See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/23781257

Comparison of Diffractive and Refractive Multifocal Intraocular Lenses in

Presbyopia Treatment

Article  in  Collegium antropologicum · November 2008

Source: PubMed

CITATIONS READS

16 152

7 authors, including:

Ante Barisic Iva Dekaris

Eye Hospital Svjetlost, Zagreb, Croatia Eye Hospital Svjetlost, University of Rijeka
13 PUBLICATIONS   79 CITATIONS    83 PUBLICATIONS   1,327 CITATIONS   

SEE PROFILE SEE PROFILE

Nikica Gabrić Maja Bohac

University of Rijeka Specialty Eye Hospital "Svjetlost", Zagreb, Croatia
83 PUBLICATIONS   738 CITATIONS    21 PUBLICATIONS   74 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Comparison of SMILE and Femto LASIK in myopia View project

Simple Fixation Technique of Three Piece Intraocular Lens to the Posterior Iris Surface View project

All content following this page was uploaded by Iva Dekaris on 20 May 2014.

The user has requested enhancement of the downloaded file.

 Coll. Antropol. 32 (2008) Suppl. 2: 27–31
Original scientific paper

Comparison of Diffractive and Refractive

Multifocal Intraocular Lenses in Presbyopia
Treatment
Ante Bari{i}, Iva Dekaris, Nikica Gabri}, Maja Boha~, Ivana Romac,
Ivana Mravi~i} and Ratimir Lazi}
Eye Clinic »Svjetlost«, Zagreb, Croatia

ABSTRACT

Multifocal intraocular lenses (MFIOL) enable good near and far vision after cataract surgery. Excellent results with
cataract patients encouraged ophthalmologists to implant MFIOL after clear lens extraction (CLE). There are two types
of MFIOL: diffractive and refractive. In our prospective study we compared clinical outcomes after CLE and bilateral im-
plantation of diffractive (Tecnis Multifocal), (N = 100 eyes, 50 patients) and refractive (ReZoom), (N = 100 eyes, 50 pa-
tients) MFIOL to patients with presbyopia and hyperopia. Near and distant uncorrected visual acuity (UCVA), spectacle
dependency, subjective satisfaction and visual disturbances were measured and compared between two groups. Patients
achieved good near and distant UCVA in both groups. »Tecnis« group had better near UCVA (statistically not signifi-
cant) and less night time visual disturbances. »ReZoom« group reported less problems with intermediate vision. Diffra-
ctive and refractive MFIOL enable high rate of spectacle independency to presbyopic hyperopic patients with low rate of
side-effects. Refractive MFIOL provide better intermediate vision and diffractive slightly better near vision and less ha-
loes and glare.

Key words: presbyopia, hyperopia, multifocal, lenses, diffractive, refractive, phacoemulsification, pseudophakia

Introduction
Presbyopia and its treatment options are intensively have well near and far uncorrected visual acuity
investigated in modern ophthalmology. Although, there (UNCVA), low spectacle dependency and they are highly
are numerous discussions regarding causes and optimal satisfied5. Thanks to the fact that MFIOL can produce
treatment of presbyopia, clear answers are still not avail- two images and excellent experience in cataract patients,
able. At the moment, glasses are mostly used for correc- we started to use them in refractive lens exchange (RLE)
tion of presbyopia but many patients dislike them. In ev- as presbyopia treatment.
eryday practice we see that more and more people want There are some side-effects of MFIOL implantation
to become independent of glasses. such as visual disturbances at night, halos and glare and
»Monovision« principle, contact lenses, laser refrac- problems with intermediate vision (work at computer)6.
tive surgery and new accommodative intraocular lenses Those problems are reduced three to twelve postopera-
are current attempts for presbyopia treatment1. Those tive months, so most of patients do not have serious
methods did not achieve completely satisfying outcomes complains7. Postoperative astigmatism is one of the most
and have many limits in patient selection. important issues. It is the most common reason for wear-
Multifocal intraocular lenses (MFIOL) have two or ing glasses after MFIOL implantation so we have to
more focuses and they enable good near and distant vi- avoid patients with more than 1D of preoperative astig-
sion after lens removal2,3. They can be implanted to cataact matism.
patients and after clear lens extraction as refractive sur- There are two types of MFIOL: diffractive and refrac-
gery procedure4. Cataract patients who received MFIOL tive. Diffractive MFIOL use light diffraction at an inter-

