Presbyopia-correcting Intraocular Lenses in Cataract Surgery—A Focus on ReSTOR® Intraocular Lenses
independence,32,51 and comparison with a monofocal AcrySof® IQ ReSTOR® IOL showed increased near vision acuity.52
More recently, two
studies comparing the +4 D and +3 D add power iterations observed equivalent distant and near vision acuity in the two IOLs, but the +3 D add power iteration improved intermediate distance vision (see Figures 4 and 5).34,53
Patient Suitability for the AcrySof® IQ ReSTOR® Intraocular Lens While the AcrySof® IQ ReSTOR® IOL is appropriate for use in any patient with visually significant cataracts and otherwise healthy eyes, careful preoperative judgment must be made to ensure safe treatment. Alternatives to IOL implantation should therefore be considered if patients suffer from one or more of the following retinal conditions including retinal detachment, significant irregular corneal aberration, corneal dystrophy or previous corneal transplant, amblyopia, shallow anterior chamber, inflammation of the anterior or posterior segments, aniridia, iris neovascularization, glaucoma, microphthalmos or macrophthalmos, and optic nerve atrophy.34,42
Patients should understand that while VA across
all distances may be restored to a high degree, and their spectacle independence may be significant, their reading or near vision acuity may be poor in low light situations and adverse optical effects may occur (see below). Furthermore, patients with other significant ocular morbidities such as corneal endothelial disease, macular degeneration or significant macular vascular occlusions, proliferative diabetic retinopathy, or irregular stigmatism may not achieve the same level of VA as patients without these problems. Surgical complications may include infection, corneal endothelial damage or edema, retinal detachment, vitritis, cystoid macular edema, transient or persistent glaucoma, hypopyon, and possible secondary surgical intervention.34,42
Visual Disturbances and Patient Experience of AcrySof® IQ ReSTOR® Intraocular Lens As with most multifocal IOLs, patients implanted with apodized diffractive IOLs are liable to suffer from photic problems including glare, halos, and night vision disturbances. Patients implanted with older, spherical iterations of the AcrySof® ReSTOR® IOL reported no severe visual phenomena and the majority exhibited only mild halos or glare.44,45 Furthermore, >80% of patients reported never using spectacles for near vision.44,45
In comparison to those implanted with the ReZoom® IOL, patients implanted with the spherical AcrySof® ReSTOR® IOL reported fewer and milder glare and halos and were more spectacle independent for near vision.39,46,47
Comparison between AcrySof® ReSTOR® IOLs and
the Tecnis® full optic diffractive IOL showed no differences in visual disturbances or spectacle independence.39
In patients implanted with the AcrySof® IQ ReSTOR® IOLs with either +3 D or +4 D add power, between 63 and 65% reported glare and halos as being either absent or mild, and between 83 and 88% reported mild or no night vision disturbances, with no significant differences between the two IOLs (see Figure 6).33
Fewer severe photic disturbances were
reported with the +3 D add power iteration, however (see Figure 6).34 Furthermore, 78–81% of patients achieved spectacle independence for near vision in both groups (see Figure 7).34,51
Mean overall patient
satisfaction scores following implantation of the +3 D or +4 D add power IOLs were ≥8.3 (scale: zero=worst possible vision, 10=best
US OPHTHALMIC REVIEW
possible vision), indicating the vast majority of patients were satisfied with their vision.32,34,49,51
Conclusion
While the original monofocal IOLs provided excellent distance vision in cataract patients, it is only in the past decade that the full range of VA normally provided by the crystalline lens is capable of being restored by the latest generation of IOLs. Different technologies are currently utilized to correct for presbyopia, including pseudophakic accommodation, refraction, and diffraction. The latest generation of apodized diffractive IOLs, the AcrySof® IQ ReSTOR®, provides excellent presbyopic correction and enables the vast majority of patients to achieve spectacle independence for near vision. Moreover, severe visual disturbances
47
Figure 6: Comparison of Visual Disturbances Reported by Patients Implanted with AcrySof® IQ ReSTOR® Intraocular Lenses with Either +3 D or +4 D Add Power
100
10 20 30 40 50 60 70 80 90
0
Grare/flare +3 D IOL
Halos +4 D IOL
Patients were evaluated six months post-operatively. D = diopters; IOL = intraocular lens. Reproduced with permission from Maxwell et al, 2009.34
Figure 7: Comparison of Spectacle Independence Pre- and Post-operatively in Patients Implanted with AcrySof® IQ ReSTOR® Intraocular Lenses with Either +3 D or +4 D Add Power
100
10 20 30 40 50 60 70 80 90
0
Always Sometimes Baseline
Never +3.0 D IOL
Always Sometimes Never Six months post-operatively
+4.0 D IOL
Patients were evaluated six months post-operatively. D = diopters; IOL = intraocular lens. Reproduced with permission from Maxwell et al, 2009.34
Problems with night vision
Patients
Proportion of patients (%)
None/mild Moderate
Severe
None/mild Moderate
Severe
None/mild Moderate
Severe
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