IOL choice hinges on patterns of daily routine
DECIDING which multifocal IOL to implant may depend on a patient’s
lifestyle requirements, according to a German ophthalmologist.
In a study involving 40 cataract patients who underwent bilateral
implantation of either of two types of multifocal IOL, the AMO Array
or the IOLtech MF-4, those with the Array lens achieved better distance
UCVA while those with the MF-4 achieved better near UCVA, Magda
Rau MD told the seventh ESCRS Winter Refractive Surgery Meeting.
“Following our experience, we now offer the AMO Array lens
to younger and more active patients and the MF-4 lens to those who
are older and less mobile, with higher expectations for near vision,”
Dr Rau said.
The mean UCVA for distance vision was 0.72 for the AMO Array lens
and 0.63 for the MF-4-group. The mean UCVA for near vision was 0.72
for the AMO Array group and 0.78 for the MF-4 one.
In the AMO group, 60% had a UCVA for distance of 20/25 or better,
compared to only 20% in the MF-4 group. BCVA for distance was 20/25
or better in 87% of the AMO group, compared to only 51% in the MF-4
In the MF-4 group, 52% had a UCVA for near of 20/25 or better, compared
to only 33% of those in the AMO group. All patients in the MT-4
group and 96% of those in the AMO group achieved a near BCVA of
20/25 or better.
In the AMO group 65% still used glasses, although 55% used them
only occasionally and 10% used them constantly. In the MF-4 cohort,
50% still used glasses, 48% only occasionally and 2% constantly.
The incidence of optic phenomena was similar with both lenses. In
the AMO group, 35% reported glare and 70% reported halos. In the
MF-4 group, 25% reported glare and 65% reported halos.
The mean contrast sensitivity, tested with a Pelli-Robson chart,
was 1.62 in the AMO-Array group and 1.56 in the MF-4 group.
The AMO Array (AMO-Allergan) is a foldable silicone lens, with five
annular concentric zones, three for distance and two for near vision.
Autofocus-Lens MF-4 (IOLtech) is a foldable hydrophilic acrylic-lens
with four annular concentric zones, two for distance vision and
two for near vision.
Dr Rau suggested that the better performance at distance and near
for the Array and MF-4 lenses respectively might be due to their
different optical designs.
The centre zone of the AMO lens focuses for distance, and the lens
therefore emphasises the distance image while the central zone of
the MT-4 lens focuses for near and therefore emphasises the near
“Both lenses provide very good near and distance visual acuity
results and a high degree of patient satisfaction. According to
their design, the visual acuity for distance vision is better with
the AMO Array and the visual acuity for near vision is better with
the MF-4,” Dr Rau explained.
She has recently begun to implant both types of IOL in alternate
eyes of the same patient to provide vision optimised for distance
in one eye and for near in the other.
“Having access to both lenses gives the surgeon the possibility
of satisfying a larger share of patients,” she said.
Tagesklinik, Cham, Germany