The ReSTOR intraocular lens presents a unique apodized diffractive design within a refractive foldable acrylic optic, which makes an unprecedented level of mulifocal optical performance available. We describe the history and principles of diffractive optics used in the development of this refractive-diffractive IOL.

History and development of the apodized diffractive intraocular lens.

Purpose To determine whether implantation of an intraocular lens (IOL) with a modified anterior surface designed to compensate for the positive spherical aberration of the cornea in eyes of cataract patients results in improved pseudophakic quality of vision. Setting Department of Ophthalmology, Bundesknappschaft’s Hospital, Sulzbach, Germany. Methods In an intraindividual randomized study of 45 patients with bilateral cataract, an IOL with a modified anterior surface (Tecnis Z9000, Pharmacia) was compared with a biconvex lens with spherical surfaces (SI-40, Allergan). All patients had bilateral cataract surgery; in 1 eye the Z9000 IOL was implanted and in the other, the SI-40 IOL. After 1 and 3 months, the following investigations were performed: assessment of the anterior and posterior segments including IOL decentration and tilt, pupil size, high- and low-contrast visual acuities, photopic and mesopic contrast sensitivities, and wavefront aberration of the cornea and eye. Results Thirty-seven patients were examined at all follow-up visits. Although the eyes with the Z9000 IOL had significantly better best corrected visual acuity after 3 months, the improved quality of vision was more apparent when assessing low-contrast visual acuity and contrast sensitivity. Wavefront measurements revealed no significant spherical aberration in eyes with a Z9000 IOL but significantly positive spherical aberration in eyes with an SI-40 IOL. Conclusions The clinical results confirm the theoretical preclinical calculations that the spherical aberration of the eye after cataract surgery can be eliminated by modifying the anterior surface of the IOL. The Tecnis Z9000 lens compensates for the positive spherical aberration in older eyes. This leads to a significant improvement, particularly in contrast sensitivity and mesopic visual quality.

Impact of a modified optic design on visual function: clinical comparative study.

A prospective comparative study of the AMO ARRAY zonal-progressive multifocal silicone intraocular lens and a monofocal intraocular lens.

This literature review looks at the current status of multifocal intraocular lenses (IOLs) in cataract surgery. The results of implantation of multifocal IOLs of diffractive, refractive, and hybrid diffractive–refractive design are described with regard to uncorrected near and distance visual acuity and spectacle independence. The occurrence of photic phenomena and contrast sensitivity loss with multifocal IOLs are also addressed. Financial Disclosure Neither author has a financial or proprietary interest in any material or method mentioned.

Multifocal intraocular lenses in cataract surgery: literature review of benefits and side effects.

One-year outcomes with new-generation multifocal intraocular lenses.

Purpose To evaluate the functional outcome after implantation of the Tecnis ZM900 multifocal intraocular lens (IOL) (AMO) and the Array SA40 multifocal IOL (AMO). Setting Department of Ophthalmology, Bundesknappschaft´s Hospital, Sulzbach, and the Department of Ophthalmology, Marienhospital, Aachen, Germany. Methods In a prospective comparative 2-center trial, Tecnis ZM900 and the Array SA40 multifocal IOLs were bilaterally implanted in 50 patients (50 eyes Tecnis, 50 eyes Array) by 1 surgeon at each center. The following parameters were assessed 30 to 60 days and 120 to 180 days after surgery in both eyes: refraction, pupil size, uncorrected and best corrected visual acuities for distance and near at different contrast levels, and photopic and mesopic contrast sensitivity at different spatial frequencies. Patient satisfaction (spectacle independence, photic phenomena, overall satisfaction) was assessed by a questionnaire. Results The main differences between the 2 multifocal IOLs were the better uncorrected near visual acuity ( P P P Conclusion The aspherical diffractive Tecnis multifocal IOL gave better outcomes than the Array multifocal IOL.

Functional outcomes after implantation of Tecnis ZM900 and Array SA40 multifocal intraocular lenses.

Optic edge design as long-term factor for posterior capsular opacification rates.

Purpose: To perform an intraindividual comparison of posterior capsule opacification (PCO) with 2 foldable intraocular lenses (IOLs) and a foldable acrylic IOL 1 year after in-the-bag implantation.

Settings: Seven German ophthalmology centers.