Received for publication July 30, 2008

27
A. Bari{i} et al.: Comparison of Diffractive and Refractive MFIOL in Presbyopia Treatment, Coll. Antropol. 32 (2008) Suppl. 2: 27–31

ference grid to produce two different focal points8. In re- 120

fractive MFIOL, refractive power changes from centre to
periphery of lens and produces many focuses9. Tecnis
100
Multifocal is diffractive MFIOL which has diffractive
posterior surface and prolate anterior surface that sup-
presses spherical aberrations. It has +4.00 D addition for 80

Number of eyes
reading distance. Light distribution between two focuses
is 50–50%. ReZoom is refractive MFIOL composed of 5
optical zones with aspherical transition. Three zones, in- 60
cluding central, are for far vision, other two for near.
ReZoom distributes 10–11% of light to intermediate fo-
cus. In our study we have investigated clinical outcomes 40
of Tecnis and ReZoom implantation to presbyopic and
hyperopic patients after clear lens extraction and com-
pared obtained differences between two lenses. 20
<0.8

Patients and Methods 0 >0.8

Tecnis Multifocal ReZoom
In this prospective, randomized, comparative study, Fig. 2. Statistical analysis of difference between distance uncor-
we divided patients in two groups. Clear lens extraction rected visual acuity (UCVA) in Tecnis Multifocal and ReZoom
was performed in both groups on the same PHACO ma- group. c2 = 0.41; df = 1; p = 0.670.
chine using the same operative technique by two experi-
enced surgeons, followed by MFIOL implantation. In
first group, Tecnis MFIOL were bilaterally implanted to SPSS 11.0 for Windows was used for statistical analy-
50 patients (N = 100 eyes) and in second, ReZoom sis. Since there were two investigated groups with di-
MFIOL also to 50 patients (N = 100 eyes). There were no chotomous variables, statistical significance was deter-
significant differences between the two investigated groups mined by c2 test at level of 5%.
regarding age, gender and ocular pathology. Mean age
was 52 ± 3.7 years in »Tecnis« group and 54 ± 2.6 years in
other one, 29 females and 21 males in both groups. In-
Results
cluding criteria were presbyopia and hyperopia more Patients achieved excellent distance and near uncor-
than +1.00 D, need for a bilateral IOL implantation, pa- rected visual acuity (UCVA) in both groups. UCVA better
tients who dislike glasses and were highly motivated for than 0.8 (20/25) was achieved in 89.00% eyes in »Tecnis«
such procedure. Patients with astigmatisms over 1.00 D, group and 86.00% in »ReZoom« group (Figure 1). There
retinal or any other serious ocular pathology, profes- was no statistically significant differences between groups
sional drivers, people with high professional visual needs (c2 = 0.41; df = 1; p = 0.670) (Figure 2). Near UCVA was
or unrealistic expectations were excluded. Preoperative also good, 85.00% read J2 or better in »Tecnis« group and
best corrected visual acuity in all cases was 1.0. Follow up 79.00% in »ReZoom group (Figure 3), without statisti-
was at least 6 months. Near and distant uncorrected vi- cally significant differences between lenses (c2 = 0.866;
sual acuity (UCVA), spectacle dependency, subjective sat- df = 1; p = 0.457) (Figure 4). 72.00% of patients never
isfaction and visual disturbances were measured and wear glasses and 28.00% wear them sometimes when
compared in both groups. they read small letters or work at computer in »Tecnis«

70 70
60 60
50 50
No. of eyes

No. of eyes

40 40
Tecnis Multifocal Tecnis Multifocal
30 30
ReZoom ReZoom
20 20
10 10
0 0
1 0,9 0,8 0,7 0,6 0,5 0,4 J1 J2 J3 J4 J5
Distant UCVA Near UCVA

Fig. 1. Distance uncorrected visual acuity (UCVA) at six postop- Fig. 3. Near uncorrected visual acuity (UCVA) at six postopera-
erative months on eyes implanted with diffractive (Tecnis Multi- tive months on eyes implanted with diffractive (Tecnis Multifocal)
focal) and refractive multifocal intraocular lens (ReZoom). and refractive multifocal intraocular lens (ReZoom).

