.50 diopters (D) of emmetropia. In both groups, median uncorrected distance and intermediate visual acuity were 20/20 and 20/25, respectively. Median uncorrected near visual acuity was 20/20 in the add-on group and 20/25 in the standard group. The survey analysis resulted in a slightly higher patient satisfaction in the standard group regarding distance and near vision without glasses. Contrast sensitivity measures were comparable in both groups. Halos were the most commonly reported visual disturbance, but the perceived impairment by light effects was minimal even in the early postoperative period and the majority of patients got used to it relatively quickly.

CONCLUSIONS:

Secondary multifocal add-on IOL implantation provides the opportunity for multifocal imaging in already pseudophakic eyes. The functional outcomes are comparable to those achieved after primary multifocal IOL implantation in the capsular bag.

[J Refract Surg. 2016:32(11):742–747.]

Abstract

PURPOSE:

To compare the long-term results of a secondary sulcus-placed, multifocal add-on intraocular lens (IOL) with those of a multifocal IOL implanted in the capsular bag.

METHODS:

In this prospective clinical trial, 30 pseudophakic eyes were treated with a multifocal add-on IOL and 30 cataractous eyes with a standard multifocal IOL. The main outcome measures comprised manifest refraction, visual acuity, defocus curves, and contrast sensitivity. Patients who had bilateral implantation of the same lens type were asked to complete a questionnaire.

RESULTS:

One year postoperatively, all eyes from the multifocal add-on IOL group (add-on group) and 97% from the standard multifocal IOL group (standard group) were within ±0.50 diopters (D) of emmetropia. In both groups, median uncorrected distance and intermediate visual acuity were 20/20 and 20/25, respectively. Median uncorrected near visual acuity was 20/20 in the add-on group and 20/25 in the standard group. The survey analysis resulted in a slightly higher patient satisfaction in the standard group regarding distance and near vision without glasses. Contrast sensitivity measures were comparable in both groups. Halos were the most commonly reported visual disturbance, but the perceived impairment by light effects was minimal even in the early postoperative period and the majority of patients got used to it relatively quickly.

CONCLUSIONS:

Secondary multifocal add-on IOL implantation provides the opportunity for multifocal imaging in already pseudophakic eyes. The functional outcomes are comparable to those achieved after primary multifocal IOL implantation in the capsular bag.

[J Refract Surg. 2016:32(11):742–747.]

In modern cataract and refractive surgery, the establishment of spectacle independence for different object distances becomes a more standard procedure. The implantation of intraocular lenses (IOLs) with multifocal optics that form sharp images for near, intermediate, and far distance objects is already an established method. Over the past decade, lens manufacturers have optimized the IOL design significantly to reduce potential side effects.

A new option that offers multifocality in eyes that are already pseudophakic is the implantation of an additional IOL in the sulcus ciliaris. These lenses allow for a subsequent implantation of the multifocal part and, if necessary, a refractive correction. In case of intolerance of multifocality, these lenses can be removed easily without alteration of the zonula or capsular bag. Modern add-on lenses specifically optimized for their implantation site have shown their safety and functionality in different studies.1–3

In this study, we compared the functional outcomes of a multifocal add-on IOL after secondary sulcus implantation in pseudophakic eyes with those after primary implantation of a multifocal IOL in the capsular bag after standard cataract surgery.

Patients and Methods

This prospective, single-site clinical study was conducted in accordance with the tenets of the Declaration of Helsinki. The clinical investigation plan was reviewed and approved by the Ethical Review Board, Sächisischen Landesärztekammer, Dresden, Germany, and all patients provided written informed consent for participation in the study.

In the standard group, standard cataract surgery was performed with simultaneous implantation of a multifocal IOL in the capsular bag. Inclusion criteria were the patient's desire for spectacle independence, an expected postoperative visual acuity of at least 20/40, and the sufficient cognitive awareness to comply with the follow-up examinations. Exclusion criteria were a corneal astigmatism of 1.00 diopter (D) or greater or an irregular astigmatism in corneal topography, previous corneal or intraocular surgery (except pseudophakia in the add-on group), and eye diseases that might significantly impair vision.