Methods: In an open prospective randomized multicenter study, each center intraindividually compared a high-refractive-index, sharp-edged optic silicone IOL (CeeOn® Edge 911A, Pharmacia) with a high-refractive-index, round-edged optic silicone IOL (PhacoFlex® SI-40NB, Allergan) or a sharp-edged optic acrylic IOL (AcrySof® MA60BM, Alcon). Of 288 randomized patients, 247 had standard phacoemulsification with in-the-bag IOL implantation in both eyes by the same surgeon. One eye of each patient received a CeeOn Edge IOL and the fellow eye, an AcrySof or PhacoFlex IOL. A morphologic evaluation of PCO was performed using the Evaluation of Posterior Capsule Opacification (EPCO) system 1 to 2 weeks and 11 to 14 months after surgery. The digital pictures were evaluated by an independent investigator who was blind to the type of IOL. Intraindividual differences in EPCO scores were statistically evaluated by a 1-sided binomial test at an α-level of 5%.

Results: One year after surgery, 127 patients with the AcrySof IOL and 102 patients with the PhacoFlex IOL in the control eye were reexamined. Functional results, safety, and handling were not significantly different between the 3 IOLs. All reexamined eyes had a very low PCO grade. The EPCO values revealed less PCO in eyes with the CeeOn Edge IOL than in eyes with the AcrySof or PhacoFlex IOL, but the difference was not statistically significant. A neodymium:YAG laser capsulotomy was performed in 1 eye with a CeeOn Edge IOL, 1 eye with an AcrySof IOL, and 2 eyes with a PhacoFlex IOL.

Conclusions: The EPCO PCO grade was low 1 year after implantation of CeeOn Edge 911A, PhacoFlex SI-40NB, and AcrySof MA60BM IOLs; there was no statistically significant difference between the IOLs. The impact of IOL material and edge design on PCO development might be relevant in a long-term follow-up of this study.

Posterior capsule opacification after implantation of CeeOn Edge 911A, PhacoFlex SI-40NB, and AcrySof MA60BM lenses: one-year results of an intraindividual comparison multicenter study.

We did a follow-up study of 35 patients who had phacoemulsification with implantation of diffractive, multifocal intraocular lenses (IOLs) 2.5 years ago. The patients had an average age of 58.2 +/- 9.6 years. Fifty multifocal IOLs were implanted (3M 815LE, n = 45; 3M 825X, n = 5). Refractive values, visual acuity, depth of focus, and the dependence on corrective glasses were evaluated. Eighty percent of the spherical equivalents ranged from -1 to +1 D (mean 0.25 +/- 0.71). In 76% the cylindric power was not higher than 1 D (mean 0.87 +/- 0.64). With distance correction, 100% of the patients achieved a visual acuity of 20/40 or better. Without correction, 86% achieved 20/40 or better. Near acuity of 20/40 or better with only distance correction was achieved in 98% of patients. Ninety-four percent had a near acuity of 20/40 or better without any correction. The depth of focus was significantly better in the multifocal group than in a control group of patients with monofocal IOLs (P < .01). Although 90% of the patients had good uncorrected visual acuity results of 20/40 or better for near and distance, 58% preferred glasses for distance and/or near.

Depth of focus and functional results in patients with multifocal intraocular lenses: A long-term follow-up

OBJECTIVE--To test the longterm findings for glare and contrast sensitivity in patients with diffractive multifocal intraocular lenses STUDY DESIGN--Measurements were done using the Mesoptometer II under standardized contrast level and brightness illumination settings (0032 and 01 cd/m2 brightness illumination for testing contrast sensitivity (01 cd/m2 brightness illumination and glare of 035 Lux for glare testing) Furthermore the patients were tested on their ability to fulfill the requirements of the German Ophthalmological Society (DOG) for mesopic vision to obtain a driver's license PATIENTS--40 patients with multifocal intraocular lenses (MIOL), aged 593 +/- 91 years, were examined 2 years after lens implantation (3M 815 LE and 3M 825 XE) and compared to results of a control-group of 40 patients with monofocal IOL's RESULTS--There were no significant differences testing contrast sensitivity Patients with monofocals, however, reached significant better results than patients with multifocals (p Language: de

Wilfried Hunold

Papers

Functional outcomes after implantation of Tecnis ZM900 and Array SA40 multifocal intraocular lenses.

Optic edge design as long-term factor for posterior capsular opacification rates.

Posterior capsule opacification after implantation of CeeOn Edge 911A, PhacoFlex SI-40NB, and AcrySof MA60BM lenses: one-year results of an intraindividual comparison multicenter study.

Depth of focus and functional results in patients with multifocal intraocular lenses: A long-term follow-up

[Long-term results of contrast perception and glare sensitivity in patients with diffraction multifocal lenses].