Comparison of Clinical Outcomes between Diffractive and Refractive Multifocal Intraocular Lens with Same Near Added

Jee Hyun Kim; Eun Joo Kim; Yong Il Kim; Gwang Ja Lee; Kyoo Won Lee; Young Jeung Park

doi:10.3341/jkos.2015.56.6.875

Journal List > J Korean Ophthalmol Soc > v.56(6) > 1010300

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Kim, Kim, Lee, Lee, and Park: Comparison of Clinical Outcomes between Diffractive and Refractive Multifocal Intraocular Lens with Same Near Added

Original Article

J Korean Ophthalmol Soc 2015;56(6):875-884.

Published online: 7 September 2015

DOI: https://doi.org/10.3341/jkos.2015.56.6.875

Comparison of Clinical Outcomes between Diffractive and Refractive Multifocal Intraocular Lens with Same Near Added

Jee Hyun Kim, MD, Eun Joo Kim, MD, Yong Il Kim, MD, Gwang Ja Lee, MD, Kyoo Won Lee, MD, PhD, Young Jeung Park, MD, PhD

Cheil Eye Hospital, Daegu, Korea

Address reprint requests to Young Jeung Park, MD, PhD 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 27 September 201415 January 2015 Accepted 12 May 2015

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 outcomes between refractive-type multifocal intraocular lenses (IOL) (Lentis Mplus^® LS 313, Oculentis GmbH., Berlin, Germany) and diffractive-type multifocal IOL (Acrysof Restor^®; SN6AD1, Alcon Lab., Fort Worth, TX, USA) with same near added.

Methods

We evaluated 30 eyes implanted with Lentis Mplus^® IOL and 33 eyes implanted with Acrysof Restor^® IOL after phacoemulsification. The distant, intermediate, and near uncorrected visual acuities of the 2 groups were evaluated at 2 weeks and 1, 3, and 6 months postoperatively. Optical quality obtained using the Optical Quality Analysis System II (OQAS II^®, Visiometrics, Castelldefels, Barcelona, Spain), higher-order aberrations (HOAs), and patient satisfaction questionnaire of the 2 groups were evaluated at 3 months postoperatively.

Results

The visual acuity of intermediate 100 cm was statistically better in the Lentis Mplus^® group (p < 0.05). There were no significant differences between the 2 groups with distant, intermediate 63 cm, and near vision. At the 3-month postoperative fol-low-up, objective scatter index, modulation transfer function (MTF) cutoff value, and pseudo-accommodation range measured by OQAS II^® showed no differences between the 2 groups, but Strhel ratio was higher in the Acrysof Restor^® group. HOAs of 5 mm and 6 mm increased significantly in the Lentis Mplus^® group. No significant differences were found in the patient satisfaction questionnaire.

Conclusions

Both refractive and diffractive-type multifocal IOL implantation in patients with cataracts and presbyopia offered good and comparable visual acuity at distance and near. However, the Lentis Mplus^® IOL provided better intermediate vision than the Acrysof Restor^® IOL.

Keywords: Cataract, Diffractive, Multifocal intraocular lens, Presbyopia, Refractive

References

1. Alfonso JF, Fernández-Vega L, Baamonde MB, Montés-Micó R. Prospective visual evaluation of apodized diffractive intraocular lenses. J Cataract Refract Surg. 2007; 33:1235–43.

2. 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.

3. de Vries NE, Webers CA, Montés-Micó R, et al. Long-term fol-low-up of a multifocal apodized diffractive intraocular lens after cataract surgery. J Cataract Refract Surg. 2008; 34:1476–82.

4. Woodward MA, Randleman JB, Stulting RD. Dissatisfaction after multifocal intraocular lens implantation. J Cataract Refract Surg. 2009; 35:992–7.

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. 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.

7. de Vries NE, Nuijts RM. Multifocal intraocular lenses in cataract surgery: literature review of benefits and side effects. J Cataract Refract Surg. 2013; 39:268–78.

8. Alfonso JF, Puchades C, Fernández-Vega L, et al. Contrast sensitivity comparison between AcrySof ReSTOR and Acri.LISA aspheric intraocular lenses. J Refract Surg. 2010; 26:471–7.

9. Castillo-Gómez A, Carmona-González D, Martínez-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.

10. Alfonso JF, Fernández-Vega L, Blázquez JI, Montés-Micó R. Visual function comparison of 2 aspheric multifocal intraocular lenses. J Cataract Refract Surg. 2012; 38:242–8.

11. 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.