28
 A. Bari{i} et al.: Comparison of Diffractive and Refractive MFIOL in Presbyopia Treatment, Coll. Antropol. 32 (2008) Suppl. 2: 27–31

120 120

100 100

80

Number of patients
80
Number of eyes

60 60

40 40

20 20
Wear glasses
<J2
Never
0 >J2 0 wear glasses
Tecnis Multifocal ReZoom Tecnis Multifocal ReZoom
Fig. 4. Statistical analysis of difference between near uncorrected Fig. 6. Statistical analysis of difference between portion of time
visual acuity (UCVA) in Tecnis Multifocal and ReZoom group. c2 patients wear reading glasses in Tecnis Multifocal and ReZoom
= 0.866; df = 1; p = 0.457. group. c2 = 0.190; df = 1; p = 0.828

group. 8.00% of »ReZoom« patients have to wear glasses Discussion

half time, 24.00% wear them sometimes and 68.00%
never (Figure 5), also there was no statistically signifi- Hyperopic and presbyopic patients in this study, who
cant differences between groups (c2 = 0.190; df = 1; p = underwent refractive lens exchange followed by implan-
0.828) (Figure 6). Binocular UCVA was even better, 84.00% tation of diffractive or refractive multifocal intraocular
of patients read 1.0 and 72.00% J1. All »Tecnis« patients lens, were highly satisfied. They have good near and far
would implant the same lens again (Figure 7) and aver- vision in both groups, diffractive and refractive and they
age satisfaction mark was 8.9 at 1–10 scale. In »ReZoom« are free of glasses most of time. ReZoom patients have
group, 4 patients would not implant it again (Figure 7) excellent far vision in bright light because central zone is
and average mark was 7.8. 10 patients in »Tecnis« group for distant focus and it acts like monofocal lens, but they
and 21 in »ReZoom« complained at mild to moderate have very poor near vision in same light conditions. Pa-
night driving visual disturbances. In »ReZoom« group we tients who received ReZoom reported less problems with
had to explant 4 lenses (2 patients) due to severe haloes intermediate vision and less need for small hyperopic
and secondary implanted monofocal IOL. In »Tecnis« correction (+0.75 dsph). Refractive lenses produce mul-
group 7 patients had problems with work at computer tiple focuses and distribute 10–18% of light, depend on
and they have to use reading glasses (+ 0.75 dsph) when pupil size so they have better vision at 60–80 cm. Di-
they work for a longer time. In »ReZoom« group 4 pa- ffractive lenses are bifocal and light distribution is be-
tients had to wear glasses for computer occasionally. tween near and far focus (50–50%) so intermediate vision
Three patients had decentration of IOL, we made suc- is poorer than refractive, but they are independent on
cessful reposition of IOL. Other intra-operative or post- pupil size10. Night time visual disturbances, haloes and
-operative complications were not reported. glares were reported by patients in both groups and

Near spectacle wear

80% Would you have Tecnis/ReZoom
IOL implanted again
70%
100%
Patients (%)

60%
50% 80%
Patients (%)

Tecnis
40% 60%
ReZoom Yes
30% No
20% 40%

10% 20%

None Some Half Most All 0%

Tecnis ReZoom
Portion of timewearing glasses

Fig. 5. Portion of time patients wear reading glasses at six post- Fig. 7. Patient’s subjective satisfaction after diffractive (Tecnis
operative months after implantation of diffractive (Tecnis Multi- Multifocal) and refractive multifocal intraocular lens (ReZoom)
focal) and refractive multifocal intraocular lens (ReZoom). implantation.

