Clinical Outcomes of Diffractive Multifocal Toric Intraocular Lens Implantation

Jee Hyun Kim; Sung Yu; Sung Hyun Koo; Gwang Ja Lee; Kyoo Won Lee; Young Jeung Park

doi:10.3341/jkos.2014.55.8.1139

Journal List > J Korean Ophthalmol Soc > v.55(8) > 1009744

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Yu, Koo, Lee, Lee, and Park: Clinical Outcomes of Diffractive Multifocal Toric Intraocular Lens Implantation

Original Article

J Korean Ophthalmol Soc 2014;55(8):1139-1149.

Published online: 31 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.8.1139

Clinical Outcomes of Diffractive Multifocal Toric Intraocular Lens Implantation

Jee Hyun Kim, MD, Sung Yu, MD, Sung Hyun Koo, MD, Gwang Ja Lee, MD, Kyoo Won Lee, MD, Young Jeung Park, MD

Cheil Eye Hospital, Daegu, Korea

Address reprint requests to Young Jeung Park, MD, Cheil Eye Hospital, #1 Ayang-ro, Dong-gu, Daegu 701-820, Korea, Tel: 82-53-959-1751, Fax: 82-53-959-1758, E-mail: eyepark9@naver.com

Received 13 December 2013 Revised 7 March 2014 Accepted 17 July 2014

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 evaluate the clinical outcomes of patients with diffractive multifocal toric intraocular lens (IOL) implantation.

Methods

Thirty-four eyes of 26 patients underwent diffractive multifocal toric IOL. Uncorrected visual acuity (UCVA) at distant, intermediate and near and residual refractive astigmatism were measured on the first day, at 2 weeks, and 1, 3 and 6 months postoperatively. Optical quality obtained using the Optical Quality Analysis System II (OQAS II), high-order aberrations (HOA) and patient satisfaction questionnaire were evaluated 3 months postoperatively.

Results

At the 6 month postoperative visit, the mean UCVA at distant, intermediate (63 cm, 100 cm) and near were 0.06 ± 0.07, 0.18 ± 0.11, 0.16 ± 0.12 and 0.03 ± 0.06 (log MAR), respectively. The refractive astigmatism decreased significantly from −1.66 ± 1.04 D to-0.54 ± 0.32 D at 6 months postoperatively (p< 0.01). The means of objective scatter index, modulation transfer function (MTF) cut-off value, Strehl ratio and pseudo-accommodation range measured by OQAS II were 1.33 ± 0.67, 37.24 ± 9.67 cdp, 0.22 ± 0.09 and 3.08 ± 0.53 D, respectively. HOA scores for 5 mm and 6 mm were 0.30 ± 0.09 and 0.49 ± 0.15, respectively; 82.3% of the patients were satisfied with the postoperative results, 79.4% of the patients reported they would recommend the procedure to others, and 14.7% of patients reported moderate or severe visual disturbance at night.

Conclusions

Implantation of a diffractive multifocal toric IOL in patients with cataract and corneal astigmatism provided excellent distant, intermediate, and near visual outcomes, good optical quality and high patient satisfaction.

Keywords: Astigmatism, Cataract, Multifocal toric intraocular lens, Patient satisfaction

References

1. 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.

2. Kohnen T, Allen D, Boureau C, et al. European multicenter study of the AcrySof ReSTOR apodized diffractive intraocular lens. Ophthalmology. 2006; 113:578–84.

3. Alfonso JF, Fernandez-Vega L, Baamonde MB, Montes-Mico R. Prospective visual evaluation of apodized diffractive intraocular lenses. J Cataract Refract Surg. 2007; 33:1235–43.

4. Lee HS, Park SH, Kim MS. Clinical results and some problems of multifocal apodized diffractive intraocular lens implantation. J Korean Ophthalmol Soc. 2008; 49:1235–41.

5. Cheon MH, Lee JE, Kim JH, et al. One-year outcome of monocular implant of aspheric multifocal IOL. J Korean Ophthalmol Soc. 2010; 51:822–8.

