Clinical Outcome of Diffractive Multifocal Aspheric Intraocular Lens

Minwook Chang; Youngsub Eom; Su-Yeon Kang; Kyun-Hyung Kim; Jong-Suk Song; Hyo-Myung Kim

doi:10.3341/jkos.2009.50.4.529

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Chang, Eom, Kang, Kim, Song, and Kim: Clinical Outcome of Diffractive Multifocal Aspheric Intraocular Lens

Original Article

J Korean Ophthalmol Soc 2009;50(4):529-536.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.4.529

Clinical Outcome of Diffractive Multifocal Aspheric Intraocular Lens

Minwook Chang, MD, Youngsub Eom, MD, Su-Yeon Kang, MD, Kyun-Hyung Kim, MD, Jong-Suk Song, MD, PhD, Hyo-Myung Kim, MD, PhD

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea

Address reprint requests to Hyo-Myung Kim, MD, PhD, Department of Ophthalmology, Anam Hospital, Korea University College of Medicine #126-1 5-ga, Anam-dong, Seongbuk-gu, Seoul 136-705, Korea Tel: 82-2-920-5366, Fax: 82-2-924-6820, E-mail: hyomkim@kumc.or.kr

Received 26 May 2008 Accepted 3 December 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the clinical outcome between Tecnis ZM900 and Tecnis ZA9003.

Methods

We reviewed 20 eyes of 11 patients implanted with Tecnis ZM900 and 20 eyes of 20 patients implanted with Tecnis ZA9003. The clinical outcomes of these two intraocular lenses were evaluated one month after operation and consisted of distant, intermediate, and near visual acuity; depth of focus; contrast sensitivity; wavefront aberration; and patient satisfaction. Six months after the operation a reevaluation was performed for the group who had received the Tecnis ZM 900 implant.

Results

Near and intermediate vision was better in the Tecnis ZM900 group. There were no statistical differences between the two groups with respect to distant vision and wavefront aberration. Contrast sensitivity was better in the Tecnis ZA9003 group and depth of focus was deeper in the Tecnis ZM900 group. There were no statically significant differences in the result between one month and six month after the operation.

Conclusions

The Tecnis multifocal ZM900 IOL can be effective at improving patient satisfaction after cataract surgery as well as for correcting presbyopia.

Keywords: Contrast sensitivity, Depth of focus, Multifocal, Visual acuity, Wavefront aberration

References

1. Martínez Palmer A, Gómez Faiña P, España Albelda A, et al. Visual function with bilateral implantation of monofocal and multifocal intraocular lenses. J Refract Surg. 2008; 24:257–64.

2. Goes FJ. Refractive lens exchange with the diffractive multifocal tecnis ZM900 intraocular lens. J Refract Surg. 2008; 24:243–50.

3. Fernández-Vega L, Alfonso JF, Rodríguez PP, Montés-Micó R. Clear lens extraction with multifocal apodized intraocular lens implantation. Ophthalmology. 2007; 114:1491–8.

4. Fernández-Vega L, Alfonso JF, Montés-Micó R, Amhaz H. Visual acuity tolerance to residual refractive errors in patients with an apodized diffractive intraocular lens. J Cataract Refract Surg. 2008; 34:199–204.

5. Lee DY, Roh JH, Shyn KH. Current trends in cataract surgery in Korea – 2005 survey for KSCRS members. J Korean Ophthalmol Soc. 2007; 48:485–92.

6. Lane SS, Morris M, Nordan L, et al. Multifocal intraocular lenses. Ophthalmol Clin North Am. 2006; 19:89–105.

7. Hütz WW, Eckhardt HB, Röhrig B, Grolmus R. Reading ability with 3 multifocal intraocular lens models. J Cataract Refract Surg. 2006; 32:2015–21.

8. Kohnen T, Allen D, Boureau C, et al. European multicenter study of the AcrySof ReSTOR apodized diffractive intraocular lens. Ophthalmology. 2006; 113:584.

9. Blaylock JF, Si Z, Vickers C. Visual and refractive status at different focal distances after implantation of the ReSTOR multifocal intraocular lens. J Cataract Refract Surg. 2006; 32:1464–73.

10. Chiam PJ, Chan JH, Aggarwal RK, Kasaby S. ReSTOR intraocular lens implantation in cataract surgery: quality of vision. J Cataract Refract Surg. 2006; 32:1459–63.

11. Sallet G. Refractive outcome after bilateral implantation of an apodized diffractive intraocular lens. Bull Soc Belge Ophtalmol. 2006; 299:67–73.

12. Souza CE, Muccioli C, Soriano ES, et al. Visual performance of AcrySof ReSTOR apodized diffractive IOL: a prospective comparative trial. Am J Ophthalmol. 2006; 141:827–32.

13. Bi H, Cui Y, Ma X, et al. Early clinical evaluation of Acrysof ReSTOR multifical intraocular lens for treatment of cataract. Ophthalmologica. 2008; 222:11–6.

14. Pepose JS, Qazi MA, Davies J, et al. Visual performance of patients with bilateral vs combination Crystalens, Rezoom, and ReSTOR intraocular lense implants. Am J Ophthalmol. 2007; 144:347–57.

