Vision quality with diffractive multifocal IOLs worse in older patients

This retrospective study found that corrected distance and near visual acuities and contrast sensitivity in eyes with diffractive multifocal IOLs decreased with patient age, although the results in older patients did not restrict the use of multifocal IOLs and were clinically negligible. Visual acuity with monofocal lenses, however, was not associated with patient age.

We found this study very interesting and important to keep in mind regarding expectations of patients after multifocal IOL implantation. While this phenomenon is well known to those of us who use a lot of multifocals, this concept does deserve elaboration for the uninitiated. We believe arcus and other corneal issues (tear film) contribute to this effect. However, the effect of arcus has never been studied in monofocal lens use.

The study included 365 eyes of 237 patients who received a Tecnis ZM900 or Tecnis ZMA00 diffractive multifocal IOL (Abbott Medical Optics, Inc.) after cataract extraction. Their mean age was 59.5 years (range 30 to 79 years). The control group consisted of 121 eyes of 85 patients with a mean age of 55.1 years who received a monofocal IOL.

One month postoperatively, mean CDVA in eyes with a multifocal IOL was significantly better in patients in their 30s and 50s than those in their 60s and 70s (P < 0.033).

There was also a significant decline in distance CNVA in patients in their 60s and 70s compared with those in their 30s (P < 0.03). CNVA was also better in younger patients.

Furthermore, contrast sensitivity was significantly better in patients in their 30s than in their 60s and 70s at 6 cycles per degree (cpd) (P < 0.025) and in their 50s to 70s at 18 cpd (P < 0.027). No change in CDVA was found with monofocal IOL implantation.