Monofocal aspheric IOL alternative for presbyopia

Key Points

San Diego-Bilateral implantation of the aberration-free aspheric IOL (SofPort AO, Bausch & Lomb) in a monovision approach can provide patients undergoing cataract surgery excellent binocular distance and near uncorrected visual acuity (UCVA) with high rates of spectacle independence and low rates of night-time vision complaints, said James E. McDonald II, MD, at the annual meeting of the American Society of Cataract and Refractive Surgery.

"With presbyopic IOLs, we want to establish spectacle independence while preserving quality of vision. However, my concern about multifocal IOLs is that they are all associated with qualitative loss of visual information resulting in glare, halos, and reduced contrast sensitivity.

"My strategy is based on using an aspheric lens that has the optically highest contrast. The outcomes with monofocal aspheric IOL surgery are similar to the newer multifocal IOLs with respect to spectacle independence and better in terms of moderate to severe night vision complaints," said Dr. McDonald, a private practitioner in Fayetteville, AR.

Dr. McDonald emphasized that astigmatic control was attacked aggressively. Incisional keratotomy was performed in all patients with ≥ 0.75 D of astigmatism preoperatively or with ≥ 0.50 D of postop astigmatism, especially if the astigmatism was in the nonvertical axis. Within the series, 28% of eyes underwent astigmatic keratotomy or limbal relaxing incisions; all touch-ups were completed within the first 3 months after surgery.

With a minimum of 3 months of follow-up available for all eyes, mean spherical equivalent was –0.213 D in the distance eye and –1.431 D in the near eye. Distance UCVA of 20/30 or better was achieved by 96% of patients, and 100% saw 20/40 or better. In near vision testing, 88% could read J2 or better uncorrected and 44% achieved J1 or better.

Results of a patient survey revealed that nearly all patients (97%) were spectacle-free for intermediate vision, 81% reported they did not wear spectacles for distance, and 68% were spectacle-free for near vision.

These spectacle-independence outcomes are comparable to those reported in FDA and other studies of two lenses (AcrySof ReSTOR, Alcon Laboratories; ReZoom, Advanced Medical Optics), Dr. McDonald said, and data on nighttime visual complaints showed that moderate to severe problems were much less with this strategy compared with the multifocal IOLs.

"A recent paper reporting outcomes of recipients of the [apodized diffractive] IOL [AcrySof ReSTOR] reported [that] more than 40% of patients complained about different daytime quality-of-vision issues, and it is well known that with multifocal IOLs, the more the multifocality, the more reduction in contrast sensitivity. Based on patient surveys and published papers, perceptions of visual quality are related more to contrast sensitivity than to any other factor," he said.

The monovision approach with the aberration-free aspheric IOL does not eliminate optical access to downstream technology using a monofocal attack, he said. In addition, it is reversible if necessary intermittently with spectacles or permanently with refractive surgery.