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

November 1, 2007

Multifocal and accommodative IOLs can be implanted safely in patients who have undergone prior refractive surgery, and visual results can be good. Frequently, however, enhancements are necessary, and decreased best-corrected visual acuity may be seen more often than with aspheric monofocal IOL insertion, according to the results of a prospective study of 22 eyes in 18 patients.

Key Points

Rockville Centre, NY-Multifocal and accommodative IOLs can be implanted safely in patients who have undergone prior refractive surgery, and visual results can be good, according to Renée Solomon, MD, in private practice in New York. Frequently, however, enhancements are necessary, and decreased best-corrected visual acuity (BCVA) may be seen more often than with aspheric monofocal IOL insertion, she added.

Postoperative BCVA in those who have undergone refractive surgery prior to lens implantation may not be as good as it is in patients who have not undergone refractive surgery prior to IOL implantation, but "with preoperative selection and enhancement, patient satisfaction is excellent" in the former group, Dr. Solomon said.

In the past 10 years, more than 8 million refractive procedures have been performed, she said. "As these post-LASIK patients have aged, there has been an increased incidence in cataract surgery in this population," she added. "The rehabilitation of the cataract patient has been revolutionized with the advent of multifocal, accommodative, and aspheric lenses."

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

One refractive surgeon, Eric D. Donnenfeld, MD, performed all operations, implanting the apodized diffractive lens in seven eyes, the refractive lens in four eyes, the accommodative lens in four eyes, and the aspheric lens in six eyes; members of the latter group served as controls. Researchers measured BCVA and uncorrected visual acuity (UCVA) preoperatively and postoperatively and recorded BCVA and subjective quality of vision after performing any LASIK enhancement. Enhancements were performed in five eyes receiving the apodized diffractive lens and in one eye in each of the other lens groups.

Results

Implantation of the refractive multifocal lens or the accommodative lens resulted in better intermediate vision than did implantation of the other lenses in the study, Dr. Solomon said, whereas implantation of the apodized diffractive lens resulted in the best near vision.

In the apodized diffractive lens group, postop UCVA at distance ranged from 20/20 to 20/30, and BCVA ranged from 20/20 to 20/25. Intermediate UCVA ranged from J3 to J5, and at near, from J1 to J3. On a scale of 1 to 10, satisfaction ranged from 9 to 10.

For those receiving the refractive lens, at distance, UCVA and BCVA ranged from 20/20 to 20/25. Intermediate UCVA ranged from J1 to J2; at near, UCVA ranged from J2 to J3. Again, satisfaction ranged from 9 to 10.

In the accommodative lens group, postoperative UCVA and BCVA at distance ranged from 20/20 to 20/25. Intermediate UCVA ranged from J2 to J3, and near, from J3 to J5. Patient satisfaction ranged from 8 to 9.

With the aspheric lens, UCVA at distance ranged from 20/20 to 20/25, and BCVA was 20/20 at distance. Postoperative patient satisfaction ranged from 9 to 10.

"In these IOLs," Dr. Solomon said, "patients must be informed [that with] their use [comes] the added risk of glare and halos. Patients must also be made aware of the increased need for a refractive enhancement if they have had prior refractive surgery."