In the JournalsPerspective

Diffractive multifocal toric IOL restores near, intermediate, distance vision

A diffractive multifocal toric IOL restored near, intermediate and distance visual acuity and offered spectacle independence in patients with corneal astigmatism, according to a post-marketing study.

The multicenter study included 284 eyes of 142 patients who underwent microincision cataract surgery and implantation of the At Lisa toric 909M toric IOL (Carl Zeiss Meditec).

At 6 months, 165 of 185 eyes (89.2%) were within ±1 D of emmetropia.

Mean refractive cylinder decreased from –2.39 D to –0.49 D.

At 1 month postoperatively, uncorrected distance visual acuity was 0.1 logMAR or better in 100 of 208 eyes (48%) and 0.3 or better in 177 of 208 eyes (85%). This was stable at 6 months. Also at 1 month, monocular corrected distance visual acuity was 0.1 or better in 187 of 225 eyes (83%) and 0.3 or better in 225 of 225 eyes (100%). This was stable after 1 month, as was binocular corrected distance visual acuity.

Distance corrected near visual acuity was 0.3 or better in 79 of 87 eyes (91%) from 1 month to 6 months; binocular distance corrected near visual acuity equaled monocular corrected near visual acuity.

Intermediate visual acuity exceeded 0.22 at each follow-up visit.

IOL rotation was 5° or less in 95.8% of IOLs at 3 months and 6 months.

A diffractive multifocal toric IOL restored near, intermediate and distance visual acuity and offered spectacle independence in patients with corneal astigmatism, according to a post-marketing study.

The multicenter study included 284 eyes of 142 patients who underwent microincision cataract surgery and implantation of the At Lisa toric 909M toric IOL (Carl Zeiss Meditec).

At 6 months, 165 of 185 eyes (89.2%) were within ±1 D of emmetropia.

Mean refractive cylinder decreased from –2.39 D to –0.49 D.

At 1 month postoperatively, uncorrected distance visual acuity was 0.1 logMAR or better in 100 of 208 eyes (48%) and 0.3 or better in 177 of 208 eyes (85%). This was stable at 6 months. Also at 1 month, monocular corrected distance visual acuity was 0.1 or better in 187 of 225 eyes (83%) and 0.3 or better in 225 of 225 eyes (100%). This was stable after 1 month, as was binocular corrected distance visual acuity.

Distance corrected near visual acuity was 0.3 or better in 79 of 87 eyes (91%) from 1 month to 6 months; binocular distance corrected near visual acuity equaled monocular corrected near visual acuity.

Intermediate visual acuity exceeded 0.22 at each follow-up visit.

IOL rotation was 5° or less in 95.8% of IOLs at 3 months and 6 months.

    Perspective

    This large multicenter binocular study addresses the combined challenge of satisfying patients with both significant corneal astigmatism and the desire to be free of spectacles for distance and near. With effective counseling and adequate consent, as included in the study, patient satisfaction can be high when addressing these two acceptability thresholds simultaneously.

    Uncorrected distance vision was logMAR 0.16 monocularly, and 19% of patients had 1 D or more of cylinder remaining. Monocular uncorrected near was 0.21 and monocular distance corrected near acuity 0.13. At 6 months, 89% of eyes were ±1 D of sphere.

    For astigmatism, rotation was less than 5° in 96% of IOLs with a mean angle of error of zero and absolute mean 6° showing good stability and accuracy. The correction index of 1.05 showed mild overcorrection of the corneal astigmatism, but overall accuracy of correction was excellent with a flattening index of 0.99 and a difference vector of 0.23 D.

    The attention to detail in this multicenter study was substantial. This type of commitment is necessary to gain patient satisfaction when both astigmatism and presbyopia are treated concurrently.

    • Noel A. Alpins, MD
    • OSN Refractive Surgery Board Member

    Disclosures: Alpins has a financial interest in the Assort surgical management system for outcome analysis.