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10 T wo recent studies have shown that patients are highly satisfied with their visual outcomes after multi- focal IOL implantation. An FDA clinical trial, as well as a subse- quent Datalink study, found that the Tecnis Multifocal IOL (Abbott Medical Optics, AMO, Santa Ana, Calif.) had great visual outcomes and patient satisfaction. Obviously, the FDA clinical trial patients were very well selected, and this was a restricted population. Patients with any extraneous circumstances or any eye concerns were excluded. Likewise, with the Datalink analysis, data were entered by surgeons post- market approval, but one of the limitations of the study was that the data were submitted by a small number of surgeons who were very high volume. So the FDA study had a very select group of patients, and the Datalink study had a select group of surgeons. We wondered whether the data would be valid among a general population of patients and the general population of surgeons. To answer this question, we conducted a multicenter, prospec- tive, open-label, observation study. The study evaluated the Tecnis one- piece multifocal IOL with regard to patients' clinical outcomes, patient satisfaction, and satisfaction of surgeons who had limited to no experience with the IOL. The study included 106 patients at 17 sites. Patients' mean age was 66.0 years±8.11. The majority (61.7%) were women. Patients un- derwent bilateral implantation of the Tecnis one-piece multifocal IOL and were followed for 3 months. Patient satisfaction Of the 98 patients tested, 92% of patients had 20/32 or better binocu- lar uncorrected distance visual acuity, 68% had 20/32 or better binocular uncorrected intermediate visual acuity, and 94% had 20/32 or better binocular near visual acuity. Of the 86 patients tested, 99% had 20/25 or better binocular distance-corrected distance visual acuity, 62% had 20/25 or better binocular distance-corrected inter- mediate visual acuity, and 90% had 20/25 or better binocular distance- corrected near visual acuity. In assessing outcomes, it is important to not just examine Snellen acuity. Patient satisfaction is a better measure of functional vision and visual quality. In this study, 90% of patients reported that they were satisfied or very satisfied with their vision during the day without correction compared to their vision before surgery; 81% reported that they were satisfied or very satisfied with their vision at night without correction compared to their vision before surgery; and 88% reported that they were satisfied or very satis- fied with their overall vision com- pared to their vision before surgery. Ninety percent of patients said that they never wear vision correc- tion, and 83% said that they would EW Chicago 2012 10 Cataract surgery by Elizabeth A. Davis, M.D. Studies show multifocal IOL patients are highly satisfied with outcomes Elizabeth A. Davis, M.D. " 90% had 20/25 or better binocular distance- corrected near visual acuity " Multifocal IOL is forgiving of refractive error by Elizabeth A. Davis, M.D. I have found that with the Tecnis Multifocal IOL compared to other multifocal IOLs, the enhancement rate is much lower. It appears that the lens is more forgiving of refractive error, especially astigmatism. With other multifocal IOLs, I was enhancing patients with as little as 0.5 D of residual astigmatism. With the Tecnis multifocal lens, I have patients with 0.75 or 1 D of astigmatism who still feel that their vision is good. I think that speaks to the quality of vision. Some lenses produce poor quality of vision, meaning more higher-order aberrations, which can't be corrected with an enhancement. Only lower-order aberrations (i.e., sphere and cylinder) can be corrected. So in an attempt to reduce overall aberrations, I would end up correcting any lower-order aberrations that were present, even if minimal, in the hopes of getting some improve- ment. Unfortunately, this would not resolve the poor overall quality of vision. In my practice with other multifocal IOLs, I had a 20% enhancement rate, and patients still were not very satisfied because they still had higher-order aberrations and a reduced quality of vision. My enhance- ment rate with the Tecnis multifocal IOL is much less than this (in the 7-10% range). In the vast majority of these cases, an enhancement is predicted pre-op because of pre-existing corneal astigmatism. continued on page 11 AMO Saturday supplement_Chicago 2012-USE THIS ONE_Layout 1 4/20/12 4:25 PM Page 10

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