IOL Characteristics and Surgical Technique

In the add-on group, the three-piece multifocal add-on IOL (Diffractiva-sPB; HumanOptics, Erlangen, Germany) was used. It has an overall length of 14 mm and its optic is made of a silicone elastomer with a diameter of 7 mm (effective zone: 6 mm). The optic has a round anterior edge design and a square back edge. The extended C-loop haptics are made of polymethyl-methacrylate with a 10° posterior haptic angulation. The central diffractive optic design that is located at the IOL front surface provides an additional power of 3.50 D at the IOL plane for near vision.

In the standard group, we used the Diff-aA posterior chamber multifocal IOL (HumanOptics), which is made of hydrophilic acrylic with an aspheric front surface (aberration-free) and a spherical back surface with a 360° sharp square edge. Its optic diameter is 6 mm and the overall length is 12.5 mm. The diffractive element of the optic is the same as that of the add-on IOL of the add-on group.

In the add-on group, axial length measurement was performed with the IOLMaster 500 (Carl Zeiss Meditec, Jena, Germany) and pseudophakic anterior chamber depth was measured with an A-scan ultrasound system (Aviso; Quantel Medical, Cournon d'Auvergne Cedex, France). The power of the additional IOLs in the add-on group was calculated by the manufacturer's calculation service. In the standard group, the biometric measurements and IOL power calculation were performed with the IOLMaster using the Holladay formula. Target refraction was plano in both groups.

All interventions were performed by the same surgeon (JS) and as described previously.3 Implantation was performed through a temporal 2.8-mm clear corneal incision in the add-on group and a 2.3-mm incision in the standard group. After surgery, all eyes received the same medication regimen with topical steroids and antibiotics.3

Clinical Examinations and Outcome Measures

Preoperatively, all eyes underwent a detailed ophthalmic examination including biomicroscopic evaluation of the anterior and posterior eye segment, measurement of manifest refraction and uncorrected and corrected distance visual acuity (UDVA, CDVA), optical biometry (IOLMaster), ultrasonic measurement of the anterior chamber depth (add-on group only), corneal tomography (Pentacam; Oculus Optikgeräte GmbH, Wetzlar, Germany), pupillometry under photopic (100 cd/m2) and mesopic (6 cd/m2) light conditions (Goldmann Perimeter; Carl Zeiss Meditec), and Goldmann applanation tonometry.

Follow-up examinations were performed 4 to 6 weeks, 3 months, and 1 year postoperatively. At each follow-up, the main study outcome measures included assessment of refraction, UDVA and CDVA, uncorrected and distance-corrected intermediate visual acuity at 1 m (UIVA, DCIVA), uncorrected and distance-corrected near visual acuity at 0.40 m (UNVA, DCNVA), and photopic and mesopic pupil size. Additionally, at the 3-month and 1-year follow-up stages, monocular defocus curves and monocular distance-corrected contrast sensitivity under photopic (85 cd/m2) and mesopic (6 cd/m2) light conditions were assessed.

Far distance visual acuity was measured with optotypes according to DIN EN ISO 8596 at 5 m. Intermediate and near visual acuity were assessed using Early Treatment Diabetic Retinopathy Study (ETDRS) and Radner reading charts. Defocus curves were obtained using fogging from +2.00 to −5.00 D in steps of 0.50-D for six possible combinations of randomized, high-contrast letter sequences. Contrast sensitivity was derived with far distance correction with and without glare with the Optec 6500 Contrast Sensitivity View-in Tester (Stereo Optical Co., Inc., Chicago, IL).

