The Impact Of Preoperative Pupil Size On Quality Of Vision Following Implantation Of A New Complementary Multifocal

To outline the impact of preoperative pupil size on visual outcomes and quality of vision following bilateral implantation of a new complementary multifocal intraocular lens (IOL). 

Cathedral Eye Clinic, Belfast, Northern Ireland, UK.

The study enrolled 65 patients implanted bilaterally with the Cristalens Artis Symbiose complementary IOL combination were recruited. Postoperatively, patients were categorized into 3 groups based upon preoperative photopic pupil size. Group A: ≤ 3.5mm (n=28), Group B: 3.51 to 4.0mm (n=18), Group C: > 4.0mm (n=19). Uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuity, and quality of vision (QoV) were compared between the groups 3 months postoperatively.

There was no significant difference between groups with binocular UDVA, UIVA and UNVA. The mean binocular UDVA was -0.05 ± 0.09, -0.06 ± 0.06, -0.05 ± 0.10 logMAR. Binocular UIVA was 0.14 ± 0.12, 0.13 ± 0.11, 0.15 ± 0.11 logMAR. Binocular UNVA was 0.07 ± 0.12, 0.07 ± 0.10, and 0.04 ± 0.09 logMAR. Group A and group B reported mean glare of 0.54 ± 0.84 and 0.29 ± 0.47 which was significantly less than group C with 1.06 ± 0.80 (P= 0.02, and P=0.002). Group A and B showed a trend of a lower incidence of starbursts and better overall nighttime QoV scores, when compared to group C. Spectacle independence was high in each group, with 96.4%, 100% and 94.7% reporting complete spectacle independence.

Objective and subjective outcomes with this new IOL combination are high and a high level of complete spectacle independence was found. Preoperative pupil size affected the incidence of glare, despite no significant impact upon objective outcomes. Provisional one year outcomes show a reduction in dysphotopsias compared to 3 month outcomes.