Purpose To analyze the reasons for patient dissatisfaction after phacoemulsification with multifocal intraocular lens (IOL) implantation and the outcomes after intervention. Setting Emory Eye Center, Atlanta, Georgia, USA. Methods This retrospective review comprised eyes of patients dissatisfied with visual outcomes after multifocal IOL implantation. Outcomes analyzed included type of visual complaint, treatment modality for each complaint, and degree of clinical improvement after intervention. Results Thirty-two patients (43 eyes) reported unwanted visual symptoms after multifocal IOL implantation, including in 28 eyes (65%) with an AcrySof ReSTOR IOL and 15 (35%) with a ReZoom IOL. Thirty patients (41 eyes) reported blurred vision, 15 (18 eyes) reported photic phenomena, and 13 (16 eyes) reported both. Causes of blurred vision included ametropia (12 eyes, 29%), dry eye syndrome (6 eyes, 15%), posterior capsule opacification (PCO) (22 eyes, 54%), and unexplained etiology (1 eye, 2%). Causes of photic phenomena included IOL decentration (2 eyes, 12%), retained lens fragment (1 eye, 6%), PCO (12 eyes, 66%), dry-eye syndrome (1 eye, 2%), and unexplained etiology (2 eyes, 11%). Photic phenomena attributed to PCO also caused blurred vision. Thirty-five eyes (81%) had improvement with conservative treatment. Five eyes (12%) did not have improvement despite treatment combinations. Three eyes (7%) required IOL exchange. Conclusions Complaints of blurred vision and photic phenomena after multifocal IOL implantation were effectively managed with appropriate treatment. Few eyes (7%) required IOL exchange. Neodymium:YAG capsulotomy should be delayed until it has been determined that IOL exchange will not be necessary.

Dissatisfaction after multifocal intraocular lens implantation.

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.

Purpose To compare visual acuity outcomes and ocular and intraocular optical quality in patients with a monofocal intraocular lens (IOL) or a multifocal IOL with rotational asymmetry. Setting Vissum Corporation, Alicante, Spain. Design Comparative case series. Methods Consecutive eyes of cataract patients were divided into 2 groups. One group received a Lentis Mplus LS-312 multifocal IOL and the other, an Acri.Smart 48S monofocal IOL. Distance and near visual acuities, contrast sensitivity, intraocular aberrations (global minus corneal aberrations), and defocus curves were evaluated preoperatively and postoperatively during a 3-month follow-up. Results The study evaluated 52 eyes of 29 patients (age range 36 to 87 years); 24 eyes were in multifocal IOL group and 28 eyes, in the monofocal IOL group. Both groups had a significant improvement in uncorrected and corrected distance visual acuities and in distance-corrected near visual acuity (DCNVA) postoperatively ( P ≤.04). The multifocal IOL group had significantly better uncorrected near acuity and DCNVA (Jaeger [J] 5 versus J2) (both P P P ≥.25). Conclusions The new-generation multifocal IOL restored distance, intermediate, and near visual function after cataract surgery. The optical quality with this type of IOL was particularly affected by IOL tilt and decentration. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes.

Visual outcomes and optical performance of a monofocal intraocular lens and a new-generation multifocal intraocular lens.

Purpose To evaluate clinical outcomes and intraocular optical performance of a diffractive multifocal intraocular lens (IOL), Acri.Lisa 366D (Acri.Tec). Setting Vissum-Instituto de Oftalmologico de Alicante, Alicante, Spain. Methods The study included 69 eyes (52 patients) with Acri.Lisa 366D IOLs. The intraocular optical quality in vivo was characterized by the difference between postoperative total and corneal optical aberrations. Visual and optical outcomes were evaluated 6 months postoperatively. The main outcomes measures were refractive defect, uncorrected and corrected distance acuities for far and near (40 cm), intraocular aberrations (root mean square [RMS]), modulation transfer function (MTF) values, point-spread function, and Strehl ratio. Results The mean spherical equivalent (SE) was +1.22 diopters (D) ± 3.62 (SD) preoperatively and +0.39 ± 0.51 D/D postoperatively; 69.32% of eyes were within ±0.50 and 86.36%, within ±1.00 D. The mean acuities were as follows: uncorrected distance, 0.75 ± 0.20; best corrected distance, 0.94 ± 0.11; best distance-corrected near, 0.90 ± 0.14. Near corrected acuity was J1 in 91.76% of eyes and J2 in 4.71%. The mean aberration values were total RMS, 1.45 ± 0.73 μm; spherical, 0.25 ± 0.10 μm; coma, 0.37± 0.21 μm. The mean Strehl ratio was 0.26 ± 0.05. The mean 0.5 MTF was 1.60 ± 0.63 cycles per degree (cpd) and the mean cutoff value, 50.25 ± 17.18 cpd. Conclusions The Acri.Lisa 366D diffractive multifocal IOL gave good efficacy, predictability, and safety and excellent visual acuity at distance and near. An intraocular optical performance model showed good intraocular aberration, Strehl ratio, and MTF values.

