Multifocal IOL mixing, matching shows good results in European study

January 1, 2009

Mixing and matching IOLs with different optical principles was investigated in a European multicenter project. Data from 90 patients seen at 120 to 180 days after surgery showed excellent results in functional outcomes, patient satisfaction, and spectacle independence.

Key Points

Frank J. Goes, MD, was one of 12 investigators participating in this "online" study, and he reported the results at the American Academy of Ophthalmology annual meeting. He is director and senior eye surgeon, Goes Eye Centre, Antwerp, Belgium.

A total of 240 patients were enrolled and received a refractive IOL (ReZoom, Advanced Medical Optics [AMO]) in their distance-dominant eye (94%) and a diffractive aspheric IOL (Tecnis ZM900, AMO) in the fellow eye. Data available for 90 patients who completed the final visit at 120 to 180 days showed that they had excellent functional near vision with few visual complaints. Most importantly, 96.5% of patients were spectacle-independent, 100% indicated they would undergo the same procedure again, and 98% said they would recommend it to a friend.

"Custom matching of IOLs aims to tailor lens choice based on an individual patient's lifestyle," Dr. Goes said. "The experience in this European multicenter project indicates that mixing and matching of these two multifocal IOLs is a valuable option for achieving personalized multifocal vision."

The diffractive aspheric multifocal IOL has a near add of +4.00 D and gives very good, pupil-independent near and distance vision, although it is associated with limited intermediate vision. The refractive IOL has a near add of +3.5 D. Based on a multizonal refractive principle, it gives very good distance vision and good intermediate vision, although patients may find that they need glasses when reading small print or for prolonged periods, Dr. Goes said.

The 12 centers involved in the study were located in Belgium, Spain, Italy, and Germany, and the investigators represented both private and university-based practices. Follow-up visits were scheduled at 1 to 2, 30 to 60, and 120 to 180 days postoperatively, and the data were reported online.

The study was launched in June 2006. The enrolled patients had a median age of 64 years and included those undergoing both refractive lens exchange and cataract surgery.

"The heterogeneity of the patient population was reflected in their preoperative monocular distance [best-corrected visual acuity (BCVA)], which ranged from 0.1 to 1.5," he said. "Notably, 25% of patients also reported at least one optical visual symptom before the surgery, with fluctuation in acuity being most common (18%), followed by day glare (7%), and night glare (4%)."

Uncorrected visual acuity (UCVA) results from the serial follow-up visits showed that distance and near vision were excellent and improved with time, whereas intermediate vision was favorable and stable, Dr. Goes said. At the last visit, mean distance, intermediate, and near UCVA were 0.97, 0.58, and 0.85, respectively.

Reading speed and acuity were evaluated in mesopic and photopic conditions. Outcomes from the 30- to 60-day visit showed that mean reading acuity was 0.3 logRAD in mesopic conditions and 0.1 logRAD in photopic conditions. Patients read an average of 183 words per minute in mesopic conditions and 202 words per minute in photopic conditions.

Functional results

"These functional results are excellent," Dr. Goes said. "The reading acuity outcomes are identical to those reported in a 2006 published paper by Huetz et al., and the reading speeds are even better."

Data on visual symptoms were available for 90 eyes and showed that very few patients reported day glare (4.4%) or night glare (7.8%), whereas halos were more prominent (39%). The halos mentioned by patients, however, were nearly always mild, he said.

Of the five patients who reported needing glasses, one wore glasses for distance vision, two for reading, and two wore bifocals.

Dr. Goes also reviewed reports from multiple other investigators who have evaluated a mix-and-match approach to multifocal IOL implantation. He said that the results of these studies are consistent with the findings from the European multicenter project that showed overall high rates of patient satisfaction and spectacle independence with low rates of photic phenomena.