12. Kohnen T, Allen D, Boureau C, et al. European multicenter study of the AcrySof ReSTOR apodized diffractive intraocular lens. Ophthalmology. 2006; 113:578–84.e1.

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

14. McAlinden C, Moore JE. Multifocal intraocular lens with a sur-face-embedded near section: short-term clinical outcomes. J Cataract Refract Surg. 2011; 37:441–5.

15. Alió JL, Plaza-Puche AB, Piñero DP, et al. Comparative analysis of the clinical outcomes with 2 multifocal intraocular lens models with rotational asymmetry. J Cataract Refract Surg. 2011; 37:1605–14.

16. Muñoz G, Albarrán-Diego C, Ferrer-Blasco T, et al. Visual function after bilateral implantation of a new zonal refractive aspheric multifocal intraocular lens. J Cataract Refract Surg. 2011; 37:2043–52.

17. Alió JL, Plaza-Puche AB, Montalban R, Javaloy J. Visual outcomes with a single-optic accommodating intraocular lens and a low-addition-power rotational asymmetric multifocal intraocular lens. J Cataract Refract Surg. 2012; 38:978–85.

18. Alio JL, Plaza-Puche AB, Javaloy J, et al. Comparison of a new refractive multifocal intraocular lens with an inferior segmental near add and a diffractive multifocal intraocular lens. Ophthalmology. 2012; 119:555–63.

19. Chung YK, Park CW, Hwang JH, Joo CK. Clinical outcomes of M-plus intraocular lenses. J Korean Ophthalmol Soc. 2014; 55:519–26.

20. 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.

21. Nanavaty MA, Spalton DJ, Marshall J. Effect of intraocular lens asphericity on vertical coma aberration. J Cataract Refract Surg. 2010; 36:215–21.

22. Nishi T, Nawa Y, Ueda T, et al. Effect of total higher-order aberrations on accommodation in pseudophakic eyes. J Cataract Refract Surg. 2006; 32:1643–9.

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

24. Diaz-Valle D, Arriola-Villalobos P, García-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.

25. 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. 635.e1-2.

26. 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.

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

28. Castillo-Gómez A, Carmona-González D, Martínez-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.

Figure 1.

(A) Lentis Mplus LS-313 intraocular lenses (IOL) and (B) Acrysof Restor SN6AD1 IOL.

Figure 2.

An example of a image quality with pseudo-accom-modation measured by Optical quality analysis system II® at post-operation 3 months of (A) Restor® and (B) Lentis Mplus®. (A) Graph A shows good optical quality at distant (0.0 D) and near (3.0 D). (B) Graph B shows good optical quality at distant (0.0 D) and intermediate distance (1.5 D). At the 3-month postoperative visit, the mean pseudo-accom-modation range of total enrolled patients was 3.17 ± 0.45 D for Restor® and 3.10 ± 0.31 D for Lentis Mplus®.

Figure 3.

Satisfaction questionnaire of the patients at post-operative 3 months. There was no statistically significant difference in satisfaction between the two groups. ^*Student's t-test.

Table 1.

Demographics of the study group

	Restor®	Lentis Mplus®	p-value^*
No. of eyes (patients)	33 (28)	30 (24)
Male:female (eyes)	16:17	18:12
Mean age (years)	52.58 ± 5.06	55.50 ± 7.21	0.065
Preoperative S.E. (D)	-0.55 ± 2.31	0.29 ± 1.29	0.179
IOL power (D) (range)	20.36 ± 1.42 (17.5-24.0)	19.50 ± 1.64 (17.0-22.0)	0.088
Axial length (mm)	23.64 ± 0.73	23.69 ± 0.72	0.795
Preoperative UCVA (log MAR)	0.53 ± 0.37	0.42 ± 0.28	0.383

Values are presented as mean ± SD unless otherwise indicated.

S.E. = spherical equivalent; IOL = intraocular lenses; UCVA = uncorrected distance visual acuity.

^* Independent sample t-test.

Table 2.

