Transcript The ReSTOR Experience at the Henry Ford Health System

A Comparison Of Patient Satisfaction
With Modified Monovision Versus
The ReSTOR® Intraocular Lens
Neeti Parikh, MD
Fuxiang Zhang, MD
Department of Ophthalmology
Henry Ford Hospital
*The authors have no financial interest in the material presented
PURPOSE
To compare patient satisfaction of visual function
with modified monovision vs. with ReSTOR®
lens implantation

Monovision: a type of presbyopic correction in which one eye is
corrected for distance and the other eye for near

Modified monovision: smaller refractive difference between the two eyes
(Between 1.00 - 2.25 D anisometropia)

ReSTOR® : a multifocal intraocular lens that provides patients with a
range of vision, near through distance
METHODS
Part 1: Retrospective Chart review

Charts for patients who had cataract surgery between January 2005 and January 2007 from one
clinical practice in the Henry Ford Health System reviewed


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Inclusion criteria: Bilateral cataract extraction and implantation of either a conventional intraocular lens
with the goal of modified monovision or an AcrySof® ReSTOR® lens
Exclusion criteria: Other ocular co-morbidities (moderate to severe diabetic retinopathy, glaucoma with
significant visual field defects or optic nerve damage, ARMD) or Toric IOL implantations
Minimum of 1 month follow up post operative visit
Preoperative refraction , keratometry, IOL calculations
All patients underwent conventional phacoemulsification and in the bag implantations with Alcon
SN60 WF or SA60 AT lens or ReSTOR® : SN60D3 ReSTOR
Postoperative uncorrected visual acuity (distance and near), postoperative refraction
Part 2: Patient satisfaction survey


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Visual function questionnaire- 25 (VFQ-25), validated by the National Eye Institute
Amended to include questions about glare, halos, intermediate vision, and use of glasses after
surgery
Completed by patients 3- 24 months postoperatively
RESULTS
Modified Monovision
ReSTOR®
67
charts reviewed, 1 surgeon
76
charts reviewed, 8 surgeons
57
completed survey (85%)
68
completed survey (89%)
31%
male
40%
male
69%
female
60%
female
94%
Caucasian, 6% other
97%
Caucasian, 3% other
Mean

Age: 73 (SD =7 years)
modified monovision=
1.00 - 2.25 D anisometropia
Mean=1.4D,standard deviation= .3D
81% 1.00- 1.50 D
Mean
Age 68 (SD =12 years)
satisfaction score
VFQ-25 ResultsMean Satisfaction scores for Distance, Near, Driving
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
P>.05 for all
ReSTOR®
Modified
Monovision
r
e
nea stanc
di
i
driv
ng
VFQ-25 Results-Intermediate vision
How much difficulty do you have………?
No difficulty at all ............................................ 1
A little difficulty................................................ 2
Moderate difficulty........................................... 3
Extreme difficulty............................................. 4
Stopped doing this because of your eyesight ...5

Computer vision:
 ReSTOR® : 1.82 ± .92
 Modified Monovision 1.42 ± .59
 p=.036
VFQ-25 Results-Halos/Glare
I am bothered by glare/halos ….
All of the time………………….….1
Most of the time……………….….2
Some of the time………………......3
A little of the time…………………4
None of the time…………………..5
Glare:
ReSTOR® : 3.74 ±1.21
Modified Monovision: 3.98 ± 1.03
p=.339
Halos:
ReSTOR® : 3.39 ± 1.42
Modified Monovision: 4.66 ± .72
p <. 001
percent of patients
Uncorrected Visual Acuity at 1 month
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
p=.002
p=.162
ReSTOR®
Modified
Monovision
20/40 J3 or
or
better
better
Freedom from glasses
Modified Monovision: 14% of patients (who completed
survey) never wear glasses
ReSTOR® : 84% of patients (who completed survey) never
wear glasses
Use of glasses among “satisfied” patients (% pts who had
little to no difficulty with driving, distance, intermediate, or near
activities but still used glasses for these activities):
Modified
Monovision
ReSTOR®
Distance
61%
8%
Intermediate
67%
19%
Near
62%
18%
Driving
53%
9%
p<.001for all
CONCLUSIONS/DISCUSSION

Uncorrected distance visual acuity better in ReSTOR® group (20/40 or better)

No statistical difference in uncorrected near acuity (J3 or better) between the two groups

Modified monovision patients have more dependence on glasses (for all activities)

Modified monovision falls short of correcting for full monovision


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Average of only 1.4 D difference between 2 eyes
May not be enough to achieve high rate of glasses independence
No preoperative tolerance test performed for this group
 This is the reason for the modified approach to monovision in these patients
Astigmatism


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ReSTOR ® patients with ≥ 1 D of astigmatism treated with limbal relaxing incisions
26% of modified monovision patients had ≥ 1 D of preoperative astigmatism that was
not corrected
Patients with toric implants who had monovision were excluded from this study
CONCLUSIONS/DISCUSSION

Monovision patients more likely to wear glasses, but
still very satisfied

No statistical difference in satisfaction scores for driving,
distance, or reading between 2 groups

Statistically significant higher satisfaction score in modified
monovision group for intermediate (computer) vision

Modified monovision patients had no out of pocket costs for
the surgery (ReSTOR® cost to patient = $1895 per eye )

Modified monovision patients more likely to be willing to pay
for glasses
REFERENCES
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Boerner, C.F., Thrasher BH. Results of Monovision Correction in Bilateral
Pseudophakia. American Intraocular Implant Society Journal, 10. 1982. 49-50
Greenbaum S. Monovision Pseudophakia. Journal of Cataract and Refractive
Surgery. 28, 2003, 1439-1443
Handa et al. Ocular Dominance and patient satisfaction after monovision induced
by intraocular lens implantation. Journal of Cataract and Refractive Surgery, 30.
2004, 769-774
Maloney, W.F. Conventional IOL presbyopia correction:six steps to success. Ocular
Surgery News U.S. Edition March 1,2006.
Maloney, W.F. 20 years of developing conventional IOL presbyopia correction.
Ocular Surgery News U.S. Edition January 1, 2006.
Maloney, W.F. Conventional IOL still offen best choice for presbyopia correction.
Ocular Surgery News U.S. Edition November 1, 2005.
Maloney, W.F. Presbyopia success depends on comprehensive preop evaluation.
Ocular Surgery News U.S. Edition August 1.2005.
Maloney, W.F. Presbyopia correction will set a new standard for cataract surgery.
Ocular Surgery News U.S. Edition July 1,2005.
Mangione, C. M., Lee, P. P., Gutierrez, P. R., Spritzer, K., Berry, S., & Hays, R. D.
(2001). Development of the 25 – item National Eye Institute Visual Function
Questionnaire (VFQ – 25). Archives of Ophthalmology, 119, 1050-1058
Mangione, C. M., Lee, P. P., Pitts, J., Gutierrez, P., Berry, S., & Hays, R. D. (1998).
Psychometric properties of the National Eye Institute Visual Function
Questionnaire, the NEI – VFQ. Archives of Ophthalmology, 116, 1496 – 1504