In patients with bilateral implantation of the same lens type, binocular far distance, intermediate distance, and near distance visual acuities were determined. Additionally, patients answered a questionnaire 3 months and 1 year after IOL implantation in the second eye. In this questionnaire, the patient's postoperative subjective satisfaction concerning quality of vision without glasses was evaluated for far, intermediate, and near distance under different lighting conditions (response options: very satisfied, satisfied, moderate, dissatisfied, very dissatisfied). Furthermore, patients were asked to indicate whether they were disturbed by photic phenomena (response options: none, glare, halos, blurred vision, distorted vision) and to state the level of disturbances (response options: minimal, mild, moderate, moderately severe, severe) and how fast they had adapted to them (response options: very quickly, quickly, slowly, not yet). Finally, patients had to state whether they would choose the same lens again (response options: yes, possibly, no).

Statistical Analysis

Statistical analyses were performed using SPSS software (version 22.0; IBM Corp., Armonk, NY). Decimal visual acuity values were converted to logMAR. All tests were two-tailed and a P value of .05 was considered significant. Comparisons between groups were assessed with the non-parametric Mann–Whitney U test and the chi-square test for unpaired samples. The non-parametric Friedman omnibus test for one-way analysis of variance was used to compare intra-group differences across all times of examination. With a statistically significant difference in the Friedman test, post hoc pairwise comparisons were applied using the non-parametric Wilcoxon rank sum test.

Results

This study included 60 eyes of 35 patients (30 pseudophakic eyes: add-on group and 30 cataract eyes: standard group). In the add-on group, the mean time interval between cataract surgery and the second intervention was 9.57 ± 12.51 months (range: 1 to 52 months). The mean spherical IOL power of the add-on IOL in the add-on group was −0.02 ± 0.48 D (range: −1.00 to 1.00 D). In the standard group, the mean power of the multifocal IOL was 20.70 ± 1.83 D (range: 17.00 to 24.50 D). Table A (available in the online version of this article) summarizes the patients' preoperative demographics with no relevant differences between the two study groups.


Preoperative Patient Demographics

Table A:

Preoperative Patient Demographics

At the postoperative 3-month visit, all eyes could be included for statistical analysis. After 1 year, 5 patients (5 eyes) from the add-on group were lost to follow-up examinations. Table B (available in the online version of this article) demonstrates intraocular pressure (IOP) and corneal astigmatism over time. During the follow-up period (preoperatively to 1 year postoperatively), IOP in the add-on group showed no significant changes. In the standard group, it was reduced from 15.5 to 12.5 mm Hg. Corneal astigmatism did not show significant changes over time in either group (Friedman test).


Intraocular Pressure and Corneal Astigmatism 3 Months and 1 Year After Surgery

Table B:

Intraocular Pressure and Corneal Astigmatism 3 Months and 1 Year After Surgery

Refraction and Visual Acuity

Postoperative refraction was stable over time (6 weeks to 1 year) in both groups (Friedman test). After 1 year, the spherical equivalent (SE) of spectacle refraction was 0.00 D in all patients in the add-on group and between −0.50 and 0.75 D in the standard group (median: 0.00 D) without statistically significant differences between groups (Mann–Whitney U test). At the 1-year follow-up, all eyes in the add-on group and 29 of 30 eyes in the standard group were within ±0.50 D of emmetropia. The median deviation of the 1-year postoperative SE from the intended target refraction was 0.00 D (range: −0.50 to 0.25 D) in the add-on group and −0.05 D (range: −0.73 to 0.59 D) in the standard group. No statistically significant differences were found between groups (Mann–Whitney U test). Figure 1 illustrates the deviation of the manifest refractive SE to the intended target refraction at 1-year follow-up.


Accuracy of the refractive manifest spherical equivalent (SE) to the intended target refraction at 1-year follow-up. TR = target refraction; D = diopters

Figure 1.

