Eyeworld

EW RESIDENTS 74 February 2018 by Michael Chai, MD, Eileen Choudhury, MD, Anna Do, MD, Katherine McCabe, MD, Miel Sundararajan MD, and Anita Gupta MD EyeWorld journal club Review of "Comparative analysis of visual intraocular lenses: monofocal, multifocal A pproximately 24.5 million Americans suffer from cataracts. It has been reported that cataract surgery of both eyes can increase quality of life by 36%. 1 As technology advances, the demand for improvements in post-surgical visual outcomes is becoming increasingly important. Likewise, patients today expect not only improved vision after cataract surgery, but spectacle independence as well. Multifocal and extended range of vision intraocular lenses are available to address this expectation. These intraocular lenses are designed to overcome the loss of accommo- dative function that accompanies extraction of the natural crystalline lens. Understanding the benefits and limitations of such intraocular lenses is critical for cataract surgeons when offering patients informed choices for cataract surgery. Pedrotti and colleagues report- ed on the visual outcomes of 185 patients who underwent bilateral implantation of one of four different intraocular lenses (IOLs): Tecnis one- piece monofocal IOL (Johnson & Johnson Vision, Santa Ana, Califor- nia), ReSTOR +2.5 D multifocal IOL (Alcon, Fort Worth, Texas), ReSTOR +3 D multifocal IOL (Alcon), and Tecnis Symfony extended range of vision IOL (Johnson & Johnson Vision). The parameters evaluated included distance, intermediate, and near visual acuity, refractive outcomes, spectacle independence, contrast sensitivity, objective ocular optical quality, and rate of visual aberration (glare perception and contrast sensitivity). The study showed that the Tecnis Symfony and ReSTOR +2.5 D IOLs provided better intermediate vision and high- er rates of spectacle independence after cataract surgery compared with the other IOLs evaluated. The Tecnis Symfony IOL also provided signifi- cantly better quality of vision, while the ReSTOR +3.0 D provided the best near vision outcomes. By design, multifocal lenses tend to provide sharp vision only within a limited range surrounding the foci, leaving vision between the foci blurred. Additionally, multifocal lenses can degrade quality of vision by decreasing contrast sensitivity and increasing photic phenom- ena such as glare and halos. The Symfony is an extended depth of focus lens that aims to avoid these downfalls by providing a plateau of sharp vision by means of its saw- tooth pattern of echelettes. The main benefit of the Symfony lens is its extended depth of focus, which is demonstrated by Pedrotti et al. in its defocus curve. The Symfony lens had statistically significant superior performance over each of the fellow lenses, maintaining visual acuity of 0.21 logMAR or better achieved up to a defocus level of –2.50 D. These favorable outcomes have been reproducible in other studies as well. Attia et al. similarly show that the Symfony lens can maintain a visual acuity of 0.3 logMAR or better achieved between the broad range of +1.50 and −2.50 D. 2 The advantages of premium IOLs over monofocal lenses are demonstrable even outside the tran- sition zone. In an article by Monaco et al., both a trifocal IOL (PanOptix, Alcon) and an extended range of vi- sion IOL (Symfony) were compared against a monofocal IOL (SN60WF, Alcon). 3 Although there was no statistically significant difference among the three groups for distance vision, both premium lenses fared better than the monofocal lenses at intermediate and near distances, and the trifocal lens gave the best near vision outcomes. Pedrotti et Anita Gupta, MD, residency program director, and director of comprehensive ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine With EDOF and low add multifo- cal IOLs, we have more presbyopia correcting IOL options than ever. I asked the New York Eye and Ear residents to review this IOL com- parison study that appears in the February issue of JCRS. —David F. Chang, MD, EyeWorld journal club editor From left: Rachel Lee, MD, Michael Chai, MD, Helen Jiang, MD, Phillip Tenzel, MD, Eileen Choudhury, MD, Masako Chen, MD, Adam Botwinick, MD, Katherine McCabe, MD, Anna Do, MD, Miel Sundararajan, MD, Jonathan Lo, MD, Thomas Quehl, MD, Ekaterina Semenova, MD, Anita Gupta, MD, Manan Sampat, MD, Jennifer Park, MD, Cissy Yang, MD, Ashwinee Ragam, MD, and Richard Kaplan, MD Source: New York Eye and Ear Infirmary of Mount Sinai

• Blank Page
• Blank Page (1)