Comparison of the Visual Outcomes after Cataract Surgery with Implantation of a Bifocal and Trifocal Diffractive Intraocular Lens

Sung Yu; Yong Il Kim; Sang Won Ha; Gwang Ja Lee; Kyoo Won Lee; Young Jeung Park

doi:10.3341/jkos.2016.57.3.405

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Yu, Kim, Ha, Lee, Lee, and Park: Comparison of the Visual Outcomes after Cataract Surgery with Implantation of a Bifocal and Trifocal Diffractive Intraocular Lens

Original Article

J Korean Ophthalmol Soc 2016;57(3):405-412.

Published online: 3 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.3.405

Comparison of the Visual Outcomes after Cataract Surgery with Implantation of a Bifocal and Trifocal Diffractive Intraocular Lens

Sung Yu, MD, Yong Il Kim, MD, Sang Won Ha, 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 41196, Korea, Tel: 82-53-959-1751, Fax: 82-53-959-1758, E-mail: eyepark9@naver.com

Received 17 July 2015 Revised 3 September 2015 Accepted 11 November 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 evaluate and compare visual outcomes and optical quality after implantation of a bifocal (Acrysof ReSTOR^® SN6AD1) or trifocal (AT LISA^® tri 839MP) diffractive intraocular lens (IOL).

Methods

Fifty-one eyes of 43 patients undergoing cataract surgery were enrolled and assigned to one of two groups: the trifocal group, comprising 24 eyes implanted with the trifocal diffractive IOL (AT LISA^® tri 839MP), and the bifocal group, comprising 27 eyes implanted with the bifocal diffractive IOL (Acrysof ReSTOR^® SN6AD1). Visual acuity (distant, intermediate, and near vision) and refractive postoperative outcomes were evaluated at one and three months postoperatively. Measurements of optical quality (using OQAS II^®), contrast sensitivity (using CGT-2000^®), automated visual field examination, and evaluation of defocus curve were performed three months postoperatively.

Results

No statistically significant differences between the two groups were found in three-month postoperative distant and near (40 cm) visual acuities and optical quality. However, intermediate (63 cm, 80 cm, and 100 cm) visual acuities were significantly better in the trifocal group. Distant contrast sensitivity (5 m) under mesopic conditions was significantly better with the bifocal lens, whereas near contrast sensitivity (30 cm) under mesopic and scotopic conditions was significantly better with trifocal lens. There was no statistical difference between the groups under photopic conditions. In the defocus curve, the visual acuity was significantly better at intermediate distance in the trifocal group.

Conclusions

Trifocal diffractive IOLs provide significantly better intermediate vision than bifocal IOLs, with equivalent postoperative levels of distant and near vision and ocular optical quality. Further, they provide better near contrast sensitivity under scotopic condition compared to diffractive bifocal IOLs.

Keywords: Bifocal, Cataract, Diffractive, Multifocal intraocular lens, Trifocal

References

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Figure 1.

AT LISA^® tri 839MP (left, adapted from Sheppard et al¹⁰), Acrysof ReSTOR^® SN6AD1 (right, adapted from Davison and Simpson¹).

Figure 2.

Contrast sensitivity test by CGT-2000^®. (A) Contrast sensitivity at 5 m, (B) contrast sensitivity at 30 cm. Superior column tested when glare off, inferior column tested when glare on. deg = degree. ^*p < 0.05.

Figure 3.

Visual acuity at various defocus levels. The values are a mean of log MAR visual acuity. ^*p < 0.05.

Table 1.

Patient demographics

	Intraocular lens type		p-value^*
	AT LISA® tri 839MP	Acrysof ReSTOR® SN6AD1	p-value^*
Number of eyes (patients)	24 (20)	27 (23)
OD:OS	14:10	16:11
Sex (male:female)	16:4	16:7	0.455
Age (years)	49.5 ± 6.7	52.4 ± 9.3	0.697
S.E. (D)	0.39 ± 1.09	0.32 ± 1.97	0.298
UCDVA (log MAR)	0.58 ± 0.79	0.38 ± 0.77	0.916
Axial length (mm)	24.03 ± 1.11	23.80 ± 0.78	0.372
Corneal power (D)	43.50 ± 1.48	43.73 ± 1.36	0.551
Anterior chamber depth (mm)	3.47 ± 0.41	3.34 ± 0.36	0.252
Intraocular lens power (D)	19.41 ± 2.72	20.03 ± 2.41	0.140

Values are presented as mean ± SD unless otherwise indicated.

