Multifocals show similar results but lower power offers better vision range

Reviewed by Jennifer Loh, MD

Take-home: Both the Tecnis multifocal +2.75 D and +4.00 D IOLs had good visual results, but the +2.75 D IOL had a better range of vision across near, intermediate, and distance.

Although both the Tecnis multifocal +4.00 D and +2.75 D (Abbott ) intraocular lenses (IOLs) provided similar uncorrected visual acuity (UCVA) for distance vision, the +2.75 add had a higher percentage of eyes with 20/25 or better intermediate vision and seemed to provide a better broad range of vision.

Jennifer Loh, MD, in private practice, Coral Gables, FL, reported that researchers in the retrospective, multicenter study evaluated UCVA and best corrected visual acuity (BCVA) for distance, intermediate, and near with the +4.00 add (models ZMA00 and ZMB00) and +2.75 add (ZKB00).

The study included 141 eyes receiving the +4.00 add and 97 eyes receiving the +2.75 add. Researchers had eliminated results from patients with a BCVA of 20/30 or higher because of posterior capsule opacification, ocular surface disease, or similar conditions. The mean patient age in both groups was similar-66 years old in the +4.00 add group and 67 years old in the +2.75 add group.

Point of separation

The percentage of patients achieving 20/30 or better distance visual acuity was similar-76% in the +2.75 group versus 70% in the +4.00 group. “Yet, when we looked at uncorrected intermediate and near vision, that’s where a separation really happened,” Dr. Loh said.

In fact, 93% of patients with the +2.75 add had intermediate visual acuity of 20/30 or better compared with only 63% who had received the +4.00 add. For near visual acuity, 73% achieved 20/30 or better with the +2.75 add compared with 91.5% with the +4.00 add.

Courtesy of Jennifer Loh, MD

Researchers also decided to study a subgroup of optimized patients. “We wanted to look at patients who had achieved the intended, planned refractive outcome because we know these lenses work best when the refractive target is met,” Dr. Loh said.

The subgroup included patients with a visual acuity of 20/25 or better, a spherical equivalent refractive outcome of less than 0.5 D, and astigmatism of 0.75 D or less. The subgroup did not include patients with previous LASIK.

“When you look at the optimized group, the results are very comparable, but again there was a difference in uncorrected intermediate visual acuity between the low add versus the near add,” Dr. Loh said. “The lower power add still achieved better uncorrected intermediate vision in the optimized group.”

Lesson learned

Lesson learned

Courtesy of Jennifer Loh, MD

The biggest lesson for clinicians is that the lower power add appears best for the broadest range of vision, Dr. Loh said. “It doesn’t seem to sacrifice much near, and in my experience, most patients with the lower power add are very happy with their near vision,” she added.

Cataract surgeons should consult with patients about what they want from their vision. If they want a full range of quality vision, including tasks such as grocery shopping and using the computer, the +2.75 add usually works best. For patients who are avid knitters or sewers and want closer focal point vision, the +4.00 add may suit them better, she said.

Courtesy of Jennifer Loh, MD

Jennifer Loh, MD

E: jenniferlohmd@gmail.com

This article was adapted from a presentation that Dr. Loh presented at the 2016 American Society of Cataract and Refractive Surgery annual meeting. Dr. Loh is a consultant for Abbott.