Accuracy of the refractive manifest spherical equivalent (SE) to the intended target refraction at 1-year follow-up. TR = target refraction; D = diopters

Table C (available in the online version of this article) indicates the results of the monocular and binocular uncorrected and far distance-corrected visual acuities for far, intermediate, and near distance 1 year after surgery. Binocular visual acuity was assessed in patients who had bilateral implantation of the same lens type (add-on group: n = 9; standard group: n = 13). For the add-on group, a statistically significantly higher performance was observed for monocular near visual acuity (UNVA and DCNVA). All other comparisons showed no significant differences between groups. All patients reached uncorrected monocular visual acuity of at least 20/25 for far distance and at least 20/40 for intermediate and near distance (Figure 2).


Visual Acuity Outcomes (logMAR) 1 Year Postoperatively

Table C:

Visual Acuity Outcomes (logMAR) 1 Year Postoperatively


Cumulative Snellen monocular uncorrected visual acuity for distance (5 m), intermediate (1 m), and near vision (40 cm) 1 year postoperatively.

Figure 2.

Cumulative Snellen monocular uncorrected visual acuity for distance (5 m), intermediate (1 m), and near vision (40 cm) 1 year postoperatively.

Figure 3 compares the median monocular defocus curves between groups. Best visual acuity was achieved for far and near distance equivalent with fogging of 0.00 and −2.50 D, respectively. Significant differences between groups were found at the borders of the intervals with a fogging of 2.00 and −3.00 to −4.00 D, respectively, where the add-on group performed better. In contrast, the standard group performed better within the interval with a fogging of −2.00 D.


Median monocular defocus curves 1 year postoperatively. Asterisks indicate statistically significant differences between groups (P ≤.05, Mann–Whitney U test). D = diopters

Figure 3.

Median monocular defocus curves 1 year postoperatively. Asterisks indicate statistically significant differences between groups (P ≤.05, Mann–Whitney U test). D = diopters

Contrast Sensitivity

In the add-on group (all eyes were postoperatively independent from spectacles), monocular contrast sensitivity testing was performed without correction. In the standard group, measurements were obtained using far distance correction in 5 eyes and without correction in the 25 emmetropic eyes. The median contrast sensitivity under different lighting conditions with and without glare is shown in Figure 4. Under photopic light conditions with glare, the standard group achieved statistically significant better outcomes at 18 cycles per degree (cpd) (P = .023; Mann–Whitney U test). The add-on group performed significantly better under mesopic conditions without glare at 12 and 18 cpd (P = .001 and .018; Mann–Whitney U test) and under mesopic conditions with glare at 6 cpd (P = .033; Mann–Whitney U test). All other comparisons showed no significant differences.


Median monocular log contrast sensitivity under photopic (85 cd/m2) and mesopic (6 cd/m2) conditions with and without glare at 1-year follow-up examination. The dotted lines limit the normal range of contrast sensitivity. Asterisks indicate statistically significant differences between groups (P ≤ .05, Mann–Whitney U test). cpd = cycles per degree

Figure 4.

Median monocular log contrast sensitivity under photopic (85 cd/m2) and mesopic (6 cd/m2) conditions with and without glare at 1-year follow-up examination. The dotted lines limit the normal range of contrast sensitivity. Asterisks indicate statistically significant differences between groups (P ≤ .05, Mann–Whitney U test). cpd = cycles per degree

Patient Survey

One year after surgery, the questionnaire was evaluated in patients who underwent bilateral IOL implantation of the same type. The results concerning subjective quality of vision for far and near distance under different light conditions are given in Table 1. More than one-third of patients from both groups experienced no photic disturbances (Figure 5), and halos were most common in patients reporting optical phenomena (add-on group: 56%; standard group: 54%; in combination with glare: only in add-on group: 11%). No patient reported blurred or distorted vision. Visual disturbances were described as minimal in 66% and 75%, mild in 17% and 25%, and moderately severe in 17% and 0% in the multifocal add-on IOL and standard groups, respectively. In the add-on group, one patient (17%) stated no adaptation to halos yet, 33% adapted slowly to visual disturbances in general, 33% adapted quickly, and another patient (17%) had adapted very quickly during follow-up. In the standard group, the majority of patients (63%) adapted very quickly, 25% adapted quickly, and 12% adapted slowly.


