Comparison of outcomes with multifocal intraocular lenses: a meta-analysis

Béatrice Cochener, Antoine Lafuma, Babak Khoshnood, Laurène Courouve, Gilles Berdeaux, Béatrice Cochener, Antoine Lafuma, Babak Khoshnood, Laurène Courouve, Gilles Berdeaux

Abstract

Purpose: To compare the clinical outcome of different multifocal intraocular lenses (IOLs) based on information reported in the international literature.

Methods: All comparative clinical trials that involved implanting at least one multifocal IOL in patients with cataract or presbyopia were extracted from the literature. Clinical outcomes included uncorrected near visual acuity, uncorrected distance visual acuity, visual acuity, spectacle independence, and halos. Random effects meta-analyses were conducted to compare outcomes for the different IOL types.

Results: Twenty papers were identified describing 11 monofocal IOLs and 35 multifocal IOLs (19 diffractive, including 12 ReSTOR(®), 14 refractive, and two accommodative) patient cohorts. Multifocal and monofocal uncorrected distance visual acuity was 0.165 (0.090-0.240) and 0.093 (0.088-0.098), respectively. Compared with monofocal IOLs, multifocal IOLs produced better uncorrected near visual acuity (0.470 [0.322-0.618] versus 0.141 [0.131-0.152]; P < 0.0001), resulting in higher spectacle independence (incidence rate ratio [IRR] 3.62 [2.90-4.52]; P < 0.0001). Compared with refractive multifocal IOLs, diffractive multifocal IOLs produced a similar uncorrected distance visual acuity (0.105 [0.098-0.111] versus 0.085 [0.029-0.140]; P ≤ 0.78, not significant) and better uncorrected near visual acuity (0.217 [0.118-0.317] versus 0.082 [0.067-0.098]; P < 0.0001) resulting in higher spectacle independence (IRR 1.75 [1.24-2.48]; P < 0.001). Compared with other multifocal IOLs, ReSTOR produced a better uncorrected distance visual acuity (0.067 [0.059-0.076] versus 0.093 [0.088-0.098]; P < 0.0001) and better uncorrected near visual acuity (0.064 [0.046-0.082] versus 0.141 [0.131-0.152]; P < 0.006), resulting in higher spectacle independence (IRR 2.06 [1.26-1.36]; P < 0.004). Halo incidence rates with different types of multifocal implants did not differ significantly.

Conclusion: Multifocal IOLs provide better uncorrected near visual acuity than monofocal IOLs, leading to less need for spectacles. Multifocal IOL design might play a role in postsurgical outcome, because better results were obtained with diffractive lenses. ReSTOR showed better uncorrected near visual acuity, uncorrected distance visual acuity, and higher spectacle independence rates compared with other multifocal IOLs.

Keywords: meta-analysis; multifocal implants; patient satisfaction; spectacle independence; uncorrected distance visual acuity; uncorrected near visual acuity.

Figures

Figure 1
Figure 1
Uncorrected distant visual acuity: random effects pooled LogMAR estimates for monofocal vs multifocal intraocular lens implants. The y-axis denotes the estimates obtained in different studies as well as the combined (pooled) estimate.
Figure 2
Figure 2
Uncorrected distant visual acuity: random effects pooled LogMAR estimates for diffractive, refractive, and ReSTOR multifocal intraocular lens implants. The y-axis denotes the estimates obtained in different studies as well as the combined (pooled) estimate.
Figure 3
Figure 3
Uncorrected near visual acuity (VA): random effects pooled LogMAR estimates for monofocal vs multifocal intraocular lens implants. The y-axis denotes the estimates obtained in different studies as well as the combined (pooled) estimate.
Figure 4
Figure 4
Uncorrected near visual acuity: random effects pooled LogMAR estimates for diffractive, refractive, and ReSTOR multifocal IOL implants. The y-axis denotes the estimates obtained in different studies as well as the combined (pooled) estimate.