29
A. Bari{i} et al.: Comparison of Diffractive and Refractive MFIOL in Presbyopia Treatment, Coll. Antropol. 32 (2008) Suppl. 2: 27–31

those are side-effects of MFIOL because one image is al- change because these patients have big expectations and
ways blurred and this defocused light energy creates dis- request perfect vision; as good as they had before opera-
turbances. ReZoom patients reported more severe prob- tion. It is important to spend enough time with patients
lems with halos and we had to explant four lenses in two before surgery and to explain them all advantages and
patients. Other patients who complained of night time some potential disadvantages of this treatment. Patients
visual disturbances had these issues weakened and al- who ask for guaranties and can not accept possibility to
most disappeared in six months of follow up. Also, after wear glasses sometimes when they work at computer are
that period, portion of time they wore reading glasses not candidates for MFIOL.
was reduced. This is explained by the fact that time is If we compare our results with recent studies (2008),
necessary for brain to adjust to new situation with two we will see that F. J. Goes and S. Cillino in their studies
images. Optimal results are accomplished with bilateral have similar results for distance UCVA, visual distur-
implantation and patients faster adapt themselves to bances and intermediate vision for both lenses, but be-
lenses if we perform simultaneous implantation. Three tter near UCVA and spectacle independence for Tecnis
patients complained of blurred image due to IOL decen- Multifocal and worse for ReZoom6,7.
tration so we performed reposition of IOL which was suc-
cessful and complains disappeared. These emphases that At the moment we do not have perfect solution for pa-
surgeon’s skill and experience is important and this kind tients with presbyopia and refractive lens exchange with
of lens must be very well centrated during surgery. Most implantation of MFIOL is the optimal treatment for
of patients who did not achieve UCVA 1.0 had postopera- carefully selected patients. Our study proved that
tive astigmatism; although we excluded those with more CLE+MFIOL highly reduce spectacle dependency and
than 1.00 D preoperative astigmatism. For them, it is insure patient’s satisfaction with minimal visual distur-
possible to perform laser refractive surgery 3–6 months bances. Attention should be made that those patients
after operation to correct this postoperative astigma- whose professional or living style is not favorable for
tism11. Satisfaction was high, especially in presbyopes MFIOL are excluded from this treatment. People who of-
with higher hyperopia. Average mark in Tecnis group ten drive in night and live active professional and private
was 8.9 and 7.8 in ReZoom group. Patients in Tecnis life are not perfect for refractive IOL. We have also con-
group complained to mild halos, glare, longer period of cluded that patients with diffractive IOL who work more
accommodation, reading problems with very small let- than 4–5 hours at computer should accept possibility to
ters and computer, but all patients would implant the wear reading glasses sometimes.
same lens again. Patients in ReZoom reported serious
problems with halos and moderate with near reading.
They needed longer period of adaptation. Four patients Conclusion
would not implant this lens again.
In our practice we meet patients who do not want to Diffractive MFIOL enable excellent near and far vi-
wear glasses. Many of them are presbyopes and laser re- sion and have no restriction on pupil size and reduce
fractive surgery or Phacic IOL is not helpful for them. night visual issues but intermediate vision is poor. Re-
MFIOLs proved to be good choice for patients who are fractive lenses give excellent far vision, good near and in-
highly motivated and have realistic expectations12,13,14. termediate images but their disadvantages are problems
Patient selection is the key point for refractive lens ex- with halo and glare.

