Transcript Tecnis - ReZoom

Visual outcome comparison of bilateral multifocal
diffractive and refractive IOLs implantation vs
"Mix and Match" approach implantation
G. Ravalico, D. Fanni
The Author has no proprietary interest in any products or devices discussed in this presentation
University Eye Clinic
Trieste (Italy)
Head: Prof. Giuseppe Ravalico
Purpose
To compare visual outcomes and contrast sensitivity at far,
intermediate and near distances, reading ability, level of
satisfaction and quality of vision of patients bilaterally
implanted with refractive multifocal AMO ReZoom and with
diffractive bifocal Alcon Restor or AMO Tecnis IOLs with
patients implanted with refractive AMO ReZoom IOLs in one
eye and with diffractive AMO Tecnis or Alcon Restor IOLs in
the controlateral eye.
Materials and Methods
■ Group A: Tecnis
■ Group B: ReZoom
■ Group C: Restor
■ Group D: Tecnis - ReZoom
■ Group E: Restor - ReZoom
(26 pts; 12 F - 14 M)
(23 pts; 14 F - 10 M)
(23 pts; 13 F - 10 M)
(35 pts; 19 F - 16 M)
(21 pts; 16 F - 5 M)
AMO Tecnis
Diffractive MIOL
Age range: 50-80 yrs
(mean 70.5 yrs)
Alcon ReSTOR
Diffractive MIOL
AMO ReZoom
Refractive MIOL
INCLUSION CRITERIA
EXCLUSION CRITERIA
■ Age range 50-80 yrs
■ Mental receptiveness
■ Uneventful bilateral cataract surgery
■ Astigmatism > 2D
■ Preoperative visual acuity > 0.2
logMAR
■ Concomitant ocular diseases
Materials and Methods
■ Best distance-corrected far, intermediate and
near visual acuity (BCDVA, BCDIVA, BCDNVA)
■ Defocus curve
■ Reading speed (MNReading Charts)
■ Contrast sensitivity at far, intermediate and near
distances (VCTS 6500, 200 lux)
■ Modified VF-7 questionnaire
Best corrected distance visual acuity
% pts
Logarithmic Visual Acuity
Chart “ETDRS”
Chart R n° 2110
Chi square ns
Snellen
BCDVA was satisfactory in all patients without statistically significant differences among the groups.
100% of patients in all groups reached VA better than 20/40. Most of patients reached 20/20 VA.
Best distance-corrected near visual acuity
Logarithmic Visual Acuity Chart 2000
“NEW ETDRS” n° 2106
% pts
Chi square p<0.05
Snellen
Near visual acuity was significantly better in patients implanted with bifocal IOLs, in particular
with Tecnis IOL, than with multifocal IOLs.
Best distance-corrected intermediate
visual acuity
Logarithmic Visual Acuity Chart 2000 “NEW ETDRS” n° 2106 for testing at 40
cm
The Snellen ratio was applied to use this test at 60 (1.5x) and 80 (2x)
80 cm
60 cm
% pts
% pts
Snellen
Chi square p<0.05
Snellen
The percentage of patients reaching high values of intermediate visual acuity was high in all
study groups except the ReStor group.
Snellen
Binocular visual acuity vs defocus
5,92
Depth of focus
5,08
6,20
Depth of focus
Depth of focus
5,47
4,95
Depth of focus
Depth of focus
ANOVA p<0.05
 Tecnis  ReZoom
 Restor  Tecnis+ReZoom
 Restor+ReZoom
The bifocal IOLs showed a better near peak of vision than multifocal IOLs. Intermediate
visual acuity was significantly better with multifocal ReZoom and bifocal Tecnis than with
Restor IOL. “Mix and Match” patients obtained high values of visual acuity at all distances.
Contrast sensitivity (VCTS 6500, 200 lux)
Far
log C.S. 2,5
log C.S.
Near
2,5
2
2
1,5
1,5
1
1
0,5
0,5
0
0
1,5
3
6
12
18 cycles / deg
Intermediate
log C.S. 2,5
2
1,5
1
0,5
 Tecnis
 ReZoom
 Restor
 Tecnis + ReZoom
 Restor + ReZoom
0
1,5
3
6
12
18 cycles/deg
1,5
3
6
12
18 cycles / deg
A slight decrease in
contrast sensitivity at
near and
intermediate
distances was noted
in all patients.
“Mix and Match”
patients performed
better than other
groups.
Modified VF-7 test
Tecnis
ReZoom
Restor
Tecnis + ReZoom
Restor + ReZoom
99,5
99,25
98
92,50
97,5
Seeing signals
99
100
99,25
100
100
Seeing steps
100
100
100
100
100
Watching TV
100
95,50
100
100
97,5
Driving
95,25
99
100
95,5
96,25
Precise handling
97,5
83,25
92,50
95
90
Reading
92,50
79,5
84,75
94,75
91,25
Cooking
100
100
100
100
100
Colours
100
98
100
100
100
17,50
18,75
16,50
36
12,50
Satisfaction
Halos
Modified VF-7 questionnaire was used to evaluate the quality of vision and the patient satisfaction for intermediate
and near distance everyday activities. When patients were requested to score daily tasks, no significant
differences were noted in particular for activities requiring intermediate vision.
Only the halos presence was statistically higher in the Tecnis-ReZoom group.
MN Reading Charts
W/min
200
150
MN reading Charts
100
50
0
Tecnis
ReZoom
Restor
Tecnis+
ReZoom
Restor+
ReZoom
No significant differences were observed
among the groups in the reading speed.
Conclusions
■ Even though far, intermediate and near distance performances
were acceptable in all study groups, diffractive IOLs proved slightly
better than refractive IOLs at near distance.
■ Intermediate visual acuity was better with refractive multifocal and
bifocal “full diffractive” IOLs.
■ A slight decrease in contrast sensitivity, particularly at near and
intermediate distances, was noted in all patients.
Bilateral implantation of multifocal IOLs with “Mix and Match approach”
assures visual performances comparable with symmetrical bilateral
implantation with diffractive and refractive multifocal IOLs.