Clinical outcomes and intraocular optical quality of a diffractive multifocal intraocular lens with asymmetrical light distribution.

Comparison of a New Refractive Multifocal Intraocular Lens with an Inferior Segmental Near Add and a Diffractive Multifocal Intraocular Lens

Purpose To compare the intraoperative and short-term postoperative outcomes of cataract surgery performed with torsional mode and conventional ultrasound mode using the Infiniti Vision System (Alcon Laboratories). Setting Cataract Service, Zhongshan Ophthalmic Center, Sun-Yat-Sen University, Guangzhou, China. Methods In this randomized comparative study, 525 eyes were assigned to phacoemulsification by torsional mode or conventional ultrasound (US) mode. The surgery was performed by an experienced surgeon, and the outcomes were evaluated by an examiner who was masked to treatment assignments. Primary outcome measures were US time (UST), cumulative dissipated energy (CDE), and surgical complications. Patients were seen 1, 7, and 30 days after surgery. Postoperative outcome measures were the final best corrected visual acuity (BCVA) and the change in corneal clarity, central corneal thickness (CCT), and endothelial cell count. Results The US group had 262 eyes and the torsional group, 263 eyes. All patients completed the follow-up visits. In the eyes with nucleus density grades of 1, 2, 3, and 4, the mean UST was 10.25 seconds ± 7.4 (SD), 25.14 ± 5.5 seconds, 36.45 ± 8.3 seconds, and 61.44 ± 17.8, respectively, in the US group and 8.32 ± 6.8 seconds, 18.45 ± 7.2 seconds, 29.48 ± 12.4 seconds, and 48.39 ± 20.3 seconds, respectively, in the torsional group ( P P P P >.01). At 1 day and 7 days, the mean CCT was 625 ± 80 μm and 568 ± 37 μm, respectively, in the US group and 601 ± 35 μm and 559 ± 40 μm, respectively, in the torsional group ( P P >.01). At 7 days and 30 days, the mean central corneal endothelial cell count was 2135 ± 858 cells/mm 2 and 2084 ± 527 cells/mm 2 , respectively, in the US group and 2004 ± 656 cells/mm 2 and 1953 ± 615 cells/mm 2 , respectively, in the torsional group ( P Conclusion The torsional mode may provide more effective lens removal with a lower level of phacoemulsification time and energy.

Torsional mode versus conventional ultrasound mode phacoemulsification: Randomized comparative clinical study

Background: Higher-order aberrations and contrast sensitivity were evaluated in patients who underwent phacoemulsification cataract extraction followed by implantation of aspherical, monofocal or multifocal intraocular lens (IOL) replacements.



Methods:  In this comparative trial, 124 patients with an average age of 66.8 ± 5.2 years and their 124 eyes were randomly divided into three surgical implantation groups to receive one of three types of IOLs in replacement of cataract lenses. The patients of group 1 were given an aspherical IOL Z9001 (AMO, Santa Ana, CA, USA) replacement, and group 2 was implanted a monofocal IOL SA60AT (Alcon, Fort Worth, TX, USA) and group 3 the multifocal IOL SA40N (AMO). Post-surgical best-corrected visual acuity, corneal aberrations, total ocular aberrations, pupil diameters, capsulorhexsis sizes and contrast sensitivity were measured and compared.



Results:  There was no statistical difference for mean best-corrected visual acuity, pupil diameter, curvilinear capsulorhexis size and corneal aberration among the three groups. For the spherical aberration, fourth-order higher-order aberration and total ocular higher-order aberration, the SA40N group was higher than the SA60AT group and the SA60AT group was higher than the Z9001 group, and the differences between the three groups were statistically significant for these measurements. Contrast sensitivity was higher for the Z9001 group than the SA60AT group and the SA60AT group was higher than the SA40N group, and the difference was statistically significant in all the spatial frequencies of 3, 6, 12 and 18.



Conclusions:  Although the multifocal IOL can provide near vision, it can increase higher-order aberration and negatively influence contrast sensitivity. However, the aspherical IOL can reduce aberration and improve contrast sensitivity as compared with the monofocal IOL.

Yuanlin Xia

Papers

Torsional mode versus conventional ultrasound mode phacoemulsification: Randomized comparative clinical study

Aberration and contrast sensitivity comparison of aspherical and monofocal and multifocal intraocular lens eyes