Subjective measures help match IOL, patient

San Francisco-It is not always easy to fit the right IOL to the right patient to correct presbyopia.

It is not that approved lenses do not work as expected, according to Richard Chu, DO, medical director, Chu Eye Associates, Fort Worth, TX, but that each lens has slightly different optical characteristics. Not every lens is right for every patient.

“We have not seen much work done on subjective patient responses to lens implants,” Dr. Chu said. “But we know there can be significant differences between subjective and objective responses to lens implantation and other procedures. We decided to find out how patients react to different lenses.”

Researchers surveyed patients following prospective, randomized, masked bilateral implantation of one of three FDA-approved IOLs for presbyopia: Crystalens AO, Bausch + Lomb (26 patients); ReSTOR +3, Alcon Laboratories (24 patients); and Tecnis Multifocal, Abbott Medical Optics (22 patients). All of the patients had sequential bilateral implantation.

At 1, 3, and 6 months following bilateral implantation, patients were given the National Eye Institute Refractive Error Quality of Life Instrument (NEI-RQL-42) and the Subjective Visual Index Questionnaire. The NEI-RQL-42 was scored and statistically compared for 13 question subgroups. Both instruments rate vision and visual quality of life items on a 100-point scale.

All three lenses met patient expectations, Dr. Chu noted. There was not statistically significant difference between the three lenses for distant vision (p > 0.28).

The Crystalens AO group had fewer patients (15.3%) who reported moderate to high difficulty with intermediate and near vision compared with ReSTOR +3 (28%) and Tecnis Multifocal (27.3%). The Tecnis Multifocal had the best near vision while the Crystalens AO had the best glare scores (p < 0.01). Both Tecnis Multifocal and ReSTOR +3 had subjective halo scores more than two times better than the Crystalens AO.

“All three lenses showed excellent satisfaction scores,” Dr. Chu said. “Assessment of patients subjective visual experiences corroborates visual acuity and optical scatter outcomes. This study allows comparisons of the three lenses to previous quality of life studies. It is important as we evaluate lenses to have a standard comparison and this will help us to tailor lens selection to our patients’ needs.”