6. Kang EC, Kim EK, Kim TI. Comparisons of visual acuity, spherical aberration and contrast sensitivity among spheric, aspheric ReSTOR(R), and Crystalens HD(R) lenses. J Korean Ophthalmol Soc. 2011; 52:1275–80.

7. Kim SM, Kim CH, Chung ES, Chung TY. Visual outcome and patient satisfaction after implantation of multifocal IOLs: three- month follow-up results. J Korean Ophthalmol Soc. 2012; 53:230–7.

8. Kim S, Kim MS. The study on target refraction to improve visual quality in patients implanted with multifocal IOL. J Korean Ophthalmol Soc. 2012; 53:223–9.

9. Gwak JY, Choi JS, Pak KH, Baek NH. Visual and optical functions after diffractive multifocal intraocular lens. J Korean Ophthalmol Soc. 2012; 53:396–402.

10. Hayashi K, Manabe S, Yoshida M, Hayashi H. Effect of astigmatism on visual acuity in eyes with a diffractive multifocal intraocular lens. J Cataract Refract Surg. 2010; 36:1323–9.

11. Ferrer-Blasco T, Montes-Mico R, Peixoto-de-Matos SC, et al. Prevalence of corneal astigmatism before cataract surgery. J Cataract Refract Surg. 2009; 35:70–5.

12. Budak K, Friedman NJ, Koch DD. Limbal relaxing incisions with cataract surgery. J Cataract Refract Surg. 1998; 24:503–8.

13. Kaufmann C, Peter J, Ooi K, et al. Limbal relaxing incisions versus on-axis incisions to reduce corneal astigmatism at the time of cataract surgery. J Cataract Refract Surg. 2005; 31:2261–5.

14. Jendritza BB, Knorz MC, Morton S. Wavefront-guided excimer laser vision correction after multifocal IOL implantation. J Refract Surg. 2008; 24:274–9.

15. Kim SI, Kim SJ, Oh JY, et al. The effects of laser refractive surgery for correcting residual refractive error after implantation of ReSTOR(R) multifocal IOL. J Koμ Ophthalmol Soc. 2012; 53:1742–8.

16. Kim MH, Chung TY, Chung ES. Long-term efficacy and rotational stability of AcrySof toric intraocular lens impalntation in cataract surgery. Korean J Ophthalmol. 2010; 24:207–12.

17. Visser N, Bauer NJ, Nuijts RM. Toric intraocular lenses: Historical overview, patient selection, IOL calculation, surgical techniques, clinical outcomes, and complications. J Cataract Refract Surg. 2013; 39:624–37.

18. Ferreira TB, Marques EF, Rodrigues A, Montes-Mico R. Visual and optical outcomes of a diffractive multifocal toric intraocular lens. J Cataract Refract Surg. 2013; 39:1029–35.

19. Visser N, Nuijts RM, de Vries NE, Bauer NJ. Visual outcomes and patient satisfaction after cataract surgery with toric multifocal intraocular lens implantation. J Cataract Refract Surg. 2011; 37:2034–42.

20. Mojzis P, Pinero DP, Ctvrteckova V, Rydlova I. Analysis of internal astigmatism and higher order aberrations in eyes implanted with a new diffractive multifocal toric intraocular lens. Graefes Arch Clin Exp Ophthalmol. 2013; 251:341–8.

21. Koch DD, Ali SF, Weikert MP, et al. Contribution of posterior corneal astigmatism to total corneal astigmatism. J Cataract Refract Surg. 2012; 38:2080–7.

22. Ho JD, Tsai CY, Liou SW. Accuracy of corneal astigmatism estimation by neglecting the posterior corneal surface measurement. Am J Ophthalmol. 2009; 147:788–95.

23. Eom Y, Nam KT, Kang SY, et al. Axis Difference between corneal and internal astigmatism to consider for toric intraocular lenses. Am J Ophthalmol. 2013; 156:1112–9.e2.

24. Lee JM, Seo KY, Kim EK. Comparison of optical aberrations and contrast sensitivity between monofocal and multifocal intraocular lens. J Korean Ophthalmol Soc. 2002; 43:1882–6.

