August 2008

 

CATARACT/ IOL

 

Scoping out expectations for multifocal lenses


by Maxine Lipner Senior EyeWorld Contributing Editor 

   

Study results show what bilateral implantation with multifocal lenses can bring

Source: Robert J. Weinstock, M.D.

Source: Robert P. Lehmann, M.D.

It’s a request more and more practitioners are getting—their patients are asking to use multifocal lenses. Here in the United States that means either the ReZoom (Advanced Medical Optics, Santa Ana, Calif.), the ReStor (Alcon, Fort Worth, Texas), or the ReStor aspheric (Alcon) implant. But what exactly can patients expect with bilateral implantation of one of these multifocal lenses? The two lenses function very differently: with the refractive ReZoom, light is distributed over five optical zones while the ReStor is an apodized diffractive lens.

ReZoom results

Recent study results with bilateral implantation of the ReZoom lens show that approximately 90% of patients enjoy uncorrected near acuity of J3 or better, with close to 50% at J1, according to Robert J. Weinstock, M.D., associate professor, University of South Florida, St. Petersburg. Dr. Weinstock was using the lens for many of his patients and had the impression that patients were very happy with the IOL. To tally just how they were really doing he looked back at results for 79, initial consecutive patients. “I found that overall satisfaction with the ReZoom was very high,” he said. Dr. Weinstock determined that 37% were happy enough with the lens that they would recommend it to someone else. Among bilateral ReZoom users 90% of patients had uncorrected distance acuity of 20/30 or better and upwards of 40% were in the 20/20 range. With each eye alone, close to 80% had J3 acuity with the ReZoom and nearly 30% were at J1. Just 26 of the 79 patients reported the need to use reading glasses. Some patients, however, did have complaints. “A small percentage of patients were disappointed in their reading ability,” Dr. Weinstock said. “Also, a small to moderate segment were frustrated with their night driving.” He found that 15 of the patients reported having mild to moderate halos. In five cases the glare and halos were deemed severe and four of the patients opted to have the lenses explanted. “I did find that there was about a one to two percent explantation rate.” However, these were early cases, done before all the current tools for screening patients were available, he points out.

These numbers, however, do not fully highlight some of the intrinsic factors that the ReZoom brings to patients, Dr. Weinstock believes. He finds that while reading vision is better among his patients with the ReStor lens; however, the ReZoom had other things to offer. “I found that the ReStor didn’t give the same quality of distance visual acuity,” Dr. Weinstock said. “Also, the ReStor required a much more perfect optical system to perform well at distance.” For example, if a patient’s eyes are a little dry, if there is a little bit of residual corneal edema, or a little bit of posterior capsule opacification, Dr. Weinstock finds the ReZoom tends to perform better. “With any irregularity with the eye at all I think that the ReZoom is going to be more forgiving,” he said.

ReStor face-off

Meanwhile, Robert P. Lehmann, M.D., clinical associate professor of ophthalmology, Baylor College of Medicine, Houston, recently went back to see how bilateral patients fared with the AcrySof ReStor IOL (SN60D3) versus the ReStor aspheric lens (SN6AD3), which counters the positive asphericity of cornea with negative asphericity. Included here were 15 bilateral ReStor patients and 25 ReStor Aspheric IOL subjects. At the six-month mark Dr. Lehmann found that when it came to uncorrected binocular vision just 0.03% of patients had distance acuity of less than 20/20 with the aspheric lens versus 0.08% of those with the traditional ReStor. In terms of best corrected visual acuity while none of the traditional subjects attained better than 20/20 distance acuity, 0.05% of aspheric patients reached this mark. When it came to near acuity only 0.03% of traditional ReStor patients had less than 20/20 uncorrected acuity with none of the aspheric users falling into this group. Among bilateral aspheric lens users 0.04% had better than 20/20 uncorrected reading acuity. When distance vision was corrected to 20/20 just 0.07% of traditional ReStor users had less than 20/20 near acuity and again none of the aspheric users were below this mark. In the aspheric group 0.03% of patients still had better than 20/20 uncorrected reading acuity. Aspheric patients also fared better in terms of reading speed and functionality. “With the aspheric lens, those patients tested a little bit better in every parameter,” Dr. Lehmann said. These results validate what Dr. Lehmann was seeing in his own practice with the new aspheric lens. “I have enough experience to know that the aspheric has been a step in the right direction,” he said. “But I’m not naïve enough to think that 10 years from now we may not have something even better.” For now he sees both ReStor lenses as offering better reading vision than other presbyopic IOLs and good distance acuity.

Overall, presbyopic lenses such as the ReZoom now have an important place in the armamentarium, Dr. Weinstock believes. “I feel that for surgeons to become successful refractive cataract surgeons and be able to provide good results for their patients, they have to be able to use all the different technologies that are out there because this is becoming a customized procedure,” he said. “You have to choose the right technology for the right patient and then know how to use that technology properly to have the best chance for success.

Editors’ note: Dr. Weinstock has financial interests with Advanced Medical Optics (Santa Ana, Calif.). Dr. Lehmann has financial interests with Alcon (Fort Worth, Texas).

Contact

Lehman: 936-569-8278, rplehmann@cox.net

Weinstock: 727-585-6644, rjeinstock@yahoo.com

Scoping out expectations for multifocal lenses Scoping out expectations for multifocal lenses
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