Less spectacle dependence should be expectation of bilateral multifocal lens implantation

Less spectacle dependence, not spectacle independence, should be the expectation after bilateral implantation of multifocal IOLs, said David F. Chang, MD, of Altos Eye Physicians, Los Altos, CA.

He conducted a prospective, non-randomized study comparing real-world multifocal lens performance after bilateral implantation of either a second-generation refractive IOL (ReZoom, Advanced Medical Optics) or an apodized diffractive lens (AcrySof ReSTOR, Alcon Laboratories) and reported 6-month data here. Results for 15 consecutive patients receiving each lens were compared.

"What I think is a little unique about this study is that I limited the people who were under the age of 70, thinking these would be the people who were more demanding in their visual tasks-out at night, using the computer, and what not," Dr. Chang said.

Patients were not randomly assigned to receive either lens "because I wanted to at least try to pick the lens that I thought would best match the needs of that patient by understanding their differences," he said.

The study found that "both of these lenses do what they set out to do, improving uncorrected vision compared with a monofocal, with good lifestyle evaluation and satisfaction," Dr. Chang said. Results "give the edge" to the refractive lens for distance vision, he added, and "a clearer edge" to the diffractive lens for near vision.

The lenses performed similarly for intermediate vision, but 25% of patients in both groups continued wearing glasses for computer use, "so I wouldn't say either group has excellent intermediate vision, at least in my patient population," Dr. Chang said.

The diffractive lens was associated with less-severe halo.

The study found that 50% to 70% of patients continued using glasses for something after lens implantation.

"That tells me that the expectation has to be decreased spectacle dependence, and if it is, that's 70% of people who are happy," he said.

Dr. Chang's paper was named the best of the session in which it was presented (2-L, Intraocular Surgery: Multifocal IOLs). Dr. Chang is a consultant to Alcon, AMO, and Visiogen.