25. Montes-Mico R, Espana E, Bueno I, et al. Visual performance with multifocal intraocular lenses mesopic contrast sensitivity under distance and near conditions. Ophthalmology. 2004; 111:85–96.

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

27. Nochez Y, Majzoub S, Pisella PJ. Effect of interaction of macroaberrations and scattered light on objective quality of vision in pseudophakic eyes with aspheric monofocal intraocular lenses. J Cataract Refract Surg. 2012; 38:633–40.

28. Diaz-Valle D, Arriola-Villalobos P, Garcia-Vidal SE, et al. Effect of lubricating eyedrops on ocular light scattering as a measure of vision quality in patients with dry eye. J Cataract Refract Surg. 2012; 38:1192–7.

29. Cabot F, Saad A, McAlinden C, et al. Objective assessment of crystalline lens opacity level by measuring ocular light scattering with a double-pass system. Am J Ophthalmol. 2013; 155:629–35.

30. Lee K, Ahn JM, Kim EK, Kim TI. Comparison of optical quality parameters and ocular aberrations after wavefront-guided laser in-situ keratomileusis versus wavefront-guided laser epithelial keratomileusis for myopia. Graefes Arch Clin Exp Ophthalmol. 2013; 251:2163–9.

31. Saad A, Saab M, Gatinel D. Repeatability of measurements with a double-pass system. J Cataract Refract Surg. 2010; 36:28–33.

32. Castillo-Gomez A, Carmona-Gonzalez D, Martinez-de-la-Casa JM, et al. Evaluation of image quality after implantation of 2 diffractive multifocal intraocular lens models. J Cataract Refract Surg. 2009; 35:1244–50.

33. Yoon JU, Chung JL, Hong JP, et al. Comparison of wavefront analysis and visual function between monofocal and multifocal aspheric intraocular lenses. Korean J Ophthalmol. 2009; 50:195–201.

Figure 1.

The AcrySof® IQ Restor® diffractive multifocal toric intraocular lens.

Figure 2.

An example of a patient's image quality with accommodation measured by optical quality analysis system II at post-op 3 months. The graph shows good optical quality at distant (0.0 D) and near (3.0 D). At the 3-month postoperative visit, the mean pseudo-accommodation range of total enrolled patients was 3.08 ± 0.53 D.

Figure 3.

Satisfaction of the patients with the diffractive multifocal toric intraocular lens (IOL) (%).

Table 1.

Patient demographics and clinical information

Parameter	Values
Eyes (n)	34
Patients (n)	26
Sex (M:F)	12:14
Age (years) (range)	51.8 ± 5.5 (43-66)
UCDVA (log MAR)	0.77 ± 0.48
Spherical equivalent (diopter) (range)	-3.57 ± 4.41 (2.00∼-11.75)
Mean astigmatism magnitude (diopter)
Refractive^* (range)	-1.66 ± 1.04 (-0.50∼-4.00)
Corneal^† (range)	1.21 ± 0.95 (0.50-3.50)
Mean D power (diopter) (range)	17.24 ± 4.42 (7.50-22.5)
IOL model (n)
SND1T2	2
SND1T3	16
SND1T4	9
SND1T5	7

Values are presented as mean ± SD unless otherwise indicated.

D = diopter; IOL = intraocular lens; UCDVA = uncorrected distant visual acuity.

^* Obtained by autorefractometry;

^† Obtained by autorefractokeratometry.

Table 2.

