Title: Comparative visual outcome and quality of life between bilateral aspheric diffractive ReSTOR
1Comparative visual outcome and quality of life
between bilateral aspheric diffractive ReSTOR
with addition 4D versus 3D, or mix-match
implantation.
- M-A. BIGOU, B. COCHENER
- FRANCE
Financial interest code E My travel expenses
have been reimbursed, paid in full or subsidized,
by a company that makes/develops/provides
ophthalmic products or services (Alcon).
2POPULATION
- 42 patients (84 eyes)
- Mean age 50 /- 5 years
- Patent presbyopia addition 2.5 to 3 D
- All of them expected independancy of spectacles
- Lensectomy december 2007 to december 2008
- 3 groups
- Bilateral diffractive RestorAD1 (3) (ALCON)
20 eyes - Bilateral diffractive RestorAD3 (4) (ALCON)
40 eyes - Mix-Match diffractive Tecnis (AMO) and in the
dominant eye refractive Rezoom (AMO) 24 eyes
3EVALUATION ( 5 /- 1.5 months post-surgery)
- Visual acuities
- without correction, binocular
- Distance, intermediate and near.
- Quality of vision
- Functional signs dysphotopsy (halo, glare),
satisfaction rate - Contrast sensitivity (static, mesopic) /- glare
- PC software EyeVis Pod for the quality of
vision study and visual performance score - Defocus
4IOL REFRACTIVE / DIFFRACTIVE
- REZOOM (AMO) non absorbent acrylic
- Refractive , 5 zones with aspheric transition,
optiedge - Addition 4D
- Incision 2.8mm
- TECNIS (AMO) non absorbent acrylic
- Diffractive on the posterior side, aspheric on
the anterior side - Addition 4D
- Incision 2.8mm
- RESTOR (ALCON)
- Joint optical diffractive in the central 3.6mm
and refractive in the periphery, apodisation
included - Addition 4D (AD3) and recently 3D (AD1)
- Incision 2mm
5RESULTS Visual Acuity
Diffractive bilateral ReStor AD1 Diffractive bilateral ReStor AD3 Mix -Match Rezoom / Tecnis
Distance VA gt20/25 20/40-20/25 lt20/40 87.5 12.5 0 73 27 0 81 19 0
Interme-diate VA gt20/25 20/40-20/25 lt20/25 85 10 5 30 31 39 86 13 1
Near VA P2 100 100 80
Do need accasional wear of spectacles
Increase to 85 after excimer treatment for
residual ametropia
6Results dysphotopsy
7Results contrast sensitivity
ReStor AD1 and Mix-Match better than AD3 in high
spatial frequency ( higher visual discrimination)
Mix-Match seems to be lightly better compared
with bilateral diffractive implantation for
mesopic and with glare contrast
8 PC platform for vision quality
evaluation
9Results Visual Performance
Reading Test Fluence and Comprehension
Satisfaction rate for intermediate vision
activities (PC test)
10Defocus
Log
-1
-2
0
1
2
11DISCUSSION / litterature data
- Deterioration of the quality of life when
presbyopia appears - Luo BP, Brown MM. The quality of life associated
with presbyopia. Am J Ophthalmol 2008
apr145(4)618-622. - No way to recover acommodation but only to
compensate it, with unperfect results - Spectacles / contact lenses
- Presbylasik
- Accommodative IOL / multifocal IOL
- Mix-match requires neuro-adaptation but allows
better visual performances at all distance
vision. - Eye Q Report. ESCRS. 2006 oct 3rd
- Goes FJ. Visual results following implantation of
a refractive multifocal IOL in one eye and a
diffractive multifocal IOL in the contralateral
eye. J Refr Surg 2008 mar24(3)300-5 - Gunenc U, Celik L. Long term experience with
mixing and matching refractive array and
diffractive CeeOn multifocal IOL. J Refr Surg
2008 mar24(3)233-42
12CONCLUSION
- Restor AD1 seems to give a better depth of focus
compared with Restor AD3 and better visual
performances than Mix-Match implantation. - Further investigations have to be driven ,
increasing the number of patients and including
other methods for presbyopia compensation or
restoration. - Specific care required for patients selection ,
according to preoperative ametropia and to their
way of life , in order to select the best
custom implantation