Aspheric IOL a monovision viable alternative for presbyopia correction in cataract patients

Bilateral implantation of an aberration-free aspheric IOL (SofPort AO, Bausch & Lomb) in a monovision approach can provide cataract surgery patients excellent binocular distance and near UCVA along with low rates of spectacle dependence and night-time complaints, said J.E. "Jay" McDonald II, MD, director of McDonald Eye Associates, Fayetteville, AR.

Dr. McDonald reported results from a retrospective study of 40 patients. Refractive targets were to achieve a slight myopic defocus (–0.75 to –2 D) in the near eye and near plano (0 to –0.50 D) in the distance eye. Astigmatic control was attacked aggressively for all patients with 0.75 D or more of astigmatism preoperatively or with 0.50 D or more of postop astigmatism. Slightly over one-fourth of eyes underwent AK or LRI touch-up within the first 3 months after surgery.

At 3 to 6 months follow-up, mean spherical equivalent was –0.213 D in the distance eye and –1.431 D in the near eye. Distance UCVA of 20/30 or better was achieved by 96% of patients and 88% could read J2 uncorrected. Almost all patients (97%) reported being spectacle-free for intermediate vision, 81% reported they did not wear spectacles for distance, and 68% were spectacle-free for near vision.

"With presbyopic IOLs we want to establish spectacle independence while preserving quality of vision," Dr. McDonald said. "However, my concern about multifocal IOLs is that they are all associated with qualitative loss of visual information resulting in reduced contrast sensitivity, glare, and halos.

"My strategy is based on using an aspheric lens which has the optically highest contrast, and the outcomes with monofocal aspheric IOL surgery are similar to the newer multifocal IOLs with respect to spectacle independence and better in terms of moderate-to-severe night vision complaints," Dr. McDonald concluded.