OCT 2013

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

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September 2013 this was a retrospective study, contrast testing was not performed under mesopic conditions, nor was glare testing performed in photopic and mesopic conditions, both presumably relevant conditions for pre-surgical counseling of elderly patients. The authors acknowledge a weakness in the non-uniform distribution of subjects in the various age groups. We highlight that age is an ordinal value and that analysis with parametric analysis of variance test could have been performed. We would also have been interested to know the sex and race distribution of this patient population. This article addresses a very specific question: the influence of age on the short-term best corrected visual acuities measured after implantation of multifocal intraocular lenses. Other important questions include the subjective satisfaction of patients with multifocal lenses, as well as the applicability of this study to our individual patient populations. With regard to subjective patient satisfaction, while the measures of visual acuity were emphasized in this study, a larger proportion of patients with multifocal lenses have subjective visual complaints, such as halos and glare.8,9 These visual phenomena are likely related to known reduced contrast sensitivity and straylight.5 Such visual phenomena can certainly affect the visual satisfaction at various ages and thus the apparent success of multifocal lenses, which is not directly addressed in this study. We commend the authors in their attempt to address a previously unanswered question regarding the influence of age on short-term visual outcomes with multifocal intraocular lenses. The knowledge that corrected visual acuities and contrast sensitivity may be worse in older patients than in younger patients who receive diffractive multifocal intraocular lens implantation can be a factor in the overall decision to use a multifocal lens, which will still require an individualized patientbased approach. EW References 1. de Vries NE, Nuijts RM. Multifocal intraocular lenses in cataract surgery: literature review of benefits and side effects. J Cataract Refract Surg. 2013 Feb;39(2):268–78. 2. Amano S, Amano Y, Yamagami S, Miyai T, Miyata K, Samejima T, Oshika T. Age-related changes in corneal and ocular higher-order wavefront aberrations. Am J Ophthalmol. 2004 Jun;137(6):988–92. 3. Hayashi K, Hayashi H, Nakao F, Hayashi F. Aging changes in apparent accommodation in eyes with a monofocal intraocular lens. Am J Ophthalmol. 2003 Apr;135(4):432–6. 4. Nomura H, Ando F, Niino N, Shimokata H, Miyake Y. Age-related change in contrast sensitivity among Japanese adults. Jpn J Ophthalmol. 2003 May-Jun;47(3):299–303. 5. Cillino S, Casuccio A, Di Pace F, et al. One-Year Outcomes with New-Generation Multifocal Intraocular Lenses. Ophthalmology 2008;115:1508–16. 6. Hayashi K, Manabe S, Hayashi H. Visual acuity from far to near and contrast sensitivity in eyes with a diffractive multifocal intraocular lens with a low addition power. J Cataract Refract Surg 2009;35:2070–6. 7. Packer M, Chu RY, Waltz K, et al. Evaluation of the aspheric Tecnis multifocal intraocular lens: one-year results from the first cohort of the Food and Drug Administration clinical trial. Am J Ophthalmol 2010;149:577–84. 8. Calladine D, Evans JR, Shah S, Leyland M. Multifocal versus monofocal intraocular lenses EW RESIDENTS 101 after cataract extraction. Cochrane Database Syst Rev. 2012 Sep 12. 9. Haring G, Dick HB, Krummenauer F, Weissmantel U, Kroncke W. Subjective photic phenomena with refractive multifocal and monofocal intraocular lenses; results of a multicenter questionnaire. J Cataract Refract Surg 2001; 27:245–249. Contact information Mudumbai: raghum@uw.edu

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