Eyeworld

75 EW RESIDENTS February 2018 outcomes with four different and extended range of vision" al. found that the Symfony lens achieved the best distance visual acuity, whether uncorrected or cor- rected, though in the latter category, statistical significance was attained only with respect to both ReSTOR lenses. The ReSTOR +2.5 D IOL fared best for intermediate vision, and the ReSTOR +3 D had the best near vision outcomes. Despite this promising data, it is observed that some patients with multifocal IOLs may experience bothersome dysphotopsias. In this study, however, Pedrotti et al. found no difference in reported glare among patients with monofocal, traditional multifocal, and extended range of vision IOLs using the NEI Refractive Quality of Life Instru- ment. In contrast, a prior study by Monaco et al. showed that patients with premium IOLs report more dys- photopsias than those with mono- focal IOLs using a validated Quality of Vision (QoV) questionnaire. 3 In addition, the Food and Drug Admin- istration (FDA) summary of safety and effectiveness report on the Tecnis Symfony IOL directly assessed subjective dysphotopsias for patients who received the Tecnis Symfony IOL compared to the monofocal Tecnis one-piece IOL, model ZCB00, using the Patient Reported Visual Symptoms Questionnaire (PRVSQ). 4 This report showed that 59.2% of patients with the Symfony lens were bothered by halos, which was double the proportion of monofocal patients with any such complaints (29.1%). Similarly, 57.8% of pa- tients with the Symfony lens were bothered by starbursts, more than twice the percentage of those in the monofocal lens group. Discrepancy in the findings of these three studies may be attributed to the varied methods of collecting this subjective data. The selected questions from the NEI instrument do not address dysphotopsia as directly as the QoV questionnaire or the PRVSQ, which both expressly ask how bothered patients are by multiple symptoms of dysphotopsia including glare, halos, and starbursts. Rather, the NEI instrument focuses on perceived limitations in activity and function, with only two questions directly addressing glare and distortion. Therefore, the risk of dysphotopsia remains an important point for preoperative counseling and patient selection. Few other important limitations in the study design exist as well. Notably, the element of patient self-selection introduces a form of volunteer bias to the study. Those patients who select multifocal or extended range of vision lenses may have higher expectations of out- comes than those interested in the reliability of accurate distance vision with a monofocal lens. Though this may not be elicited in the more objective outcome measures, such as near or distance visual acuity, this bias may be demonstrated in the more subjective surveys regarding dysphotopsias. Furthermore, the broad exclusion criteria ensure that patients with many ocular comor- bidities are not represented in this study, which may not reflect the true applicability of these lenses to the general population. Strengths of this work include a low attri- tion rate, as no patient was lost to follow-up. In addition, all data was uniformly collected at 6 months postoperatively. This study provides valuable information for any cataract surgeon interested in offering patients the most appropriate choices of IOLs for their visual needs. It confirms that extended range of vision and mul- tifocal lenses are useful additions to the ophthalmologist's arsenal, but factors such as contrast sensitivity, optical resolution, dysphotopsias, and performance at a variety of distances must be considered before recommending such IOLs. EW References 1. Brown GC, et al. Cataract surgery cost utility revisited in 2012: a new economic paradigm. Ophthalmology. 2013;120:2367–76. 2. Attia MSA, et al. Clinical evaluation of an extended depth of focus intraocular lens with the Salzburg Reading Desk. J Refract Surg. 2017;33:664–669. 3. Monaco G, et al. Visual performance after bilateral implantation of 2 new presbyopia- correcting intraocular lenses: Trifocal versus extended range of vision. J Cataract Refract Surg. 2017;43:737–747. 4. Summary of Safety and Effectiveness Data. TECNIS Symfony Extended Range of Vision Intraocular Lens. Abbott Medical Optics Inc. www.accessdata.fda.gov/cdrh_docs/pdf/ P980040S065B.pdf Contact information Gupta: AGupta@nyee.edu Comparative analysis of visual outcomes with four different intraocular lenses: monofocal, multifocal and extended range of vision Emilio Pedrotti, MD, Francesco Carones, MD, Francesco Aiello, MD, Rodolfo Mastropasqua, MD, Enrico Bruni, MD, Erika Bonacci, MD, Pietro Talli, MD, Carlo Nucci, MD, Cesare Marriotti, MD, Giorgio Marchini, MD J Cataract Refract Surg. 2018;44(2). Article in press. Purpose: To compare the visual acuity, refractive outcomes, and quality of vision in patients with bilateral implantation of four different intraocular lenses (IOLs) Setting: Department of Neurosciences, Biomedicine and Movement Sciences. Eye Clinic, University of Verona, Verona, Italy and at Carones Ophthalmology Center, Milano, Italy Design: Prospective, comparative clinical study Methods: The study included 185 patients who underwent bilateral cataract surgery with the implantation of four different IOLs: Tecnis one-piece monofocal IOL (30 patients) (Johnson & Johnson Vision), Tecnis Symfony extended range of vision (55 patients) (Johnson & Johnson Vision), ReSTOR +2.5 D (50 patients) (Alcon), and ReSTOR +3 D (50 patients) (Alcon), both multifocal IOLs. Visual acuity, refractive outcome, defocus curve, objective optical quality, contrast sensitivity (CS), spectacle independence, and glare perception were evaluated at 6 months after surgery. Results: The Tecnis Symfony IOL showed better distance visual outcomes than the monofocal and high add apodized diffractive refractive IOLs (p≤0.002). The ReSTOR +3.0 D showed the best near visual outcomes (p<0.001). The ReSTOR +2.5 D and Tecnis Symfony IOLs provided significantly better intermediate visual outcomes than the other two IOLs, with significantly better vision for a defocus level of –1.5 D (p<0.001). Better spectacle independence was shown for the ReSTOR +2.5 D and Tecnis Symfony IOLs (p<0.001). A higher Strehl ratio and better CS were obtained with the monofocal and Tecnis Symfony IOLs (p<0.001). Conclusions: The Tecnis Symfony and ReSTOR +2.5 D IOLs provided significantly better intermediate visual restoration after cataract surgery than the Tecnis monofocal and ReSTOR +3.0 D IOLs, with significantly better quality of vision for the Tecnis Symfony IOL.

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