Multifocal, accommodative lenses safe in patients who have undergone prior refractive surgery

Multifocal and accommodative IOLs may be implanted safely in patients who have undergone prior refractive surgery, and visual results can be good, according to Renée Solomon, MD, of Ophthalmic Consultants of Long Island, Rockville Centre, NY. Frequently, however, enhancements are necessary, and decreased visual acuity may be seen as compared with monofocal IOL insertion.

To investigate the efficacy of these categories of lenses in eyes that had undergone prior LASIK, Dr. Solomon and colleagues conducted a prospective study of 22 eyes in 18 patients. In addition to having previously undergone refractive surgery, all eyes had well-centered, regular topographic ablation profiles and sufficient stromal depth for enhancement.

Two multifocal lenses were included in the study: an apodized diffractive lens (AcySof ReSTOR, Alcon Laboratories) and a refractive lens (ReZoom, Advanced Medical Optics [AMO]). Also included were an accommodative lens (crystalens, eyeonics) and an aspheric monofocal lens (Tecnis, AMO).

The diffractive lens was implanted in seven eyes, the refractive lens was implanted in four eyes, the accommodative lens was implanted in four eyes, and the aspheric lens was implanted in six eyes. Best-corrected visual acuity (BCVA) and uncorrected visual acuity were measured preoperatively and postoperatively. BCVA and subjective quality of vision were recorded after any LASIK enhancement was performed.

Five eyes receiving the diffractive lens received enhancements, and enhancements were performed in one eye in each of the other lens groups.

The refractive multifocal lens and the accommodative lens provided better intermediate vision results than the other lenses in the study, whereas implantation of the diffractive multifocal lens resulted in better near vision.