LogMAR-Analysis of multifocal intraocular lenses: Clinical performance

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LogMAR-Analysis of multifocal intraocular lenses
Clinical performance
E-mail annett.mannsfeld_at_med.uni-heidelberg.de

• A. Mannsfeld, I.-J. Limberger,
• A. Ehmer, M.P. Holzer, G. U.Auffarth

University of Heidelberg, Department of
Ophthalmology, Germany Acting-chairman G.U.
Auffarth, MD
Dr. Holzer receives research and travel
reimbursement from 20/10 Perfect Vision, AMO,
Haag-Streit, Oculus and WaveLight. None of the
authors have a financial interest in the subject
matter of this poster.
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Background
The implantation of multifocal intraocular lenses
is gaining more and more importance by offering
patients spectacle-independence
postoperatively. Purpose of this clinical
prospective trial was to compare two diffractive
and refractive multifocal intraocular lenses
(MIOLs) in terms of postoperative functional
results. Moreover it should be tested if there
is a difference between subjective and objective
refraction between those two optical principles.

Annett Mannsfeld, Msc
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Background
Multifocal intraocular lenses

• TECNIS ZM 900 (AMO)
• 3-piece, silicone, 6 mm optic diameter,
• 12 mm total diameter
• diffractive posterior surface ? two focal points
  between near and distance vision
• near addition 4.0 D
• pupil size independent
• prolate anterior surface to compensate for
  corneal spherical aberrations

• ReZoom (AMO)
• 3-piece, acrylic, 6 mm optic, 13 mm total
  diameter
• five refractive zones 100 light transmission
  over all five optical zones
• transitions are supposed to provide intermediate
  vision
• pupil size dependent
• total near addition 3.50 D

Annett Mannsfeld, Msc
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Patients and Methods

• Tecnis ZM 900
• age 59.10 9.24 years (43 - 74)
• 20 patients (14 female, 6 male)
• 39 eyes were examined

• ReZoom
• age 57.83 15.73 years (19 - 78)
• 23 patients (17 female, 6 male)
• 36 eyes were examined

After a mean follow-up time of 13.43 12.96
months (range 3 to 41 months after surgery), the
patients were re-examined evaluating functional
results Un- and best-corrected distance visual
acuity was evaluated using the Nidek CP 690
DIN/ISO chart projector (OCULUS). Un-, distance-
and best-corrected near visual acuity was tested
using the Zeiss near reading charts in 33 cm
distance with logarithmic increments.
Furthermore, subjective and objective refraction
data measured with the Nidek AR-660A
autorefractor was compared.
Annett Mannsfeld, Msc
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Results
Distance visual acuity
The postoperative monofocal uncorrected distance
visual acuity (UCDVA) was 0.12 0.14 logMAR
(ReZoom) and 0.17 0.12 logMAR (Tecnis).
Bestcorrected monofocal distance visual acuity
(BCDVA) was 0.0 0.11 logMAR with ReZoom and
0.04 0.08 logMAR with Tecnis.
Comparison UCDVA
Comparison BCDVA
Annett Mannsfeld, Msc
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Results
Near visual acuity
UCNVA was 0.05 0.20 logMAR with Tecnis and 0.29
0.23 logMAR with ReZoom (monocular). Both IOLs
achieved a very good bestcorrected visual acuity
of 0.0 vs. 0.04 logMAR (Tecnis vs. ReZoom). The
ReZoom patients required an additional correction
of 1.76 1.01 D in average to improve UCNVA,
the Tecnis patients needed only 0.01 0.08 D
near addition
Comparison near additon
Annett Mannsfeld, Msc
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Results
Comparison autorefractor subjective refraction
Autorefractor revealed a bestcorrected visual
acuity of 0.16 0.18 (ReZoom) and 0.05 0.08
(Tecnis), while subjective BCDVA was 0.04
0.08 logMAR with Tecnis and 0.0 0.11 logMAR
with ReZoom.
Comparison BCDVA
Annett Mannsfeld, Msc
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Results
Comparison autorefractor subjective refraction
The ReZoom eyes showed a statistically
significant difference (P 3.86E-13, t-Test)
with a mean spherical equivalent of -1.09 0.83
D (objective) vs. -0.01 0.49 D (subjective).
52.78 of eyes showed a spherical equivalent
between -1.0 and -1.5 D with the autorefractor.
Subjectively evaluated 86.12 of eyes were
within 0.5 D. In the Tecnis group, subjective
and objective refraction were comparable with
only slight differences being not statistically
significant. Objectively, a mean spherical
equivalent of 0.32 0.83 D was calculated
compared to 0.51 0.2 D subjectively.
Annett Mannsfeld, Msc
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Conclusions
The Tecnis MIOL showed better near visual acuity
results while ReZoom offers better distance
visual acuity results and reading glasses are
often necessary postoperatively. Autorefractor
measurements in diffractive multifocal lenses are
possible with a high accuracy between objective
and subjective refraction. In refractive lenses
autorefractor measurements are not reliable with
differences of -1 D compared to the subjective
refraction.
Annett Mannsfeld, Msc
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G.U. Auffarth, MD A. Ehmer, MSc M.P. Holzer,
MD I.J. Limberger, MD A. Mannsfeld, Msc T.M.
Rabsilber, MD M.J. Sanchez, MD I. Schmack, MD