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First Author: R.Ruiz Mesa SPAIN
Co Author(s): A. Aramburu Del Boz
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To assess clinical outcomes and subjective experience after implantation of three different types of diffractive intraocular lens (IOL), the Tecnis-One-Multifocal (Abbot), the AT-LISA tri 839MP (Zeiss) and the AcrySoft Restor +3.00 D (Alcon).
Clínica Oftalvist CIO Jerez, Jerez de la Frontera, Spain.
Fourty-eight eyes of twenty-four patients were implanted with the pseudoaccomodative Tecnis-One-MF IOL. This IOL has been designed with pupil-independent full diffractive posterior surface. The amount of near addition that incorporates is +4.00 diopters (D) at the lens level, an amount that is equivalent to 3.00D at the spectacle plane. Twenty-four eyes of twelve patients were implanted consecutively with the AT-LISA tri 839MP trifocal IOL. This IOL optic is also fully diffractive with an asymetrical light distribution at each distance to provide more predictable visual outcomes for patients with active pupils at all distances. Thirty-six eyes of eighteen patients after implantation of pseudoaccomodative AcrySoft Restor +3 D IOL were also evaluated. This IOL has a central apodized refractive and peripheral diffractive optic profile, to provide a full range of quality vision, neart to distant. Outcomes recorded 6 months postoperatively were uncorrected and distance-corrected (far, near, intermediate) visual acuities, contrast sensitivity (under photopic and mesopic condition), patients" quality of life (visual function questionnaire, halos and glare presence, overall satisfaction) and posterior capsular opacification (PCO).
The mean binocular visual acuity was 0.026 logMAR in the patients with Tecnis-One-MF IOL implantation, 0.014 logMAR in the group of AT-LISA Tri and 0.003 logMAR in the AcrySoft Restor patients. The mean intermediate and near visual acuity were 0.162 and 1.040 logMAR in the Tecnis-One-MF group, 0.102 and 0.093 logMAR in the AT-LISA tri patients and 0.143 and 0.057 logMAR in the AcrySoft Restor group. In the patients with Tecnis One-MF-IOL we observed grade 0 (absent) PCO in 94% and 6% of grade 1 (mild). In the group of AT-LISA tri no PCO was observed in any patient. In the patients with AcrySoft Restor IOL implantation an 88% of grade 0 and 12% of grade 1 opacification was detected. The photopic contrast sensitivity was within the standard normal range with the AT-LISA tri IOL und slightly reduced with the other lenses. Under scotopic condition it was inferior in all the patients. In the three groups about 70% of patients manifiested the presence of dysphotopsias, but these were bearable in all cases. Also, 90% of AcrySoft Restor patients noted reading difficulty with dim light while 72% of Tecnis-One-MF patients reported difficulties when working with computers.
The Tecnis-One-MF and the Acrysoft Restor IOLs consistently improves near and far visual acuity and, in a lesser degree, the intermediate vision. The trifocal AT-LISA tri IOL implanted binocularly show very good visual acuity at all evaluated distances. The third focal point is usable by the patient and does not create more dysphotopsias than other diffractive IOLs. Although the AT-Lisa tri IOL mean near visual acuity is pretty lower than with the other two lenses, it gives high rates of spectacle freedom and overall patient satisfaction.