REFERENCES
1. SARAGOUSSI J, Ophtalmol, 30 (2007) 552. — 2. BELLUCCI R, YY, DE BRABANDER J, HENDRIKSE F, NUIJTS RM, J Cataract Re-
Curr Opin Ophthalmol, 16 (2005) 33. — 3. LANE SS, MORRIS M, fract Surg, 34 (2008)1476. — 9. AUFFARTH GU, RABSILBER TM, KO-
NORDAN L, PACKER M, TARANTINO N, WALLACE RB, Ophthalmol HNEN T, HOLZER MP, Ophthalmologe, 105 (2008) 522. — 10. CHIAM PJ,
Clin North Am, 19 (2006) 89. — 4. FERNANDEZ-VEGA L, ALFONSO JF, CHAN JH, HAIDER SI, KARIA N, KASABY H, AGGARWAL RK, J Cata-
RODRIGUEZ PP, MONTES-MICO R, Ophthalmology, 10 (2007) 37. — 5. ract Refract Surg, 33 (2007) 2057. — 11. JENDRITZA BB, KNORZ MC,
DENOYER A, LE LEZ ML, MAJZOUB S, PISELLA PJ, J Cataract Re- MORTON S, J Refract Surg, 24 (2008) 274. — 12. ALIO JL, TAVOLATO
fract Surg, 33 (2007) 210. — 6. CILLINO S, CASUCCIO A, DI PACE F, M, DE LA HOZ F, CLARAMONTE P, RODRIGUEZ-PRATS JL, GALA A,
MORREALE R, PILLITTERI F, CILLINO G, LODATO G, Ophthalmol- J Cataract Refract Surg, 30 (2004) 2494. — 13. PACKER M, HOFFMAN
ogy, 115 (2008) 1508. — 7. GOES FJ, J Refract Surg, 24 (2008) 243. — 8. RS, FINE IH, DICK HB, Int Ophthalmol Clin, 46 (2006) 63. — 14. HOL-
DE VRIES NE, WEBERS CA, MONTÉS-MICÓ R, TAHZIB NG, CHENG ZER MP, RABSILBERT M, AUFFART GU, Ophthalmologe, 103 (2006) 661.

A. Bari{i}

Eye Clinic »Svjetlost«, Zagreb, Croatia

e-mail:[email protected]

30
 A. Bari{i} et al.: Comparison of Diffractive and Refractive MFIOL in Presbyopia Treatment, Coll. Antropol. 32 (2008) Suppl. 2: 27–31

USPOREDBA DIFRAKTIVNIH I REFRAKTIVNIH MULTIFOKALNIH

INTRAOKULARNIH LE]A U TERAPIJI PRESBIOPIJE

SA@ETAK

Multifokalne intraokularne le}e (MFIOL) omogu}uju dobar vid na blizinu i daljinu nakon operacije katarakte. Odli~ni
rezultati s bolesnicima kojima je operirana katarakta ohrabrila je oftalmologe na ugradnju MFIOL nakon odstranjenja
bistre le}e (CLE). Postoje dvije vrste MFIOL: difraktivne i refraktivne. U na{oj prospektivnoj studiji uspore|ivali smo
klini~ke rezultate nakon CLE i obostrane ugradnje difraktivne (Tecnis Multifocal), (N = 100 o~iju, 50 bolesnika) i
refraktivne (ReZoom), (N = 100 o~iju, 50 bolesnika) MFIOL presbiopima i hipermetropima. Mjerili smo nekorigiranu
vidnu o{trinu (UCVA) na blizinu i daljinu, ovisnost o nao~alama, subjektivno zadovoljstvo i vidne smetnje bolesnika i
uspore|ivali ih izme|u dvije skupine. Bolesnici su ostvarili dobru UCVA na blizinu i daljinu u obje skupine. »Tecnis«
skupina imala je ne{to bolju UCVA na blizinu (bez statisti~ke zna~ajnosti) i manje no}nih smetnji vida. »ReZoom«
skupina prijavila je manje problema s intermedijarnim vidom. Difraktivne i refraktivne MFIOL omogu}uju visok stu-
panj neovisnosti o nao~alama presbiopima hipermetropima uz mali broj nuspojava. Refraktivne MFIOL osiguravaju
bolji intermedijarni vid, a difraktivne ne{to bolji vid na blizinu i manje haloa i zablje{tenja.

31

View publication stats