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Multivariate regression analysis of overall bilateral patient satisfaction in patients receiving bilateral TECNIS multifocal implants

Poster Details

First Author: F.Bucci, Jr USA

Co Author(s):                  

Abstract Details



Purpose:

Perform multivariate regression analysis to identify predictors of overall patient satisfaction of bilateral visual function after implantation of two TECNIS multifocal IOLs using multivariate regression analysis.

Setting:

Bucci Laser Vision Institute, Wilkes-Barre, Pennsylvania, United States

Methods:

Two hundred (TMF/TMF) 'best case' patients with (1) six month neuroadaptation (2) correction of residual refractive error (3) all YAGs completed as necessary, and (4) aggressive management of the ocular surface, were prospectively randomized for a 1-piece vs. a 3-piece TMF and eye dominance. The dependent variable 'overall pt. satisfaction' was regressed against 40 independent variables including 31 objective clinical metrics such as reading speed, reading accuracy, angle kappa, asphericity, high order aberrations, mesopic and photopic pupil size, residual sph. equivalent. & astigmatism, near and intermediate vision at fixed and preferred focal distances, IOL centration, etc, and the responses to 9 variables from a questionnaire addressing the pt's performance while reading small print or a newspaper, working on a computer, watching TV, and driving, etc.

Results:

64% (35/55) were very satisfied, 36% (20/55) were satisfied, 0% neutral, 0% dissatisfied and 0% very dissatisfied. The regression equation for Overall Satisfaction = +2.37 constant +0.30 'newspaper' (p<.005) +0.18 'computer' (p<.005) +0.08 'intermediate vision (preferred focal distance) (p=.05) Bivariate analysis showed strong correlations between the pupil size and intermediate vision justifying a multivariate analysis with 'intermediate vision' as the dependent variable. Intermediate Vision = +112.87 (constant) -2.89 mesopic pupil (p<.005) -5.01 centration (IOL) (p=.02) Results revealed that smaller pupils are significantly (p<.005) associated with better intermediate vision beyond the pinhole effect. Better intermediate vision was also associated (p=.02) with better IOL centration. The mean residual astigmatism was 0.35 +/- 0.23D. 100% of pts had < 0.75D and 80% had < 0.50D. The mean residual sph. equivalent was 0.02 +/- 0.28D with 95% of patients (52/55) < 0.50D. The mean postop uncorrected distance vision was 20/22.0 +/- 3.0 with 95% (52/55) > 20/25 and 100% > 20/30.

Conclusions:

1. Patients with low residual refractive errors and excellent uncorrelated acuity have high patient satisfaction. 2. Overall pt. satisfaction is strongly predicted by the patient's ability to read the newspaper, work on a computer, and their intermediate visual function. 3. Intermediate visual function is significantly influenced by IOL centration and pupil size beyond the pinhole effect. 4. The central 1.0mm of the TMF is designed as a +2.00 add and explains the above findings for intermediate vision, pupil size, and IOL centration. 5. Pupil size may be a meaningful preop predictor of postop intermediate vision when implanting the TECNIS multifocal. FINANCIAL INTEREST: NONE

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