Apodized diffractive IOL offers excellent solution for presbyopia

March 15, 2005

New Orleans—Refractive lens exchange (RLE) with implantation of the Acrysof SA 60D3 ReSTOR IOL (Alcon Laboratories) is an effective method for treating myopia and hyperopia in presbyopic age patients, said Francesco Carones, MD, at the American Academy of Ophthalmology's refractive surgery subspecialty day meeting.

Observing that prior studies evaluating multifocal and accommodative IOLs for presbyopic RLE have yielded inconsistent results, Dr. Carones, medical director at the Carones Ophthalmology Center, Milan, Italy, undertook a prospective investigation to evaluate the new apo-dized diffractive IOL that is designed to provide a full range of uncorrected vision independent of pupil size.

Other results from 6 months showed best spectacle-corrected visual acuity (BSCVA) was 20/20 or better in all eyes with none having lost lines of BSCVA. Wavefront studies showed there were no significant changes in higher-order aberrations, and none of the patients experienced unwanted visual symptoms in bright light nor did any have significant symptoms at night, although two individuals reported slight rings around lights.

Overall, the patients rated themselves as extremely satisfied with their near vision and their satisfaction with their intermediate vision was relatively good.

"This is a small series with a short follow-up, but the favorable results obtained so far suggest this type of surgery may be considered more and more in the future for correcting myopia or hyperopia in presbyopic patients," Dr. Carones said.

The clear lens extraction procedures were performed through a 2.8-mm clear corneal temporal tunnel incision with creation of a 5-mm capsulorhexis. All IOLs were delivered with the Monarch C cartridge and ASICO Royale injector. A suture was used for astigmatism control in eyes with >0.5 D with-the-rule cylinder.

The analyses of binocular distance corrected intermediate and near vision from the 6-month visit highlighted the extremely good near vision and satisfactory intermediate vision provided by the apodized diffractive IOL. Ninety-two percent of eyes had near vision of J1 or better, and all eyes achieved J2 or better near vision. Intermediate vision was J1 or better in only 28% of eyes, but 67% saw J2 or better intermediate, and 93% achieved J3 or better. The one patient with poorer intermediate vision was a PC user and relied on spectacle correction to work at the computer.

Wavefront testing was performed using the LADARWave (Alcon Laboratories) at a 6-mm pupil size. Comparisons of preoperative and postoperative RMS values for all higher-order aberrations (0.32 versus 0.34 µm), coma (0.17 versus 0.24 µm), and spherical aberrations (0.18 versus 0.16 µm) showed there were no significant changes after the surgery (p ≥ 0.09 for all comparisons).