Patient Satisfaction in Terms of Quality of Far and Near Distance Vision Without Spectacles Under Different Light Conditions at 1 Year Postoperatively

Table 1:

Patient Satisfaction in Terms of Quality of Far and Near Distance Vision Without Spectacles Under Different Light Conditions at 1 Year Postoperatively


Percentage of photic phenomena experienced by patients who had bilateral multifocal intraocular lens implantation 1 year postoperatively.

Figure 5.

Percentage of photic phenomena experienced by patients who had bilateral multifocal intraocular lens implantation 1 year postoperatively.

All patients from both groups stated that they would choose the same lens again.

Complications

No intraoperative complications occurred. All IOLs were symmetrically fixated in the capsular bag or in the ciliary sulcus. During the follow-up period, mild pigment dispersion without clinical consequences was observed in 9 eyes (8 eyes from the add-on group, 1 from the standard group). Nd:YAG laser capsulotomy was performed in 7 eyes in the add-on group and in 5 eyes in the standard group between 2 and 14 months postoperatively.

Discussion

Multifocal IOLs have been successful over the past decade in the treatment of presbyopia.4 However, the patients' wish for spectacle independence for far and near vision might only come up in context with cataract surgery for the second eye or a long time after primary lens surgery of both eyes.

In contrast to multifocal IOLs implanted in the capsular bag, sulcus-based additional lenses enable a subsequent implantation of a multifocal optic even years after cataract surgery. Using this approach, alterations of the capsular bag or the zonular fibers that might be caused by in-the-bag IOL exchange or explantation are prevented. In addition, a refractive fine tuning is possible with add-on IOLs if the refraction does not match the expectation.

Poyales-Galán et al.5 recently showed good visual outcomes for a supplementary IOL with a refractive optic after secondary intervention. The authors reported a postoperative decimal UDVA of 0.93 ± 0.09 and a postoperative UNVA of 20/20 at 0.25 m, revealing comparable outcomes to our findings. These data are at an equivalent level with those showed in a thorough literature review by de Vries and Nujits4 assessing visual performance of multifocal IOLs after in-the-bag implantation. Outcomes regarding the deviation of the postoperative refractive spherical equivalent from the intended refraction likewise correlate with our two study groups, with 100% and 97% of eyes (multifocal add-on IOL and standard groups, respectively) within ±0.50 D of emmetropia. This is also reflected by the high level of spectacle independence for all eyes from the add-on group. Due to the subsequent fine-tuning option with add-on IOLs, postoperative refractive results were even slightly closer to target refraction than with primary multifocal IOL implantation.

As a result of their bifocal design, both study lenses showed two peaks at far and near distance foci (0.00 and −2.50 D, respectively) with visual acuities of 0.00 and 0.10 logMAR. In the intermediate distance range at 0.5 m (fogging of −2.00 D), the standard group performed significantly better, whereas the add-on group attained better outcomes at near distance vision. Contrast sensitivity testing showed good outcomes under photopic lighting conditions with both groups being within the normal age-related ranges.6 Under mesopic conditions, better values were observed in the add-on group at middle and high spatial frequencies with and without glare. We did not find any correlation between pupil size and visual impairment or contrast sensitivity.

