A Comparison Of Patient Satisfaction With Modified Monovision Versus The ReSTOR

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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
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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

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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
• 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
• 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

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RESULTS
Modified Monovision 67 charts reviewed, 1 surgeon 57 completed survey (85) 31 male 69 female 94 Caucasian, 6 other Mean Age 73 (SD 7 years) modified monovision 1.00 - 2.25 D anisometropia Mean1.4D,standard deviation .3D 81 1.00- 1.50 D ReSTOR 76 charts reviewed, 8 surgeons 68 completed survey (89) 40 male 60 female 97 Caucasian, 3 other Mean Age 68 (SD 12 years)
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VFQ-25 Results-Mean Satisfaction scores for
Distance, Near, Driving
Pgt.05 for all
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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

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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 time4
• 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 lt. 001
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Uncorrected Visual Acuity at 1 month
p.002
p.162
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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
plt.001for all

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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
• 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
• 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

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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

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