That’s the finding of researchers in France and Spain who conducted a study of 304 patients with an average age of 65.6 years who underwent bilateral implantation of the multifocal lens. The surgery was performed to treat cataracts or to reduce the need for eyeglasses via refractive lens exchange.

The researchers had three goals:

1. To determine how many patients would be glasses-free 18 months after surgery.
2. To determine the degree of satisfaction patients had with the multifocal IOL.
3. To identify psychological factors most likely to predict independence from glasses after surgery.

At 18 months after surgery, the researchers found:

• Uncorrected distance visual acuity was 20/25 or better for 88.6 percent of patients.
• Uncorrected near visual acuity was 20/25 or better for 93.3 percent of patients.
• 87.2 percent of patients reported being glasses-free throughout the day.
• 88.2 percent of patients said their vision had improved and 78.0 percent considered their sight problems to be resolved.

In addition, the researchers found that patients who said that wearing glasses was bothersome and also said they preferred their appearance without glasses were three times more likely not to wear glasses after the ReSTOR surgery.

The researchers concluded that bilateral implantation of ReSTOR multifocal IOLs provides patients with good vision at distance and near without glasses, a high rate of spectacle independence and a high degree of satisfaction with their vision after surgery.

A full report of the study appears Clinical Ophthalmology (Vol 4), published online February 2010.

Ed. note:  ReSTOR is one of several brands of multifocal IOLs approved by the U.S. FDA for use in cataract surgery performed in the United States. Discuss your vision correction options with your refractive surgeon during your pre-surgical consultation.

It was believed that the light-absorbing nature of these lens implants might offer advantages over clear lens implants, including providing sharper vision, better contrast sensitivity and reduced risk of macular degeneration.

But recent research has shown that blue-blocking IOLs fail to provide measureable visual or eye-protective benefits for people under going cataract surgery, according to two reports in this month’s issue of Survey of Ophthalmology. In fact, blue-blocking IOLs may perform worse than clear IOLs in some measures of visual performance.

In the first report, researchers at the University of Kansas School of Medicine say blue-blocking IOLs fail to decrease glare or improve contrast sensitivity, and the reduced light transmittance of the blue-blocking lens implants appears to reduce visual performance in dim and dark environments.

The researchers also say that most scientific evidence shows that environmental light exposure and cataract surgery are not significant risk factors for the progression of age-related macular degeneration (AMD), and that blue-blocking IOLs are unlikely to prevent or reduce one’s risk of AMD.

In the second report, researchers at Ophthalmic Consultants of Boston and Harvard Medical School reviewed the results of 56 peer-reviewed studies of blue-blocking IOLs. Eleven of these studies directly compared the visual outcomes of blue-blocking IOLs and conventional (non-blue-blocking) lens implants.

Of the 11 studies that directly compared the two types of IOLs, 10 of the studies (91 percent) concluded that blue-blocking IOLs offered no significant benefits over conventional IOLs in measures of visual performance that included visual acuity, contrast sensitivity, color perception and visual sensitivity in bright, medium and low-light conditions.

The researchers said one study suggested blue-blocking IOLs might produce worse vision than clear IOLs in low-light conditions and could possibly affect circadian rhythms and thereby cause sleep disturbances in susceptible individuals.

Also, regarding the possible protective effect of shielding the retina from blue light, the researchers said the benefits of blocking the transmittance of blue light to the retina and the relationship between light transmittance and the progression of AMD “remain unclear.”

Ed. note:  Blue-blocking IOLs are one of many types of premium refractive IOLs used in cataract surgery and refractive lens exchange. Ask your refractive surgeon to discuss your IOL options during your pre-surgical consultation.

SOURCES:
1. Blue-blocking IOLs decrease photoreception without providing significant photoprotection. Survey of Ophthalmology. May 2010.
2. Blue-blocking IOLs: A complete review of the literature. Survey of Ophthalmology. May 2010.

