Purpose: To compare visual function, visual quality, and quality of life (QOL) in eyes with implantation of (1) multifocal intraocular lens (MIOLs) versus monofocal IOL, (2) MIOLs versus Accommodative IOLs, (3) MIOLs versus Aspherical monofocal monovision in Taiwan.
Setting: Taipei City Hospital, Hoping Branch and B & B Eye Clinics, Taipei, Taiwan.
Design: A prospective and comparative study was from January 2007 to May 2010.
Methods: All complete ophthalmologic examination including visual function, visual quality and QOL were performed 3 to 6 months after IOL implantation. Visual function included uncorrected and best distance corrected visual acuity (VA) at 6 m (distance), and 33cm (near), reports of spectacle independence, and contrast sensitivity (CS) with Rabin CS test. Visual quality assessment included wavefront analysis of total root-mean-square (RMS) high order aberrations (HOAs) and spherical aberrations (SAs) with 5 mm and 6 mm pupils using Zywave II aberrometer, and reports of Glare and Halos Questionnaire. QOL was measured by the 25-items National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) in Chinese version. Differences by group were compared using two-sample Student t test for visual function, visual quality and QOL.
Results: Similar distance uncorrected VA was in all IOL groups except the accommodative group.?Better near uncorrected VA were in the MIOL group than in the monofocal, accommodative or aspherical IOL with monovision group (p<.05). Postoperatively spectacle independence for near vision was greater in the multifocal groups (90.9%) than in the monofocal group (31.8%), accommodative group (18.2%), and aspherical IOL with monovison (30.0%) (p<.05). Binocular mean log CS values were not significantly statistical difference among all IOL groups. The posteroperative RMS values for total HOAs and SAs with 5mm and 6 mm pupil were significantly lower in the multifocal IOL and in the aspherical groups than in the monofocal and accommodative groups (p<.05). Positive and negative dysphotopsia (47.37% and 57.89%) were significantly higher with the MIOLs group than with the other IOL groups 31.80%, and 18.18%). Significantly more patients with the MIOLs groups reported glare and halos when driving at night but there were not significantly different in reading and satisfaction.?Although postoperative high scores of 11 subscales of the 25 items of NEI VFQ, there were no postoperatively significant differences among all the IOL groups.
Conclusions: The MOLs such as ReSTOR and Tecnis ZM900 demonstrated excellent distance and near vision with high spectacle independence (~90%), and without compromising binocular contrast sensitivity at distance in dim condition, which may be due to lower high order aberrations and spherical aberrations in MIOLs. Although more patients with implantation of MIOLs reported visual disturbances, eg glare and halos driving at night, there were no significant influences on patients’ satisfaction. Postoperative scores of very domain in vision-related quality of life were high but there were not significant differences by IOLgroup. |
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