Transcript העלאת קובץ המאמר או המצגת

Controversies about binocular function and
patient satisfaction after induced conventional
monovision in case of
bilateral intraocular lens implantation
Vikas Jain, MD
Sourabh D Patwardhan, MD, DNB, FRCS
Rajvardhan Azad, MD FRCS
Level of
evidence : II
Confirmatory
Dr Rajendra Prasad Centre For Ophthalmic Sciences, AIIMS,
.
New Delhi, India
The authors have no financial interest in the subject matter of this poster.
Aim
 To evaluate the success of induced conventional
monovision
in
patients
with
bilateral
cataract
extraction with IOL implantation on the basis of
ability to achieve spectacle free life, stereopsis and
patients satisfaction
Methods

Fifteen patients with bilateral cataract were enrolled in the study. We tested ocular
dominance in all.

Non dominant eye was operated first with 1.5D overcorrection. After 4 weeks dominant
fellow eye was operated to achieve emmetropia. A questionnaire was asked to all patients
to assess satisfaction level at 2nd and 4th month follow-up. According to response
patients were divided into 4 categories.
QUESTIONNAIRE
Do you have any difficulty in-
1.
reading (near vision)
2.
watching television (intermediate vision)
3.
driving (distance vision) without spectacles
Each point had 5 responses- No difficulty at all
1
- A little difficulty
2
- Moderate difficulty
3
- Extreme difficulty
4
- Stopped doing this because of extreme difficulty
5
Method …..
Categories
According of response to questionnaire patients divide in 4
categories
Category
1
Score
3-6
Impression
No need of spectacles
2
7-9
Most of the time manage
without glasses
3
10-12
Sometimes manage without
glasses
4
13-15
Always need glasses
Results
•
The mean anisometropia between near and distant eye was 1.17D (range
0.75-1.5).
•
Uncorrected distance acuity was 20/30 or better in all eyes and 20/20 or
better in 9 (60 %) eyes.
•
All patients achieved N8 or better uncorrected near acuity and it was
better than N6 in 11(73%) of patients.
•
The mean near stereopsis on TNO was 173.33 ±65.31 seconds of arc.
•
The mean distance stereoacuity on FD-2 was 51±11.20 sec of arc.
•
Our study showed that patients' satisfaction improved with time.
•
At the end of 2nd month average satisfaction score was 4.85(range 3-7)
which improved to 4.14(range 3-5) at 4th month follow -up.
•
All patients in our study are satisfied with result and no one uses
glasses for reading, television watching or driving.
Table 1. Preoperative BCVA and Postoperative UCVA, refractive
status of dominant and non dominant eyes
Parameter
Dominant eye (n=15)
Near eye (n=15)
Mean
SD
Mean
SD
Preop BCVA for distance(log
MAR)
0.514
0.106
0.60
0.057
Postop UCVA for
distance(log MAR)
0.114
0.106
0.314
0.089
Post op Spherical equivalent
-0.285
0.172
-1.46
0.365
Table 2: Distribution of patients in different categories
Category I
(3-6)
Category II
(7-9)
Category III
(10-12)
Category IV
(>13)
Patients at 2nd
month follow-up
13 (86.6%)
2 (13.3%)
0
0
Patients at 4th
month follow-up
15 (100%)
0
0
0
Table 3: Postoperative visual function
Characteristic
Distance UCVA (Snellen)
Result
N(%)
<20/20
9(60%)
>20/20-20/30
6(40%)
>20/30
Near UCVA
0
N(%)
< N6
11(73%)
>N6-N8
4(26%)
>N8
Distance stereopsis
0
(seconds of arc)
Mean
51±11.21
Range
35-80
Near stereopsis
(seconds of arc)
Mean
173.33±65.31
Range
80-240
Mean contrast sensitivity
Distance eye
Near dominant eye
Both eyes
1.45±0.09
1.41±10
1.59±0.09
Conclusions and Recommendations
 In conclusion we recommend conventional
monovision with moderate anisometropia in bilateral
IOL implantation to improve success of monovision
and patients satisfaction level.
 With time patients satisfaction level and stereopsis
may improve because of visual adaptation.
 Preoperative counseling and patients motivation
improve the success of monovision.
References
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1. Steinert RF, Aker BL, Trentacost DJ et al. A prospective comparative study of the AMO
ARRAY zonal progressive multifocal intra ocular lens and a monofocal intraocular lens.
Ophthalmology 1999; 106: 1243-1255.
2. Haring G, Dick HB, Krummenauer F, et al. Subjective photic phenomena with refractive
multifocal and monofocal intraocular lenses; results of multicenter questionnaire. J Cataract
Refract Surg 2001; 27:245-249.
3. Ravalico G, Parentin F, Baccara F. effect of astigmatism on multifocal intra ocular lenses. J
Cataract Refract Surg 1999; 25: 804-807.
4. Hayashi k, Hayashi H, Nakao F,Hayashi F. influence of astigmatism on multifocal and
monofocal intraocular lenses. Am J Ophthalmol 2000; 130:477-482.
5. Hayashi k, Hayashi H, Nakao F, Hayashi F. Correlation between papillary size and
intraocular lens decentration and visual acuity of a zonal progressive multifocal lens and
monofocal lens. Ophthalmology 2001; 108: 2011-2017.
6. Yaron M. Finkelman, Jonathan Q, Graham D. Barrett. Patients satisfaction and visual
function after pseudophakic monovision. J Cataract Refract Surg 2009; 35: 998-1002
7. Jain S, Ou R, Azar DT. Monovision outcomes in presbyopic individuals after refractive
surgery.Ophthalmology 2001; 108: 1430-1433.
For any correspondence please contact to: Vikas Jain. Email: [email protected]