Comparative visual outcome and quality of life between bilateral aspheric diffractive ReSTOR

1
Comparative 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).
2
POPULATION

• 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

3
EVALUATION ( 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

4
IOL 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

5
RESULTS 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
6
Results dysphotopsy

7
Results 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
9
Results Visual Performance
Reading Test Fluence and Comprehension

Satisfaction rate for intermediate vision
activities (PC test)
10
Defocus
Log
-1
-2
0
1
2
11
DISCUSSION / 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

12
CONCLUSION

• 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