With the overall good visual acuity and contrast sensitivity, the majority of patients from both groups was satisfied in terms of self-reported quality of vision under different light conditions. The level of satisfaction was slightly higher in the standard group. Our results for the capsular bag are consistent with the outcomes reported by Dexl et al.,7 where halos were the most reported phenomenon noticed by more than half of patients. Other studies8–12 have shown different values for the incidence of halos and glare in the evaluation of different diffractive multifocal IOLs. The mostly mild or moderate impairment might be explained by patients' neural adaption over time.13

Loss of iris pigment is one of the risk factors for an increased intraocular pressure after add-on lens implantation. Modern additional lenses are specifically designed for their positioning in the sulcus. In the current study, we had only moderate and asymptomatic pigment dispersion in a total of 9 eyes. Eight of them were from the add-on group, which indicates a potentially higher risk in case of sulcus placement despite the specially adapted optic edge and haptic design. However, this had no clinical consequence during observation time.

The current study is also in agreement with our previous trials in which we evaluated the performance of multifocal add-on IOLs after primary intervention.3,14 Our experience with supplementary IOLs of various designs dates back more than 7 years (more than 350 implantations). Sophisticated implantation technology and modern add-on IOL designs almost completely prevent complications such as endothelial damage and intraocular pressure rise. In the current study, no serious events were observed.

Secondary multifocal add-on IOL implantation is a good alternative to allow for a multifocal imaging in already pseudophakic eyes. The functional outcomes are comparable to those achieved with conventional multifocal IOLs in the capsular bag. The current long-term results underpin the safety and efficacy of this procedure.

References

  1. Kohnen T, Klaproth OK. Pseudophakic supplementary intraocular lenses [article in German]. Ophthalmologe. 2010;107:766–772. doi:10.1007/s00347-010-2219-3 [CrossRef]
  2. Sauder G. Secondary toric intraocular lens implantation in pseudophakic eyes: the add-on IOL system [article in German]. Ophthalmologe. 2007;104:1041–1045. doi:10.1007/s00347-007-1660-4 [CrossRef]
  3. Schrecker J, Kroeber S, Eppig T, Langenbucher A. Additional multifocal sulcus-based intraocular lens: alternative to multifocal intraocular lens in the capsular bag. J Cataract Refract Surg. 2013;39:548–555. doi:10.1016/j.jcrs.2012.10.047 [CrossRef]
  4. de Vries NE, Nujits RMMA. Multifocal intraocular lenses in cataract surgery: literature review of benefits and side effects. J Cataract Refract Surg. 2013;39:268–278. doi:10.1016/j.jcrs.2012.12.002 [CrossRef]
  5. Poyales-Galán F, Garzón N, Pérez-Izquierdo R. Assessment of visual quality after secondary implantation of a multifocal refractive lens in the sulcus in pseudophakic patients. J Emmetropia. 2013;4:131–135.
  6. Hohberger B, Laemmer R, Adler W, Jünemann AGM, Korn FK. Measuring contrast sensitivity in normal subjects with OPTEC® 6500: influence of age and glare. Graefes Arch Clin Exp Ophthalmol. 2007;245:1805–1814. doi:10.1007/s00417-007-0662-x [CrossRef]
  7. Dexl AK, Zaluski S, Rasp M, Grabner G. Visual performance after bilateral implantation of a new diffractive aspheric multifocal intraocular lens with a 3.5 D addition. Eur J Ophthalmol. 2014;24:35–43. doi:10.5301/ejo.5000315 [CrossRef]
  8. Kretz FTA, Bastelica A, Carreras H, et al. Clinical outcomes and surgeon assessment after implantation of a new diffractive multifocal toric intraocular lens. Br J Ophthalmol. 2015;99:405–411. doi:10.1136/bjophthalmol-2014-305570 [CrossRef]
  9. Kretz FTA, Koss MJ, Auffarth GUfor the ZLB00 Study Group. Intermediate and near visual acuity of an aspheric, bifocal, diffractive multifocal intraocular lens with +3.25 D near addition. J Refract Surg. 2015;31:295–299. doi:10.3928/1081597X-20150423-02 [CrossRef]
  10. Frieling-Reuss EH. Comparative analysis of the visual and refractive outcomes of an aspheric diffractive intraocular lens with and without toricity. J Cataract Refract Surg. 2013;39:1485–1493. doi:10.1016/j.jcrs.2013.04.034 [CrossRef]
  11. Gil MA, Varon C, Rosello N, Cardona G, Buil JA. Visual acuity, contrast sensitivity, subjective quality of vision, and quality of life with 4 different multifocal IOLs. Eur J Ophthalmol. 2012;22:175–187. doi:10.5301/EJO.2011.8371 [CrossRef]
  12. Maurino V, Allan BD, Rubin GS, et al. Quality of vision after bilateral multifocal intraocular lens implantation: a randomized trial—AT LISA 809M versus AcrySof ReSTOR SN6AD1. Ophthalmology. 2015;122:700–710. doi:10.1016/j.ophtha.2014.10.002 [CrossRef]
  13. Kohnen T, Allen D, Boureau C, Dublineau P, Hartman C, Mehdorn E. European multicenter study of the AcrySof ReSTOR apodized diffractive intraocular lens. Ophthalmology. 2006;113:578–584. doi:10.1016/j.ophtha.2005.11.020 [CrossRef]
  14. Schrecker J, Blass S, Langenbucher A. Silicone-diffractive versus acrylic-refractive supplementary IOLs: visual performance and manual handling. J Refract Surg. 2014;30:41–48. doi:10.3928/1081597X-20131217-05 [CrossRef]

