OCT 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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100 EW RESIDENTS October 2013 University continued from page 99 A similar age-related trend is found for all quantified near visual acuities in patients with multifocal IOLs. Both uncorrected and corrected near visual acuities (UNVA and CNVA) and distance corrected near visual acuity (DCNVA) are statistically worse in the 60s and 70s than in the 30s (p=0.0024 and p=0.03 for the 6th and 7th decade, respectively). It is unclear why patients in their 40s, in this study, on average, achieve poorer postoperative near and distance visual acuities than patients in their 30s or 50s. In other words, if age is a factor, why would the 40s group result in a trend toward poorer outcomes than the 50s group? We believe one possible explanation is that age is a continuous variable and by creating distinct Visit us at AAO Booth 1023 groups, subtle trends or non-trends in the data may be erroneously highlighted. Contrast sensitivity is considered a better representation of the visual system than visual acuity alone as real world images are composed of arrays of various contrast patterns. It is well documented that contrast sensitivity deteriorates with age.3,4 In the present study, the authors show that contrast sensitivity at high and low frequencies, specifically at 6 cycles per degree (cpd) and 18 cpd, are statistically worse in the 60s and 70s than in the 30s. However, the area under the log contrast sensitivity function, a quantifiable value that captures the entire contrast sensitivity system, does not change with age decade. The finding that contrast sensitivity declines in older patients with multifocal IOLs in this study is similar to the finding in older patients with monofocal IOLs. It is unclear why the authors chose to state that, "In eyes with a monofocal IOL, no change in contrast sensitivity was observed" and reference these results as consistent with Hayashi K et al., Am J Ophthal- mol 2003, when the cited paper actually demonstrates statistically significant changes in contrast sensitivity as a function of age, especially at 18 cpd.3 The authors conclude that although a statistically significant difference exists in CDVA between patients in their 60s and 70s relative to the 30s cohort, a clinically significant difference did not exist as the older group had an excellent CDVA of logMAR 0.11. Similarly, this study found that although near acuity with multifocal IOLs does decline by age, even in the 70s decade, DCNVA were acceptable clinically. This data comes entirely from the one-month visit after surgery, where the authors argue the influence of posterior capsule opacification is minimal. Other studies looking at diffractive multifocal IOLs, however, had longer postop follow-up at three months or even up to one year with the option to perform YAG capsulotomy.5,6,7 This study also concludes that under photopic conditions tested (85 candelas/m2), there was a decrease in log contrast sensitivity by decade, but the amount was clinically acceptable. Unfortunately, as Assessment of whether visual outcomes with diffractive multifocal intraocular lenses vary with patient age Mami Yoshino, MD, Hiroko Bissen-Miyajima, MD, PhD, Keiichiro Minami, PhD J Cataract Refract Surg (Oct.) 2013; 39: 1502–1506. Purpose: To assess whether corrected visual acuities after the implantation of diffractive multifocal intraocular lenses (IOLs) vary with the patient ages. Design: Retrospective cross-sectional study Setting: Tokyo Dental College Suidobashi Hospital, Tokyo, Japan Methods: This study included eyes receiving diffractive multifocal IOLs (ZM900 and ZMA00) after the cataract extraction. The patients were divided into five age decades: 30s (30 to 39 years), 40s, 50s, 60s, and 70s. Best-corrected distance (CDVA), distance corrected near (DCNVA), and corrected near (CNVA) visual acuities one month postoperatively were compared among the age decades. Visual outcomes with monofocal IOLs were examined as the control. Contrast sensitivity with the multifocal IOL was evaluated at three months. Results: The study comprised 365 eyes of 237 patients with the multifocal IOL. Mean of CDVAs in 30s and 50s were significantly better than those in 60s and 70s (P<0.033). There was significant decline in DCNVA of 60s and 70s compared with 30s (P<0.03). In the CNVA, 30s was better than 50s, 60s and 70s (P<0.003), 40s was better than 60s and 70s (P<0.008), and 50s was better than 70s (P=0.001). In contrast, no change in CDVA was found in the monofocal IOL (P=0.065). The contrast sensitivity in the 30s was significantly higher than 60s and 70s at 6 cycles per degree (cpd) (P<0.025) and 50s to 70s at 18 cpd (P<0.027). Conclusion: Corrected visual acuities and contrast sensitivity were inferior for the elderly than younger patients implanted with a diffractive multifocal IOL, whereas the VAs for the monofocal IOL were not associated with patient age.

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