OD = oculus dexter; OS = oculus sinister; S.E. = spherical equivalent; D = diopter; UCDVA = uncorrected distance visual acuity; log MAR = logarithm of the minimum angle of resolution.

^* Independent student t-test.

Table 2.

Visual acuity and spherical equivalent at postoperative 1 month and 3 months

	1 month			3 months
	AT LISA® tri 839MP	Acrysof ReSTOR® SN6AD1	p-value^*	AT LISA® tri 839MP	Acrysof ReSTOR® SN6AD1	p-value^*
S.E. (D)	−0.29 ± 0.35	−0.19 ± 0.27	0.247	−0.29 ± 0.36	−0.13 ± 0.26	0.053
BCDVA (log MAR)	0.00 ± 0.00	0.00 ± 0.14	0.339	0.00 ± 0.00	0.00 ± 0.00	−
UCDVA (log MAR)	0.02 ± 0.07	0.02 ± 0.09	0.987	0.01 ± 0.07	0.02 ± 0.08	0.615
UNVA (log MAR)	0.10 ± 0.11	0.09 ± 0.13	0.339	0.09 ± 0.07	0.07 ± 0.10	0.446
UIVA63 (log MAR)	0.19 ± 0.12	0.24 ± 0.13	0.125	0.17 ± 0.11	0.24 ± 0.12	0.027^*
UIVA80 (log MAR)	0.07 ± 0.13	0.28 ± 0.09	<0.001^*	0.06 ± 0.13	0.29 ± 0.11	<0.001^*
UIVA100 (log MAR)	0.11 ± 0.09	0.29 ± 0.21	<0.001^*	0.11 ± 0.13	0.29 ± 0.10	<0.001^*

Values are presented as mean ± SD unless otherwise indicated.

S.E. = spherical equivalent; D = diopter; BCDVA = best corrected distance visual acuity; log MAR = logarithm of the minimum angle of resolution; UCDVA = uncorrected distance visual acuity; UNVA = uncorrected near visual acuity at 40 cm distance; UIVA63 = uncorrected intermediate visual acuity at 63 cm distance; UIVA80 = uncorrected intermediate visual acuity at 80 cm distance; UIVA100 = uncorrected intermediate visual acuity at 100 cm distance.

^* Independent student t-test.

Table 3.

Optical quality parameters measured by optical quality analysis system II® (OQAS II®) at postoperative 3 months

	Intraocular lens type		p-value^*
	AT LISA® tri 839MP	Acrysof ReSTOR® SN6AD1	p-value^*
OSI	1.28 ± 0.65	1.16 ± 0.40	0.425
MTF cut-off value (cpd)	42.52 ± 10.74	40.71 ± 8.75	0.504
Strehl ratio	0.37 ± 0.54	0.26 ± 0.10	0.325
VA100	1.42 ± 0.36	1.36 ± 0.29	0.513
VA20	1.10 ± 0.35	1.03 ± 0.34	0.512
VA9	0.70 ± 0.27	0.68 ± 0.30	0.776

Values are presented as mean ± SD unless otherwise indicated.

OSI = objective scatter index; MTF = modulation transfer function; VA100 = optical quality of the eye for 100% contrast conditions; VA20 = optical quality of the eye for 20% contrast conditions; VA9 = optical quality of the eye for 9% contrast conditions.

^* Independent student t-test.

Table 4.

Visual field parameters measured by Humphrey field analyzer®: SITA-Fast at postoperative 3 months

	Intraocular lens type		p-value^*
	AT LISA® tri 839MP	Acrysof ReSTOR® SN6AD1	p-value^*
MD	−1.95 ± 1.10	−1.72 ± 1.08	0.257
PSD	1.46 ± 0.23	1.54 ± 0.32	0.366
Fovea threshold	34.60 ± 2.01	33.76 ± 2.59	0.240

Values are presented as mean ± SD unless otherwise indicated.

SITA = Swedish Interactive Thresholding Algorithm; MD = mean deviation; PSD = pattern standard deviation.

^* Independent student t-test.

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