G. Ravalico, D. Fanni

Visual outcome comparison of bilateral multifocal

diffractive and refractive IOLs implantation vs

"Mix and Match" approach implantation

The Author has no proprietary interest in any products or devices discussed in this presentation

University Eye ClinicTrieste (Italy)Head: Prof. Giuseppe Ravalico

To compare visual outcomes and contrast sensitivity at far, intermediate and near distances, reading ability, level of satisfaction and quality of vision of patients bilaterally implanted with refractive multifocal AMO ReZoom and with diffractive bifocal Alcon Restor or AMO Tecnis IOLs with patients implanted with refractive AMO ReZoom IOLs in one eye and with diffractive AMO Tecnis or Alcon Restor IOLs in the controlateral eye.

AMO Tecnis Diffractive MIOL

AMO ReZoomRefractive MIOL

Alcon ReSTORDiffractive MIOL

■ Group A: Tecnis (26 pts; 12 F - 14 M)

■ Group B: ReZoom (23 pts; 14 F - 10 M)

■ Group C: Restor (23 pts; 13 F - 10 M)

■ Group D: Tecnis - ReZoom (35 pts; 19 F - 16 M)

■ Group E: Restor - ReZoom (21 pts; 16 F - 5 M)Age range: 50-80 yrs

(mean 70.5 yrs)

EXCLUSION CRITERIAINCLUSION CRITERIA

■ Age range 50-80 yrs

■ Uneventful bilateral cataract surgery

■ Preoperative visual acuity > 0.2 logMAR

■ Mental receptiveness

■ Astigmatism > 2D

■ Concomitant ocular diseases

■ Best distance-corrected far, intermediate and near visual acuity (BCDVA, BCDIVA, BCDNVA)

■ Defocus curve■ Reading speed (MNReading Charts)

■ Contrast sensitivity at far, intermediate and near distances (VCTS 6500, 200 lux)

■ Modified VF-7 questionnaire

% pts

SnellenChi square ns

Logarithmic Visual Acuity Chart “ETDRS”

Chart R n° 2110

BCDVA was satisfactory in all patients without statistically significant differences among the groups. 100% of patients in all groups reached VA better than 20/40. Most of patients reached 20/20 VA.

Logarithmic Visual Acuity Chart 2000 “NEW ETDRS” n° 2106

Chi square p<0.05

% pts

Snellen

Near visual acuity was significantly better in patients implanted with bifocal IOLs, in particular with Tecnis IOL, than with multifocal IOLs.

Snellen

Logarithmic Visual Acuity Chart 2000 “NEW ETDRS” n° 2106 for testing at 40 cm

The Snellen ratio was applied to use this test at 60 (1.5x) and 80 (2x)

60 cm 80 cm

The percentage of patients reaching high values of intermediate visual acuity was high in all study groups except the ReStor group.

Chi square p<0.05

% pts % pts

Snellen

The bifocal IOLs showed a better near peak of vision than multifocal IOLs. Intermediate visual acuity was significantly better with multifocal ReZoom and bifocal Tecnis than with Restor IOL. “Mix and Match” patients obtained high values of visual acuity at all distances.

ANOVA p<0.05

Tecnis+ReZoom Restor+ReZoom Tecnis ReZoom Restor

Sn

ell

en

5,92Depth of focus

5,08Depth of focus4,95

Depth of focus5,47

Depth of focus

6,20Depth of focus

0

0,5

1

1,5

2

2,5

1,5 3 6 12 18

Nearlog C.S.

cycles / deg

0

0,5

1

1,5

2

2,5

1,5 3 6 12 18

0

0,5

1

1,5

2

2,5

1,5 3 6 12 18

Far

Tecnis + ReZoom

Restor + ReZoom

Tecnis ReZoom Restor

IntermediateA slight decrease in

contrast sensitivity at near and

intermediate distances was noted

in all patients. “Mix and Match”

patients performed better than other

groups.

log C.S.

cycles / deg

log C.S.

cycles/deg

Tecnis ReZoom Restor Tecnis + ReZoom Restor + ReZoom

Satisfaction 99,5 99,25 98 92,50 97,5

Seeing signals 99 100 99,25 100 100

Seeing steps 100 100 100 100 100

Watching TV 100 95,50 100 100 97,5

Driving 95,25 99 100 95,5 96,25

Precise handling 97,5 83,25 92,50 95 90

Reading 92,50 79,5 84,75 94,75 91,25

Cooking 100 100 100 100 100

Colours 100 98 100 100 100

Halos 17,50 18,75 16,50 36 12,50

Modified VF-7 questionnaire was used to evaluate the quality of vision and the patient satisfaction for intermediate and near distance everyday activities. When patients were requested to score daily tasks, no

significant differences were noted in particular for activities requiring intermediate vision. Only the halos presence was statistically higher in the Tecnis-ReZoom group.

MN reading Charts

0

50

100

150

200

No significant differences were observed among the groups in the reading speed.

Tecnis+ReZoom

Restor+ReZoom

Tecnis ReZoom Restor

W/min

Bilateral implantation of multifocal IOLs with “Mix and Match approach” assures visual performances comparable with symmetrical bilateral

implantation with diffractive and refractive multifocal IOLs.

■ Even though far, intermediate and near distance performances were acceptable in all study groups, diffractive IOLs proved slightly better than refractive IOLs at near distance.

■ Intermediate visual acuity was better with refractive multifocal and bifocal “full diffractive” IOLs.

■ A slight decrease in contrast sensitivity, particularly at near and intermediate distances, was noted in all patients.