Self-assessment a good metric for measuring IOL success

August 1, 2007

Outcomes after implantation of an accommodating IOL (crystalens, eyeonics) were probed with a simple questionnaire designed to characterize spectacle wear and patient satisfaction. The results based on these critical metrics were favorable.

Key Points

"Studies of refractive surgery patients include many physician-measured endpoints of quality of vision and quantity of vision, but the basic goal of these procedures is to reduce the patient's need for wearing glasses or contact lenses," said Dr. Waring, clinical professor of ophthalmology, Emory University, Atlanta. "If we are setting out to get rid of glasses, then the questions we are asking to determine surgical success need to focus on that issue."

The preliminary, informal study he reported included 13 patients with the accommodating IOL implanted in an intact capsule; nine patients underwent bilateral surgery and four had monocular cataract surgery. The cohort was composed of six women and seven men who had a mean age of 59 years (range, 38 to 72 years). They included patients with myopia and hyperopia.

In monocular testing, distance uncorrected visual acuity (UCVA) of 20/32 or better and near UCVA of J3 or better was achieved in all eyes. Fifty percent of eyes had distance UCVA of 20/20 or better, and 57% could read J2 or better at near without correction, Dr. Waring reported.

In binocular testing of the nine patients who had bilateral surgery, all could see 20/25 or better at distance with or without correction. Intermediate UCVA was 20/20 or better for all nine patients who had bilateral surgery.

"These results highlight the strength of the accommodating IOL for providing excellent intermediate vision, and they are consistent with the findings of patient reports on spectacle use-great news for computer users," Dr. Waring said.

Self-evaluation

Patients' assessments of vision outcomes were collected using a mailed questionnaire that included 10 questions that asked patients to indicate how often they used glasses for distance, intermediate, and near vision using descriptors of "never," "seldom," "sometimes," "often," and "always." Their responses for near vision showed that six patients never used glasses, three seldom did, two used glasses sometimes, one patient needed glasses often, and one wore glasses always.

"Spectacle independence for near vision is really the crux of the issue for assessing outcomes with accommodating IOL implantation, and the results achieved in this cohort represent a good, but not perfect, outcome," Dr. Waring said.

For intermediate and distance vision, 11 patients said they never used glasses, one used glasses seldom, and the other needed them always.

"It is important to keep in mind that four of the patients in the study had monocular cataract surgery, but these results really highlight the performance of the accommodating IOL for providing good intermediate vision when an emmetropic outcome is achieved," Dr. Waring said.

Patients also were asked to respond to a short essay question about whether they would have the surgery again.

"Their responses sounded like a commercial for the accommodating IOL, but the reality is that they reflected the familiar positive emotional reactions we have seen among patients who are ecstatic to be rid of their glasses," Dr. Waring said.