Comparative visual outcome and quality of life between bilateral aspheric diffractive

Report
Comparative visual outcome and
quality of life between
bilateral aspheric diffractive
ReSTOR® with addition 4D versus 3D,
or mix-match implantation.
M-A. BIGOU, B. COCHENER
FRANCE
Financial interest code E : My travel expenses have been reimbursed, paid in full or subsidized, by
a company that makes/develops/provides ophthalmic products or services (Alcon).
POPULATION

42 patients (84 eyes)

Mean age 50 +/- 5 years

Patent presbyopia : addition +2.5 to +3 D

All of them expected independancy of spectacles

Lensectomy : december 2007 to december 2008

3 groups :

Bilateral diffractive Restor®AD1 (+3) (ALCON) = 20 eyes

Bilateral diffractive Restor®AD3 (+4) (ALCON) = 40 eyes

Mix-Match diffractive Tecnis ® (AMO) and in the
dominant eye refractive Rezoom ® (AMO) = 24 eyes
EVALUATION ( 5 +/- 1.5 months post-surgery)


Visual acuities

without correction, binocular

Distance, intermediate and near.
Quality of vision

Functional signs : dysphotopsy (halo, glare…), satisfaction rate

Contrast sensitivity (static, mesopic) +/- glare


PC software « EyeVis Pod » for the quality of vision study and
visual performance score
Defocus
IOL REFRACTIVE / DIFFRACTIVE

REZOOM (AMO) : non absorbent acrylic

Refractive , 5 zones with aspheric transition,
optiedge

Addition +4D

Incision 2.8mm

TECNIS (AMO) : non absorbent acrylic

Diffractive on the posterior side, aspheric on
the anterior side

Addition +4D

Incision 2.8mm

RESTOR (ALCON) :

Joint optical : diffractive in the central 3.6mm
and refractive in the periphery, apodisation
included

Addition +4D (AD3) and recently +3D (AD1)

Incision 2mm
RESULTS : Visual Acuity
Diffractive Diffractive
bilateral
bilateral
ReStor AD1 ReStor AD3
87.5%
Distance >20/25
20/40-20/25 12.5%
VA
<20/40
0%
Mix -Match
Rezoom /
Tecnis
73%
27%
0%
81%
19%
0%
Intermediate VA
>20/25
85%
20/40-20/25 10%
<20/25
5%
30%
31%
39%
86%
13%
1%
Near
VA
P2
100%
80%
100%
: Do need accasional wear of spectacles
: Increase to 85% after excimer treatment for residual ametropia
Results : dysphotopsy
%
33
35
28
30
25
20
halo
18
20
14
15
10
10
5
0
ReStor AD1
ReStor AD3
Mix-Match
glare
Results : contrast sensitivity
STATIC
30
ReStor AD1 and Mix-Match better
than AD3 in high spatial frequency
(= higher visual discrimination)
25
20
15
MESOPIC
restor D3
10
30
restor D1
5
25
0
1
2
3
4
5
mix-match
réf phake
GLARE
20
15
10
moy inf
30
5
25
moy sup
0
1
2
3
4
5
20
15
Mix-Match seems to be lightly
better compared with bilateral
diffractive implantation for
mesopic and with glare contrast
10
5
0
1
2
3
4
5
PC platform for vision quality evaluation
Results : Visual Performance
Reading Test :
70
Fluence and
Comprehension
60
50
score < 40 pts /100
40
40 pts < score < 60 pts /100
30
score > 60 pts /100
20
10
0
restor AD3
restor AD1
%
mix-match
Satisfaction rate
85
90
75
for intermediate vision
activities (PC test)
80
70
60
50
37,5
37,5
40
good
very good
25
25
30
15
20
0
10
0
0
restor AD3
restor AD1
mix-match
excellent
Defocus
Log
1,2
1
0,8
restor D3
restor D1
0,6
mix-match
0,4
ref phake
0,2
0
-1
-2
0
+1
+2
DISCUSSION / litterature data

Deterioration of the quality of life when presbyopia appears

Luo BP, Brown MM. The quality of life associated with presbyopia. Am J Ophthalmol 2008
apr;145(4):618-622.

No way to recover acommodation but only to compensate it,
with unperfect results :
 Spectacles / contact lenses
 Presbylasik
 Accommodative IOL / multifocal IOL

Mix-match requires neuro-adaptation but allows better visual
performances at all distance vision.

Eye Q Report. ESCRS. 2006 oct 3rd

Goes FJ. Visual results following implantation of a refractive multifocal IOL in one eye and a diffractive multifocal IOL in the
contralateral eye. J Refr Surg 2008 mar;24(3):300-5

Gunenc U, Celik L. Long term experience with mixing and matching refractive array and diffractive CeeOn multifocal IOL. J
Refr Surg 2008 mar;24(3):233-42
CONCLUSION

Restor AD1 seems to give a better depth of focus compared
with Restor AD3 and better visual performances than MixMatch implantation.

Further investigations have to be driven , increasing the
number of patients and including other methods for
presbyopia compensation or restoration.

Specific care required for patients selection , according to
preoperative ametropia and to their way of life , in order to
select the best « custom implantation »

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