Good visual outcomes achieved with apodized diffractive multifocal IOLs

This prospective study in the March issue of Clinical and Experimental Ophthalmology presents data on one of the largest, single-center cohorts to undergo implantation of apodized, diffractive, posterior chamber multifocal IOLs. The 203 patients (363 eyes) in this consecutive series all received the Alcon AcrySof Natural ReSTOR IOL (SN60D3) following cataract or clear lens extraction surgery. They demonstrated excellent postoperative near UCVA without significant compromise of distance UCVA. Results were safe and reliable for the majority of subjects, with spectacle independence achieved in 82 percent. However, one in 10 subjects experienced minor halos or other visual phenomenon that may be related to the IOL design.

Preoperatively, mean BCVA was 6/12 among the cataract patients and 6/6 in the clear lens extraction (CLE) group. One hundred sixty-one patients (98.2 percent) in the CLE group were hyperopic and presbyopic (mean spherical equivalent +4.25 ± 3.5D).

Postoperatively, UCVA was ≥ 6/12 in 96.5 percent of eyes (51.9 percent ≥ 6/6) and ≥ N5 in 95 percent of eyes. At six months, 182 eyes (91.4 percent) in the cataract group and 137 eyes (83.5 percent) in the CLE group were within 0.50 D of target spherical equivalent.  

No subjects required IOL exchange. The safety index at six months was 2.5 for cataract and 1.17 for CLE.

The authors say that secondary surgical procedures may be required in a small subset of eyes to correct any residual refractive error and improve patient satisfaction. Wavefront-guided LASIK was performed in 4.4 percent of patients in this study and limbal relaxing incisions in the 23.9 percent with corneal astigmatism of 1.00 D or greater.

They conclude that satisfactory results depend not only on patient selection and focusing on patient motivation and expectations but also on accurate biometry and IOL power calculation.