Patient Satisfaction in Terms of Quality of Far and Near Distance Vision Without Spectacles Under Different Light Conditions at 1 Year Postoperatively

QuestionDaylightIndoorNight



Multifocal Add-on IOLStandard Multifocal IOLMultifocal Add-on IOLStandard Multifocal IOLMultifocal Add-on IOLStandard Multifocal IOL
How satisfied are you with your far distance vision without correction?
  Very satisfied8 (89%)12 (92%)8 (89%)13 (100%)6 (67%)9 (70%)
  Satisfied1 (11%)1 (8%)1 (11%)02 (22%)2 (15%)
  Moderate00001 (11%)2 (15%)
How satisfied are you with your near vision without correction?
  Very satisfied9 (100%)12 (92%)8 (89%)12 (92%)3 (34%)9 (69%)
  Satisfied01 (8%)1 (11%)02 (22%)0
  Moderate0001 (8%)4 (44%)4 (31%)

Preoperative Patient Demographics

CharacteristicMultifocal Add-on IOLStandard Multifocal IOLP
Eyes (n)3030
Patients (n)1817
Sex.438a
  Male9 (50%)7 (41%)
  Female9 (50%)10 (59%)
Age (y).070b
  Mean ± SD64.87 ± 10.3569.97 ± 8.74
  Median68.5070.00
  Range(41.00 to 78.00)(43.00 to 84.00)
CDVA (logMAR).000b,c
  Mean ± SD0.00 ± 0.040.24 ± 0.27
  Median0.000.20
  Range(0.20 to −0.10)(1.00 to 0.00)
Axial length (mm).679b
  Mean ± SD23.67 ± 1.2623.64 ± 0.67
  Median23.5623.56
  Range(21.60 to 27.06)(22.12 to 24.88)
Corneal astigmatism (D).758b
  Mean ± SD0.53 ± 0.260.51 ± 0.55
  Median0.500.55
  Range(0.10 to 0.90)(0.10 to 0.90)
Photopic pupil size (mm).546b
  Mean ± SD2.84 ± 0.522.69 ± 0.57
  Median3.003.00
  Range(2.00 to 4.20)(1.50 to 3.50)
Mesopic pupil size (mm).201b
  Mean ± SD3.76 ± 0.713.51 ± 0.80
  Median4.003.85
  Range(2.00 to 5.50)(2.00 to 5.00)
IOP (mm Hg).090b
  Mean ± SD14.20 ± 2.4415.47 ± 2.89
  Median14.0015.50
  Range(10.00 to 19.00)(10.00 to 20.00)