References

    1. Congdon N, Vingerling JR, Klein BE, et al. Prevalence of cataract and pseudophakia/aphakia among adults in the United States. Arch Ophthalmol. 2004;122:487–494.
    1. Javitt JC, Wang F, West SK. Blindness due to cataract: Epidemiology and prevention. Ann Rev Public Health. 1996;17:159–177.
    1. Agency for Health Care Policy and Research. Cataract in Adults: Management of functional impairment. Rockville, MD: Agency for Health Care Policy and Research; 1993.
    1. Anmarkrund N, Bergaust B, Bulie T, Sand AB. Evaluation of a flexible one-piece open-loop anterior chamber lens Symflex 350B 3–4 years after implantation. Acta Ophthalmol. 1993;71:796–800.
    1. Pötzsch DK, Lösch-Pötzsch M. Four year follow-up of the Memorylens. J Cataract Refract Surg. 1996;22:1336–1341.
    1. Schmack WH, Gerstmeyer K. Long-term results of the foldable CeeOn edge intraocular lens. J Cataract Refract Surg. 2000;26:1172–1175.
    1. Milazzo S, Turut P, Artin B, Charlin JF. Long-term follow-up of threepiece, looped, silicone intraocular lenses. J Cataract Refract Surg. 1996;22 (Suppl 2):1259–1262.
    1. Linnola RJ, Holst A. Evaluation of a 3-piece silicone intraocular lens with poly(methyl methacrylate) haptics. J Cataract Refract Surg. 1998;24:1509–1514.
    1. Simpson MJ. The diffractive multifocal intraocular lens. Eur J Implant Refract Surg. 1989;1:115–121.
    1. Javitt JC, Steinert RF. Cataract extraction with multifocal intraocular lens implantation: A multinational clinical trial evaluating clinical, functional, and quality-of-life outcomes. Ophthalmology. 2000;107:2040–2048.
    1. Javitt JC, Wang F, Trentacost DJ, et al. Outcomes of cataract extraction with multifocal intraocular lens implantation: Functional status and quality of life. Ophthalmology. 1997;104:589–599.
    1. Rossetti L, Carraro F, Rovati M, et al. Performance of diffractive multifocal intraocular lenses in extracapsular cataract surgery. J Cataract Refract Surg. 1994;20:124–128.
    1. Vaquero M, Encinas JL, Jimenez F. Visual function with monofocal versus multifocal IOLs. J Cataract Refract Surg. 1996;22:1222–1225.
    1. Gimbel HV, Sanders DR, Raanan MG. Visual and refractive results of multifocal intraocular lenses. Ophthalmology. 1991;98:881–888.
    1. Auffarth GU, Dick HB. Multifocal intraocular lenses. A review. Ophthalmologe. 2001;98:127–137.
    1. Khoshnood B, Mesbah M, Jeanbat V, et al. Transforming scales of measurement of visual acuity at the group level. Ophthalmic and Physiological Optics. 2010;30:816–823.
    1. Mosteller F, Colditz GA. Understanding research synthesis (metaanalysis) Ann Rev Public Health. 1996;17:1–23.
    1. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–188.
    1. Bi H, Cui Y, Ma X, et al. Early clinical evaluation of Acrysof ReSTOR Multifocal lens for treatment of cataract. Ophthalmologica. 2008;222:11–16.
    1. Chiam PJ, Cahn JH, Haider SI, et al. Functional vision with bilateral Rezoom and ReSTOR intraocular lenses 6 months after cataract surgery. J Cataract Refract Surg. 2007;33:2057–2061.
    1. Toto L, Falconio G, Vecchiarino L, et al. Visual performance and biocompatibility of 2 multifocal diffractive IOLs. Six-month comparative study. J Cataract Refract Surg. 2007;33:1419–1425.
    1. Souza CE, Muccioli C, Soriano ES, et al. Visual performance of Acrysof ReSTOR apodized diffractive IOL: A prospective comparative trial. Am J Ophthalmol. 2006;141:827–832.
    1. 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;33:1244–1247.