Postoperative visual acuity outcomes over time (log MAR)

		UCDVA	UNVA	UIVA 63 cm	UIVA 100 cm^*
Restor®	Postoperative 2 weeks	0.03 ± 0.06	0.05 ± 0.07	0.16 ± 0.13	0.30 ± 0.16
Lentis Mplus®		0.04 ± 0.06	0.08 ± 0.07	0.13 ± 0.12	0.10 ± 0.12
Restor®	Postoperative 1 month	0.03 ± 0.04	0.05 ± 0.07	0.17 ± 0.14	0.28 ± 0.16
Lentis Mplus®		0.04 ± 0.05	0.08 ± 0.08	0.16 ± 0.27	0.10 ± 0.10
Restor®	Postoperative 3 months	0.03 ± 0.05	0.07 ± 0.09	0.15 ± 0.15	0.27 ± 0.17
Lentis Mplus®		0.04 ± 0.05	0.08 ± 0.09	0.12 ± 0.07	0.08 ± 0.10
Restor®	Postoperative 6 months	0.03 ± 0.05	0.04 ± 0.06	0.16 ± 0.15	0.28 ± 0.17
Lentis Mplus®		0.04 ± 0.05	0.08 ± 0.10	0.16 ± 0.09	0.12 ± 0.11

Values are presented as mean ± SD.

UCDVA = uncorrected distance visual acuity; UNVA = uncorrected near visual acuity at 40 cm distance; UIVA 63 cm = uncorrected intermediate visual acuity at 63 cm distance; UIVA 100 cm = uncorrected intermediate visual acuity at 100 cm distance.

^* p-value < 0.05.

Table 3.

Postoperative refractive outcomes over time

		Postoperative 2 weeks	Postoperative 1 month	Postoperative 3 months	Postoperative 6 months	p-value^*
S.E. (MR)	Restor®	-0.13 ± 0.31	-0.12 ± 0.33	-0.10 ± 0.29	-0.13 ± 0.27	0.035
	Lentis Mplus®	-0.08 ± 0.27	-0.05 ± 0.23	-0.04 ± 0.29	0.02 ± 0.28
S.E. (AR)	Restor®	-0.16 ± 0.27	-0.16 ± 0.28	-0.08 ± 0.29	-0.14 ± 0.25	<0.001
	Lentis Mplus®	-1.19 ± 0.32	-1.16 ± 0.40	-1.03 ± 0.46	-1.01 ± 0.42
S.E. (MR) and target	Restor®	0.29 ± 0.25	0.32 ± 0.20	0.27 ± 0.21	0.30 ± 0.20	0.440
ref. difference	Lentis Mplus®	0.23 ± 0.19	0.20 ± 0.16	0.26 ± 0.21	0.25 ± 0.21

Values are presented as mean ± SD unless otherwise indicated.

S.E. = spherical equivalent; MR = manifest refraction; AR = auto-refraction; ref. = refraction.

^* Data of postoperative 6 months, Independent sample t-test.

Table 4.

Optical quality parameters measured by OQASⅡ® at postoperative 3 months

	Restor®	Lentis Mplus®	p-value
OSI	1.07 ± 0.40	0.88 ± 0.39	0.065
MTF-cut off	40.98 ± 8.07	37.44 ± 8.66	0.098
Strhel ratio	0.25 ± 0.07	0.18 ± 0.05	0.000^*

Values are presented as mean ± SD unless otherwise indicated.

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

^* p-value < 0.05.

Table 5.

Ocular aberrometry analysis (μ m) measured by Zywave II® at postoperative 3 months

	Restor®	Lentis Mplus®	p-value
HOA 5 mm	0.29 ± 0.08	0.59 ± 0.17	0.000^*
HOA 6 mm	0.50 ± 0.13	1.07 ± 0.22	0.000^*
Vertical trefoil	0.21 ± 0.14	0.31 ± 0.31	0.203
Horizontal trefoil	0.16 ± 0.11	0.20 ± 0.22	0.473
Vertical coma	0.15 ± 0.10	0.47 ± 0.32	0.000^*
Horizontal coma	0.11 ± 0.10	0.22 ± 0.22	0.046^*
4th order spherical aberration	0.28 ± 0.09	0.56 ± 0.17	0.000^*
Quadrafoil	0.07 ± 0.07	0.07 ± 0.10	0.857
2nd astigmatism	0.05 ± 0.03	0.06 ± 0.07	0.413
Pentafoil	0.04 ± 0.04	0.06 ± 0.05	0.111
2nd vertical trefoil	0.02 ± 0.02	0.03 ± 0.03	0.192
2nd horizontal trefoil	0.03 ± 0.03	0.03 ± 0.03	0.843
2nd vertical coma	0.03 ± 0.03	0.05 ± 0.04	0.087
2nd horizontal coma	0.02 ± 0.03	0.03 ± 0.03	0.564

Values are presented as mean ± SD unless otherwise indicated.

HOA = high order aberration.

^* p-value < 0.05.

TOOLS

Similar articles