Postoperative visual acuity over time after implantation of the Acrysof® IQ Restor® toric IOL

Post op	1 day	2 weeks	1 month	3 months	6 months
UCDVA (log MAR)	0.07 ± 0.10	0.06 ± 0.08	0.06 ± 0.10	0.07 ± 0.07	0.06 ± 0.07
BCDVA (log MAR)	0.01 ± 0.03	0.01 ± 0.03	0.01 ± 0.03	0.02 ± 0.04	0.01 ± 0.03
UNVA (log MAR)	0.08 ± 0.08	0.04 ± 0.08	0.04 ± 0.07	0.04 ± 0.06	0.03 ± 0.06
UIVA63 (log MAR)	0.22 ± 0.11	0.18 ± 0.09	0.18 ± 0.08	0.16 ± 0.09	0.18 ± 0.11
UIVA100 (log MAR)	0.23 ± 0.11	0.17 ± 0.12	0.13 ± 0.10	0.14 ± 0.11	0.16 ± 0.12

Values are presented as mean ± SD.

IOL = intraocular lens; UCDVA = uncorrected distance visual acuity; BCDVA = best corrected distance visual acuity; UNVA = uncorrected near visual acuity at 40 cm distance; UIVA63 = uncorrected intermediate visual acuity at 63 cm distance; UIVA100 = uncorrected intermediate visual acuity at 100 cm distance.

Table 3.

Cylinder refraction (Cyl) and spherical equivalent (SE) at pre op, post op 1 day, 2 weeks, 1, 3 and 6 months

	Pre op	1 day	2 weeks	1 month	3 months	6 months	p-value^*
Cyl (D)	-1.66 ± 1.04	-0.58 ± 0.40	-0.59 ± 0.41	-0.55 ± 0.40	-0.59 ± 0.22	-0.54 ± 0.32	<0.01
SE (D)	-3.5 ± 4.41	-0.23 ± 0.45	-0.27 ± 0.37	-0.31 ± 0.32	-0.29 ± 0.37	-0.34 ± 0.35	<0.01

Values are presented as mean ± SD.

D = diopter.

^* Mann-Whitney U-test.

Table 4.

Postoperative astigmatism analysis according to preoperative corneal astigmatism

Parameter	Results
Preoperative refractive astigmatism (diopter)	-1.66 ± 1.04
Corneal astigmatism (diopter)	1.21 ± 0.95
WTR (n)	1.31 ± 0.60 (27)
ATR(n)	0.89 ± 1.78 (7)
Postoperative refractive astigmatism (n)
±0.5 D (%)	22 (64.71)
±1.0 D (%)	34 (100)
Preoperative corneal astigmatism (WTR), n	27
Postoperative refractive astigmatism
<±0.5 D (n, %)	18 (66.67)
≥±0.5 D (n, %)	9 (33.33)
Overcorrected (ATR) (n, %)	7 (77.78)
Undercorrected (WTR) (n, %)	2 (22.22)
Preoperative corneal astigmatism (ATR), n	7
Postoperative refractive astigmatism
<±0.5 D (n, %)	4 (57.14)
≥±0.5 D (n, %)	3 (42.86)
Overcorrected (WTR) (n, %)	0 (0)
Undercorrected (ATR) (n, %)	3 (100)

Values are presented as mean ± SD unless otherwise indicated. D = diopter; WTR = with-the-rule; ATR = against-the-rule.

Table 5.

Optical quality parameters measured by optical quality analysis system (OQAS) II at post-op 3 months

Parameters	OQAS values
OSI	1.33 ± 0.67
MTF cut-off value (cpd)	37.24 ± 9.67
Strehl ratio	0.22 ± 0.09

Values are presented as mean ± SD.

OSI = objective scatter index; MTF = modulation transfer function.

Table 6.

Ocular aberrometry analysis measured by Zywave II® at post-op 3 months

	Values		Values
HOA 5 mm (μm)	0.30 ± 0.09	HOA 6 mm (μm)	0.49 ± 0.15
Trefoil (μm)	0.19 ± 0.10	Coma (μm)	0.11 ± 0.08
Quadrafoil (μm)	0.11 ± 0.07	2nd astigmatism (μm)	0.05 ± 0.03
Spherical aberration (μm)	0.22 ± 0.07	Pentafoil (μm)	0.05 ± 0.03
2nd trefoil (μm)	0.02 ± 0.01	2nd coma (μm)	0.02 ± 0.01

Values are presented as mean ± SD. HOA = high-order aberration.

TOOLS

Similar articles