G. Ravalico, D. Fanni

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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
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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.
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Materials and Methods

• Group A Tecnis (26 pts 12 F - 14 M)
• Group B ReZoom (23 pts 14 F - 10 M)
• Group C Restor (23 pts 13 F - 10 M)
• Group D Tecnis - ReZoom (35 pts 19 F - 16 M)
• Group E Restor - ReZoom (21 pts 16 F - 5 M)

Age range 50-80 yrs (mean 70.5 yrs)
AMO Tecnis Diffractive MIOL
AMO ReZoom Refractive MIOL
Alcon ReSTOR Diffractive MIOL
EXCLUSION CRITERIA
INCLUSION CRITERIA

• Age range 50-80 yrs
• Uneventful bilateral cataract surgery
• Preoperative visual acuity gt 0.2 logMAR

• Mental receptiveness
• Astigmatism gt 2D
• Concomitant ocular diseases

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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

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Best corrected distance visual acuity
pts
Logarithmic Visual Acuity Chart ETDRS Chart R
n 2110
Snellen
Chi square ns
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.
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Best distance-corrected near visual acuity
Logarithmic Visual Acuity Chart 2000 NEW ETDRS
n 2106
pts
Snellen
Chi square plt0.05
Near visual acuity was significantly better in
patients implanted with bifocal IOLs, in
particular with Tecnis IOL, than with multifocal
IOLs.
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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
Snellen
Chi square plt0.05
The percentage of patients reaching high values
of intermediate visual acuity was high in all
study groups except the ReStor group.
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Binocular visual acuity vs defocus
Snellen
5,92 Depth of focus
5,08 Depth of focus
6,20 Depth of focus
4,95 Depth of focus
5,47 Depth of focus
ANOVA plt0.05

• TecnisReZoom

• RestorReZoom

• Tecnis

• ReZoom

• Restor

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.
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Contrast sensitivity (VCTS 6500, 200 lux)
Near
Far
log C.S.
log C.S.
cycles / deg
cycles / deg
Intermediate
log C.S.
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.
cycles/deg
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Modified VF-7 test
Tecnis ReZoom Restor Tecnis ReZoom Restor ReZoom
Satisfaction 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
Halos 17,50 18,75 16,50 36 12,50
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.
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MN Reading Charts
W/min
MN reading Charts
Tecnis ReZoom
Restor ReZoom
Tecnis
ReZoom
Restor
No significant differences were observed among
the groups in the reading speed.
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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.