    1. Alfonso JF, Fernandez-Vega L, Baamonde B, Montés-Mico R. Prospective visual evaluation of apodized diffractive intraocular lenses. J Cataract Refract Surg. 2007;33:1235–1243.
    1. Chiam PJT, Chan JH, Aggarwal RK, Kasaby S. ReSTOR intraocular lens implantation in cataract surgery: Quality of vision. J Cataract Refract Surg. 2006;32:1459–1463.
    1. Peposee JS, Qazi MA, Davies J, et al. Visual performance of patients with bilateral vs combination Crystalens, Rezoom, and ReSTOR intraocular lens implants. Am J Ophthalmol. 2007;144:347–357.
    1. Mester U, Hunold W, Wesendahl T, Kaymak H. Functional outcomes after implantation of Tecnis ZM900 and Array SA40 multifocal intraocular lenses. J Cataract Refract Surg. 2007;33:1033–1040.
    1. Brydon KW, Tokarewicz AC, Nichols BD. AMO array multifocal lens versus monofocal correction in cataract surgery. J Cataract Refract Surg. 2000;26:96–100.
    1. Chen M, Atebara NH, Chen TT. A comparison of a monofocal Acrysoft IOL using the “blended monovision” formula with the multifocal array IOL for glasses independence after cataract surgery. Ann Ophthalmol (Skokie) 2007;39:237–240.
    1. Sen HN, Sarikkola AU, Uusitalo RJ, Laatikainen L. Quality of vision after AMO Array multifocal intraocular lens implantation. J Cataract Refract Surg. 2004;30:2483–2493.
    1. Javitt JC, Steinert RF. Cataract extraction with multifocal intraocular lens implantation: A multinational clinical trial evaluating clinical, functional, and quality-of-life outcomes. Ophthalmology. 2000;107:2040–2048.
    1. Martinez-Palmer A, Gomez-Faina P, Espana-Albelda A, et al. Visual function with bilateral implantation of monofocal and multifocal intraocular lenses: A prospective, randomized, controlled clinical trial. J Refractive Surg. 2008;24:257–264.
    1. Chang-David F. Prospective functional and clinical comparison of bilateral Rezoom and ReSTOR intraocular lenses in patients 70 years or younger. J Cataract Refract Surg. 2008;34:934–941.
    1. Barisic A, Dekaris I, Gabric N, et al. Comparison of diffractive and refractive multifocal intraocular lenses in presbyopia treatment. Coll Antropol. 2008;32 (Suppl 2):27–31.
    1. Zelichowska B, Rekas M, Stankiewicz A, et al. Apodized diffractive versus refractive multifocal intraocular lenses: Optical and visual evaluation. J Cataract Refract Surg. 2008;34:2036–2042.
    1. Cillino S, Casuccio A, DiPace F, et al. One year outcomes with new- generation multifocal intraocular lenses. Ophthalmology. 2008;115:1508–1516.
    1. Alio JL, Tavolato M, de la Hoz F, et al. Near vision ReSTORation with refractive lens exchange and pseudoaccomodating and multifocal refractive and diffractive intraocular lenses: Comparative clinical study. J Cataract Refract Surg. 2004;30:2494–2503.
    1. Cochener B, Arnould B, Viala M, Roborel de Climens A, Berdeaux G. Corrected and uncorrected near and distance vision with ReSTOR compared to monofocal intraocular lens implantation after cataract surgery: A pooled analysis. Ophthalmologica. 2009;223:128–135.
    1. McDonnell PJ, Mangione C, Lee P, et al. Responsiveness of the National Eye Institute Refractive Error Quality of Life instrument to surgical correction of refractive error. Ophthalmology. 2003;110:2302–2309.
    1. Nichols JJ, Mitchell GL, Saracino M, Zadnik K. Reliability and validity of refractive error-specific quality-of-life instruments. Arch Ophthalmol. 2003;121:1289–1296.
    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;32:1464–1473.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться