Recently, colleagues and I conducted a study designed to compare the visual outcomes of patients implanted bilaterally with the TECNIS Multifocal IOL (Abbott Medical Optics Inc., Santa Ana, CA) and the CRYSTALENS AO Aberrationfree Accommodating IOL (Bausch + Lomb, Rochester, NY) after cataract surgery. This article reports on the 6- month data of 40 enrolled subjects in this prospective, nonrandomized study.
Each patient attended five visits: preoperative (both eyes evaluated), operative (each eye evaluated), and 1, 3, and 6 months postoperative (both eyes evaluated). At the time of this writing, 40 individuals have completed the 6-month visit. The mean ages were 67 for the TECNIS Multifocal IOL group (n=20) and 66.7 years for the CRYSTALENS AO group (n=20), and all subjects had bilateral cataracts for which we planned phacoemulsification extraction and posterior IOL implantation. The visual potential of each eye was 20/25 or better after removal of the cataract and implantation of the IOL. The preoperative distance BCVA was worse than 20/40 Snellen, and the mean preoperative spherical equivalent was -.194 (standard deviation, 2.5) in the TECNIS group and -.069 (SD, 1.3) in the CRYSTALENS group. Each eye’s naturally dilated pupil size (in dim light with no dilation medications) was > 4.0 mm, and their preoperative corneal astigmatism was 1.00 D or less. Other than the cataract, every eye was healthy.
Figure 1 shows the 1-, 3-, and 6-month outcomes for near UCVA in both study groups. By 6 months, the difference in near visual performance between the two groups was statistically significant (P=.007), with those in the TECNIS Multifocal IOL group achieving almost 20/23 UCVA, and the CRYSTALENS AO recipients reaching approximately 20/33 UCVA. The two groups achieved a similar visual performance at intermediate and distance viewing.
We also administered a subjective questionnaire to patients to judge their visual performance at 6 months. When we asked the subjects how easy it was to perform near, intermediate, and distance tasks without glasses, a nearly equal percentage of patients in the two cohorts reported that seeing objects in the distance was easy or very easy, but a greater percentage of TECNIS Multifocal recipients experienced ease with intermediate tasks (working at a computer or reading at arms’ length), and almost twice as many TECNIS Multifocal IOL subjects reported ease with reading small print in dim light (Figure 2). When we asked the subjects the distance at which reading was comfortable, 89% of the TECNIS Multifocal IOL subjects responded that they felt the distance at which they could read comfortably was perfect, versus 40% of those in the CRYSTALENS AO group (P=.035). Of the remaining Crystalens recipients, 55% felt that their reading distance was either a little or much too far (Figure 3).
Finally, we asked the patients how much their uncorrected vision fluctuated during activities. Although a similar percentage of patients in each group said that their vision fluctuated not at all or only some of the time during distance viewing, only 45% of the CRYSTALENS AO patients reported none or some fluctuation when using a computer, compared with 80% of individuals who received the TECNIS Multifocal IOL. Likewise, 89% of patients implanted with the TECNIS Multifocal IOL experienced none or some fluctuation when reading small print in dim light, versus 61% of the CRYSTALENS AO subjects.
These preliminary results show that the TECNIS Multifocal IOL provides statistically significantly better vision at near than the CRYSTALENS AO, although both lenses offer similarly excellent vision at distance and intermediate. Furthermore, the TECNIS Multifocal IOL seemed to provide greater visual flexibility for patients; a greater percentage of TECNIS patients reported more ease reading small print in dim light and reading at arms’ length. Follow-up for this study is ongoing.
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Tyson FT.Evaluation of the TECNIS multifocal and Crystalens accommodating intraocular lenses.Presented at:The ESCRS Annual Meeting;September 17-21;Vienna,Austria.