1. "Mix and Match" approach implantation
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

2. 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.

3. Age range: 50-80 yrs (mean 70.5 yrs)
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 M)
Age range: yrs (mean 70.5 yrs)
AMO Tecnis Diffractive MIOL
Alcon ReSTOR
Diffractive MIOL
AMO ReZoom
Refractive MIOL
INCLUSION CRITERIA
EXCLUSION CRITERIA
Age range yrs
Uneventful bilateral cataract surgery
Preoperative visual acuity > 0.2 logMAR
Mental receptiveness
Astigmatism > 2D
Concomitant ocular diseases

4. 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

5. Logarithmic Visual Acuity Chart “ETDRS”
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.

6. Logarithmic Visual Acuity Chart 2000
Best distance-corrected near visual acuity
% pts
Logarithmic Visual Acuity Chart 2000
“NEW ETDRS” n° 2106
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.

7. 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 p<0.05
The percentage of patients reaching high values of intermediate visual acuity was high in all study groups except the ReStor group.

8. 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 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.

9. Contrast sensitivity (VCTS 6500, 200 lux)
Far
Near
log C.S.
log C.S.
cycles / deg
cycles / deg
log C.S.
Intermediate
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.
Tecnis + ReZoom
Restor + ReZoom
Tecnis
ReZoom
Restor
cycles/deg

10. Modified VF-7 test Satisfaction 99,5 99,25 98 92,50 97,5
Tecnis
ReZoom
Restor
Tecnis + ReZoom
Restor + ReZoom
Satisfaction
99,5
99,25 98
92,50
97,5
Seeing signals 99
100
Seeing steps
Watching TV
95,50
Driving
95,25
95,5
96,25
Precise handling
83,25 95 90
Reading
79,5
84,75
94,75
91,25
Cooking
Colours
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.

11. MN Reading Charts
W/min
MN reading Charts
Tecnis
ReZoom
Restor
Tecnis+
ReZoom
Restor+
ReZoom
No significant differences were observed among the groups in the reading speed.

12. 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.