"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

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.

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

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

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.

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.

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.

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.

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

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.

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.

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.