Intraocular Pressure and Corneal Astigmatism 3 Months and 1 Year After Surgery

Parameter3 Months1 Year


Multifocal Add-on IOLStandard Multifocal IOLMultifocal Add-on IOLStandard Multifocal IOL
Intraocular pressure (mm Hg)
  Mean ± SD14.17 ± 2.1013.43 ± 3.0814.60 ± 2.5813.33 ± 2.59
  Median14.0013.0014.0012.50
  Range10.00 to 20.008.00 to 21.0010.00 to 20.0010.00 to 20.00
   P.226.045a
Corneal astigmatism (D)
  Mean ± SD0.54 ± 0.330.61 ± 0.290.57 ± 0.350.56 ± 0.30
  Median0.500.600.500.50
  Range0.00 to 1.100.10 to 1.100.10 to 1.300.10 to 1.20
   P.373.976

Visual Acuity Outcomes (logMAR) 1 Year Postoperatively

Visual AcuityMonocularBinocular


Multifocal Add-on IOL (n = 25)Standard Multifocal IOL (n = 30)PMultifocal Add-on IOL (n = 9)Standard Multifocal IOL (n = 13)P
UDVA.159.410
  Mean ± SD0.01 ± 0.030.02 ± 0.04−0.01 ± 0.030.00 ± 0.00
  Median0.000.000.000.00
  Range(0.10 to 0.00)(0.10 to 0.00)(0.00 to −0.10)(0.00 to 0.00)
CDVA1.0001.000
  Mean ± SD0.01 ± 0.030.01 ± 0.030.00 ± 0.00)0.00 ± 0.00
  Median0.000.000.000.00
  Range(0.10 to 0.00)(0.10 to 0.00)(0.00 to 0.00)(0.00 to 0.00)
UIVA.372.913
  Mean ± SD0.06 ± 0.100.09 ± 0.10−0.01 ± 0.110.00 ± 0.09
  Median0.100.100.000.00
  Range(0.30 to −0.10)(0.30 to −0.10)(0.10 to −0.20)(0.10 to −0.20)
DCIVA.516.638
  Mean ± SD0.06 ± 0.100.09 ± 0.100.00 ± 0.09−0.02 ± 0.07
  Median0.100.100.000.00
  Range(0.20 to −0.10)(0.40 to 0.00)(0.10 to −0.10)(0.10 to −0.20)
UNVA.001a.051
  Mean ± SD0.00 ± 0.080.09 ± 0.10−0.02 ± 0.040.03 ± 0.06
  Median0.000.100.000.00
  Range(0.30 to −0.10)(0.30 to −0.10)(0.00 to −0.10)(0.10 to −0.10)
DCNVA.004a.223
  Mean ± SD0.00 ± 0.060.07 ± 0.10−0.02 ± 0.040.02 ± 0.06
  Median0.000.100.000.00
  Range(0.10 to −0.10)(0.30 to −0.10)(0.00 to −0.10)(0.10 to −0.10)
Authors

From the Department of Ophthalmology, Rudolf-Virchow-Klinikum Glauchau, Glauchau, Germany (JS); and the Institute of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany (AL).

The authors have no financial or proprietary interest in the materials presented herein.

AUTHOR CONTRIBUTIONS

Study concept and design (JS, AL); data collection (JS); analysis and interpretation of data (JS); writing of the manuscript (JS); critical revision of the manuscript (AL); statistical expertise (JS, AL); supervision (AL)

Correspondence: Jens Schrecker, MD, Department of Ophthalmology, Rudolf-Virchow-Klinikum Glauchau, Virchowstr. 18, 08371 Glauchau, Germany. E-mail: jens.schrecker@t-online.de

Received: February 03, 2016
Accepted: June 23, 2016

10.3928/1081597X-20160630-02

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