15. Vingolo EM, Grenga P, Iacobelli L, Grenga R. Visual acuity and contrast sensitivity: acrysof ReSTOR apodized diffractive vursus Acrysof SA60AT monofocal intraocular lenses. J Cataract Refract Surg. 2007; 33:1244–7.

16. Toto L, Falconio G, Vecchiarino L, et al. Visual performance and biocompatibility of 2 multifocal diffractive IOLs. J Catarct Refract Surg. 2007; 33:1419–25.

Figure 1.

The design of Tecnis ZM900 aspheric multifocal intraocular lens.

Table 1.

A survey of patients who had Multifocal TECNIS IOL implantation

1.	수술후 전반적으로 얼마나 만족하십니까?
	A. 매우만족(5) B. 만족(4) C. 보통(3) D. 불만족(2) E. 매우불만족(1)
2.	원거리 시력은 얼마나 만족하십니까?
	A. 매우만족(5) B. 만족(4) C. 보통(3) D. 불만족(2) E. 매우불만족(1)
3.	근거리 시력은 얼마나 만족하십니까?
	A. 매우만족(5) B. 만족(4) C. 보통(3) D. 불만족(2) E. 매우불만족(1)
4.	중간거리 시력은 얼마나 만족하십니까?
	A. 매우만족(5) B. 만족(4) C. 보통(3) D. 불만족(2) E. 매우불만족(1)
5.	양안을 수술 받은 후 한쪽 눈만 받았을 때보다 더 만족하십니까?
	A. 그렇다 B. 그렇지 않다
6.	만족한다면 그 이유는 무엇인가요?
7.	불만족한다면 그 이유는 무엇인가요?
8.	수술 후 안경이 필요하나요?
	A. 불필요함 B. 필요함
9.	안경착용이 필요하다면 어떨 때 주로 필요하나요?
	A. 원거리 B. 근거리
10.	불편한 점은 없나요?
	A. 있다 B. 없다
11.	불편한 점이 있다면 어떤 것이 있나요? (복수답 가능)
	A. 어둡게 보임
	B. 달무리
	C. 불빛이 번져 보임
	D. 글씨가 선명하게 보이지 않음
	E. 기타
12.	다른 사람에게 이 수술을 추천하시겠습니까?
	A. 추천 하겠다. B. 추천하지 않겠다.

Table 2.

Baseline preoperative characteristics of two groups

	ZM900 (n=20)	ZA9003 (n=20)	P-value
Age (yrs)	67.9±8.2	65.8±8.2	0.650^*
Sex (M:F)	1:10	8:12	0.024^†
Preoperative SE (diopter)	1.35±1.29	1.6±3.0	0.615^*
Target diopter	0.10±0.17	−0.34±0.14	0.000^*
IOL power (diopter)	21.0±0.97	21.1±1.2	0.846^*
Postoperative SE^‡ (diopter)	0.49±0.46	−0.26±0.47	0.000^*
Refractive error^§ (diopter)	0.39±0.46	0.08±0.50	0.072^*

^* Mann-Whitney U-test

^† Fisher's exact test

^‡ SE=spherical equivalent

^§ Refractive error=postoperative SE-target diopter.

Table 3.

Comparison of visual acuity between two groups

		ZM900 (n=20)	ZA9003 (n=20)	P-value^*
Distant (logMAR)	UCVA^‡	0.08±0.13	0.07±0.10	0.739
	BCVA^∏	0.00±0.00	0.01±0.02	0.094
Intermediate 50 cm	UCVA^‡	0.11±0.07	0.38±0.20	0.000
(logMAR)	DCVA^§	0.14±0.10	0.41±0.20	0.000
	BCVA^∏	0.04±0.05	0.05±0.13	0.869
Intermediate 75 cm	UCVA^‡	0.21±0.07	0.32±0.16	0.023
(logMAR)	DCVA^§	0.24±0.08	0.35±0.16	0.016
	BCVA^∏	0.09±0.07	0.11±0.12	0.747
Near 33 cm	UCVA^‡	0.09±0.06	0.47±0.24	0.000
(logMAR)	DCVA^§	0.08±0.06	0.49±0.24	0.000
	BCVA^∏	0.06±0.02	0.05±0.13	0.141
DOF^†		8.27±2.34	4.40±1.75	0.000

^* Mann-Whitney U-test

^† DOF=depth of focus

^‡ UCVA=uncorrected visual acuity

^§ DCVA=distant corrected visual acuity

^∏ BCVA=best corrected visual acuity.

Table 4.

Comparison of contrast sensitivity between two groups

		ZM900 (n=20)	ZA9003 (n=20)	P-value^*
Photopic condition	1 (cycle/degree)	1.26±0.22	1.49±0.13	0.230
(log)	3	1.22±0.19	1.49±0.16	0.000
	6	1.11±0.21	1.31±0.16	0.034
	12	0.84±0.24	1.05±0.41	0.021
	20	0.49±0.24	0.66±0.25	0.019
Scotopic condition	1 (cycle/degree)	1.24±0.25	1.45±0.17	0.004
(log)	3	1.18±0.20	1.44±0.17	0.001
	6	1.03±0.29	1.24±0.21	0.028
	12	0.79±0.28	1.02±0.28	0.012
	20	0.51±0.28	0.65±0.19	0.091

^* Mann-Whitney U-test.

