Comparative analysis of visual outcomes with four different intraocular lenses: monofocal, multifocal and extended range of vision

  • by

Why is it necessary?
Around 24.5 million Americans experience cataracts. It has actually been observed that cataract surgical treatment of both eyes can boost quality of life by 36%. As modern technology advances, the need for improvements in post-surgical visual results is becoming ending up being progressively essential.

Tecnis Multifocal Lens IOL – An Advanced Solution For Presbyopia


Visual Outcomes with 4 different intraocular lenses (IOLs)
Patients today anticipate not just enhanced vision after cataract surgical treatment, but spectacle independence too. Multifocal and also extended range of vision intraocular lenses are readily available to address this type of expectation. These IOLs are developed to get over the loss of accommodative feature that goes along with removal of the all-natural crystalline lens. Comprehending the advantages
and also constraints of such intraocular lenses is essential for cataract surgeons when providing patients informed choices for cataract surgery. Pedrotti as well as coworkers reported on the aesthetic results of 185 patients that went through bilateral implantation of one of 4 different intraocular lenses (IOLs): Tecnis one-piece monofocal IOL (Johnson & Johnson Vision, Santa Ana, California), ReSTOR +2.5 D
multifocal IOL (Alcon, Ft Worth, Texas), ReSTOR +3 D multifocal IOL (Alcon), and also Tecnis Symfony extended variety of vision IOL (Johnson & Johnson Vision). The specifications assessed consisted of distance, intermediate, and also near visual acuity, refractive outcomes, spectacle independence, contrast sensitivity, objective ocular optical quality, and also rate of visual aberration glare perception.


Key Observations
The research study revealed that the Tecnis Symfony and ReSTOR +2.5 D IOLs offered much better intermediate vision and also higher rates of spectacle independence after cataract surgical procedure compared to the various other IOLs assessed. The Tecnis Symfony IOL additionally offered considerably much better quality of vision, while the ReSTOR +3.0 D offered the very best near vision end results. By design, multifocal lenses have a tendency to offer sharp vision just within a limited array surrounding
the foci, leaving vision in between the foci obscured. Furthermore, multifocal lenses can degrade quality of vision by decreasing contrast level of sensitivity and also enhancing photic sensations such as glare and halos. The Symfony is an extensive depth of focus lens that intends to avoid these failures by offering a plateau of sharp vision through its saw-tooth pattern of echelettes. The primary advantage of
the Symfony lens is its prolonged depth of focus, which is shown by Pedrotti et al. in its defocus contour. The Symfony lens is having statistically significant exceptional efficiency over each of the fellow lenses, preserving visual acuity of 0.21 logMAR or much better accomplishing approximately a defocus level of– 2.50 D. These beneficial results have actually been reproducible in various other research studies also.
Attia et al. in a similar way reveal that the Symfony lens can preserve a visual acuity of 0.3 logMAR or much better accomplished in between the broad variety of +1.50 and − 2.50 D. The benefits of costs of IOLs over monofocal lenses are verifiable also outside the transition change zone. In a post by Monaco et al., both a trifocal IOL PanOptix, and an extensive array of vision IOL (Symfony) were compared against a monofocal IOL (SN60WF, Alcon). Although there was no statistically substantial difference
amongst the 3 groups for distance vision, both premium lenses got on much better than the monofocal

lenses at intermediate as well as near distances, as well as the trifocal lens provided the very best near vision results. Pedrotti et al discovered that the Symfony lens accomplished the very best distance visual acuity, whether uncorrected or corrected, though in the last category, analytical relevance was achieved only relative to both ReSTOR lenses. The ReSTOR +2.5 D IOL got on finest for intermediate vision, as well
as the ReSTOR +3 D had the very best near vision results. In spite of this promising information, it is observed that some patients with multifocal IOLs might experience irritating dysphotopsias. In this research, however, Pedrotti et al found no distinction in reported glare amongst patients with monofocal, conventional multifocal, and also prolonged array of vision IOLs using the NEI Refractive Lifestyle Instrument. On the other hand, a prior research by Monaco et al revealed that patients with premium IOLs report even more dysphotopsias than those with monofocal IOLs using a verified quality of Vision (QoV) survey. Additionally, the FDA recap of safety and security as well as efficiency report on the Tecnis Symfony IOL directly evaluated subjective dysphotopsias for patients that received the Tecnis Symfony IOL compared to the mono-focal Tecnis one-piece IOL, model ZCB00, using the Patient Reported Visual Effects Set Of Questions (PRVSQ). This report revealed that 59.2% of patients with the
Symfony lens were troubled by halos, which was double the percentage of mono-focal patients with any type of such issues (29.1%). In a similar way, 57.8% of patients with the Symfony lens were troubled by starbursts, more than twice the percentage of those in the mono-focal lens group. Discrepancy in the findings of these 3 researches might be credited to the different techniques of collecting this subjective
information. The chosen questions from the NEI tool do not deal with dysphotopsia as directly as the QoV set of questions or the PRVSQ, which both expressly ask exactly how bothered patients are by multiple signs and symptoms of dysphotopsia, consisting of glare, halos, as well as starbursts. Instead, the NEI instrument concentrates on perceived constraints in activity and also function, with only 2 questions directly addressing resolving glare as well as distortion. Consequently, the risk of dysphotopsia
remains an essential factor for preoperative counseling and also patient selection. Couple of various other essential constraints in the research design exist also.


Significantly, the aspect of patient self-selection presents a type of volunteer prejudice to the research. Those patients who choose multifocal or extended array of vision lenses might have higher expectations of end results, than those curious about the integrity of precise distance vision with a mono-focal lens. Though this might not be evoked in the much more extra unbiased end result actions, such as near or
distance visual acuity, this prejudice might be shown in the much more extra subjective surveys pertaining to dysphotopsias. Additionally, the broad exemption criteria make sure that patients with many ocular co-morbidities are not represented in this research, which may not reflect the true applicability of these lenses to the basic population. Strengths of this work include a low attrition rate, as no patient was lost to follow-up. Additionally, all data was consistently gathered at 6 months postoperatively.


Conclusion
This research provides beneficial information for any type of cataract surgeon curious about offering patients the most appropriate choices of IOLs for their visual requirements. It confirms that prolonged array of vision and multifocal lenses are useful additions to the eye doctor’s arsenal, however aspects such as comparison level of sensitivity, optical resolution, dysphotopsias, and also efficiency at a range of distances should be taken into consideration before recommending IOLs.