While U.S. ophthalmologists continue to await FDA approval of the dual-optic accommodating IOL, accumulating data from a number of investigations are providing evidence about the long-term performance of this novel presbyopia-correcting implant technology.
Chicago-While U.S. ophthalmologists continue to await FDA approval of the dual-optic accommodating IOL (Synchrony, Visiogen/Abbott Medical Optics), accumulating data from a number of investigations are providing evidence about the long-term performance of this novel presbyopia-correcting implant technology.
Satisfaction high, PCO low
The dual-optic accommodating IOL couples a moving, anterior, 5.5-mm, high-plus optic (+32 D) to a compensatory, 6-mm, variable negative power posterior lens. The two optics are joined by a pair of spring haptics that help to transmit ciliary body action to cause anterior lens movement.
Colombian ophthalmologists Ricardo Alarcón, MD, and Victor Bohórquez, MD, have presented a number of reports analyzing results from 3+ years of follow-up in patients with the dual-optic accommodating IOL implanted. In one prospective case series of patients with the lens binocularly implanted, they analyzed satisfaction, spectacle independence, functional vision, and quality of vision as well as distance (4 m), intermediate (80 cm), and near (40 cm) visual acuity measured with ETDRS charts.
Data were available from 46 patients seen at 1 year, 22 followed to 2 years, and 14 patients seen at 3 years. At the longest follow-up, 90% of patients achieved 20/32 or better distance uncorrected visual acuity (UCVA), 95% achieved 20/25 or better distance corrected intermediate visual acuity, and 90% could read 20/32 (J2) or better at near with distance correction, Dr. McLeod said.
Responses from quality-of-life surveys completed by 43 patients at 1 year showed 77% were completely spectacle-free and 14% used glasses for less than 2 hours per day, mainly for near activities. Regarding specific vision tasks, 85% of patients indicated they were able to use the computer or read the paper without glasses, and 70% could read fine print without correction.
"These are favorable results from a noncomparative, relatively small patient series," Dr. McLeod said. "To determine the role of the accommodating IOL in clinical practice, an important research question is to assess its performance compared with a multifocal IOL."
This issue was investigated in a randomized, double-masked, multicenter study in which 100 subjects underwent binocular implantation of either the dual-optic accommodating IOL or the diffractive multifocal IOL (AcrySof ReSTOR +4, Alcon Laboratories).
Results from evaluations performed at 1 year postop showed distance UCVA was 20/20 or better in more than 90% of patients in both groups, and there were no statistically significant differences between groups for uncorrected vision at distance and near (40 cm).
However, the dual-optic accommodating IOL group demonstrated statistical superiority over the diffractive multifocal IOL group for better visual acuity outcomes at all distances between the near and far extremes (60 cm, 80 cm, 1 m, and 2 m) as well as for better contrast sensitivity under mesopic and photopic conditions.