Table 5.

Comparison of wavefront aberrations between two groups

	ZM900 (n=20)	ZA9003 (n=20)	P-value^*
RMS^† total (micron)	1.27±1.21	0.87±0.34	0.751
HOA^‡ (micron)	0.34±0.22	0.42±0.28	0.492
SA^§ (micron)	0.00±0.20	−0.02±0.11	0.667

^* Mann-Whitney U-test

^† RMS=root mean square

^‡ HOA=high order aberration

^§ SA=spherical aberration.

Table 6.

Comparison of variables between monocular and binocular vision after surgery

		Monocular (n=18)	Binocular (n=9)	P-value^*
Distant (logMAR)	UCVA^†	0.08±0.13	0.07±0.13	0.631
	BCVA^§	0.00±0.00	0.00±0.00	1.000
Intermediate 50 cm	UCVA^†	0.11±0.07	0.07±0.07	0.162
(logMAR)	DCVA^‡	0.14±0.10	0.08±0.08	0.139
	BCVA^§	0.04±0.05	0.04±0.05	1.000
Intermediate 75 cm	UCVA^†	0.21±0.07	0.15±0.09	0.045
(logMAR)	DCVA^‡	0.24±0.08	0.16±0.09	0.055
	BCVA^§	0.09±0.07	0.09±0.07	1.000
Near 33 cm	UCVA^†	0.09±0.06	0.05±0.07	0.220
(logMAR)	DCVA^‡	0.08±0.06	0.04±0.05	0.179
	BCVA^§	0.01±0.02	0.01±0.03	1.000
DOF∏ (diopter)		8.27±2.34	9.17±2.57	0.075
^＃ CS (photopic)	1 (cycle/degree)	1.26±0.22	1.36±0.19	0.342
(log)	3	1.22±0.19	1.36±0.19	0.085
	6	1.11±0.21	1.27±0.20	0.091
	12	0.84±0.24	0.95±0.25	0.313
	20	0.49±0.24	0.63±0.20	0.112
^＃ CS (scotopic)	1 (cycle/degree)	1.24±0.25	1.33±0.22	0.398
(log)	3	1.18±0.20	1.29±0.15	0.198
	6	1.03±0.29	1.18±0.16	0.189
	12	0.79±0.28	0.88±0.23	0.525
	20	0.51±0.28	0.65±0.25	0.188

^* Mann-Whitney U-test

^† UCVA=uncorrected visual acuity

^‡ DCVA=distant corrected visual acuity

^§ BCVA=Best Corrected Visual Acuity

^∏ DOFS=depth of focus

^＃ CS=contrast sensitiviy.

Table 7.

Comparison of results in between 1 month and 6 months after surgery

		1 month (n=18)	6 months (n=9)	p-value^*
Distant (logMAR)	UCVA^†	0.08±0.13	0.06±0.07	0.482
	BCVA^§	0.00±0.00	0.00±0.00	1.000
Intermediate 50 cm	UCVA^†	0.11±0.07	0.11±0.07	0.979
(logMAR)	DCVA^‡	0.14±0.10	0.14±0.10	0.854
	BCVA^§	0.04±0.05	0.03±0.05	0.508
Intermediate 75 cm	UCVA^†	0.21±0.07	0.20±0.08	0.697
(logMAR)	DCVA^‡	0.24±0.08	0.27±0.08	0.215
	BCVA^§	0.09±0.07	0.12±0.11	0.363
Near 33 cm	UCVA^†	0.09±0.06	0.09±0.10	0.984
(logMAR)	DCVA^‡	0.08±0.06	0.06±0.07	0.303
	BCVA^§	0.01±0.02	0.00±0.00	0.331
DOF^∏ (diopter)		8.27±2.34	8.42±1.78	0.829
CS^＃ (photopic)	1 (cycle/degree)	1.26±0.22	1.33±0.10	0.219
(log)	3	1.22±0.19	1.40±0.12	0.002
	6	1.11±0.21	1.17±0.21	0.384
	12	0.84±0.24	0.90±0.30	0.505
	20	0.49±0.24	0.59±0.29	0.293
CS^＃ (scotopic)	1 (cycle/degree)	1.24±0.25	1.32±0.12	0.222
(log)	3	1.18±0.20	1.33±0.17	0.020
	6	1.03±0.29	1.04±0.33	0.923
	12	0.79±0.28	0.83±0.27	0.715
	20	0.51±0.28	0.53±0.24	0.813
Refractive error (diopter)		0.49±0.46	0.54±0.51	0.764

^* Mann-Whitney U-test

^† UCVA=uncorrected visual acuity

^‡ DCVA=distant corrected visual acuity

^§ BCVA=best corrected visual acuity

^∏ DOF=depth of focus

^＃ CS=contrast sensitiviy.

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