The researchers evaluated the effectiveness of stimulation of the brain’s visual cortex to improve vision after removal of cataracts, using a commercially available computer-based vision training program (RevitalVision, LLC; Lawrence, Kan.).

A total of 60 subjects who had undergone cataract surgery that included implantation of one of five styles of intraocular lenses participated in the vision training sessions. The mean age of the subjects was 68 years.

Uncorrected visual acuity and contrast sensitivity at both distance and near were tested at 1 month and 3 months after surgery. In the intervening weeks, subjects underwent 20 sessions of vision training using the computer-based RevitalVision Cortex Vision Training (CVT) program.

After CVT, mean improvement in uncorrected visual acuity for all subjects was 1.3 lines on a standard eye chart for distance vision and 1.0 line for near vision. Mean improvement in contrast sensitivity function was 223 percent for distance vision and 197 percent for near vision.

Subjects demonstrated gains in uncorrected visual acuity regardless of the type of intraocular lens (IOL) they received after removal of their cataracts: aspheric monofocal IOLs, accommodating IOLs or multifocal IOLs.

The research was conducted under the direction of George O. Waring IV, MD, (Emory University School of Medicine; Atlanta Ga.), John D. Hunkeler, MD, (University of Kansas Medical Center; Prairie Village, Kan.) and Richard L. Lindstrom, MD, (University of Minnesota; Minneapolis, Minn.)

About ARVO: The Association for Research in Vision and Ophthalmology is the world’s largest eye and vision research organization with more than 12, 500 members from more than 80 countries. Membership is ARVO is multidisciplinary and includes ophthalmologists, PhDs, optometrists and other vision researchers.

Researchers in Canada evaluated the bilateral implantation of AcrySof toric refractive IOLs (Alcon; Fort Worth, Texas) in subjects undergoing cataract surgery in both eyes. The study included 234 eyes of 117 subjects.

Prior to surgery, all subjects had cataracts and astigmatism ranging from 1.0 to 2.5 diopters (D).

At 1 day and 1, 3 and 6 months after surgery, the following measurements were taken: uncorrected visual acuity (UCVA) at distance, residual refractive error, and IOL rotational stability.

In addition, all patients completed a questionnaire administered before surgery and at 3 months and 6 months after surgery. Using a 10-point scale, the questionnaire assessed dependence on eyeglasses, visual disturbances and satisfaction with vision (1 = completely unsatisfied; 10 = completely satisfied).

Post-operative findings included:

• Binocular distance UCVA was 20/40 or better in 99 percent of patients and 20/20 or better in 63 percent of patients.
• Mean residual refractive astigmatism was reduced to 0.4 D.
• IOL alignment was within 10 degrees of the intended position in 99 percent of patients and within 5 degrees in 99 percent of patients.
• 69 percent of patients reported never needing glasses for driving and other distance vision tasks.
• Halos and glare present prior to surgery were significantly reduced after surgery.
• 94 percent of patients rated their vision a 7 or higher after surgery.

The researchers concluded that cataract surgery with bilateral implantation of toric IOLs to correct astigmatism produced “excellent and stable visual outcomes that patients rated as highly satisfactory.”

A full report of the study appears in the April 2010 issue of Journal of Cataract and Refractive Surgery.

Monovision is the practice of fully correcting one eye so it sees perfectly well for distance vision, and making the other (usually non-dominant) eye mildly nearsighted so it provides acceptable near vision without reading glasses.

Monovision has been around for years, being performed with contact lenses to enable people over age 45 who have presbyopia to have functional vision at all distances without being dependent on reading glasses.

Recently, monovision also is being offered by refractive surgeons with LASIK and with refractive IOLs used in cataract surgery.

This week, eye surgeon John A. Hovanesian, MD, (Laguna Hills, Calif.) discussed monovision cataract surgery in his blog on the Ocular Surgery News website.

According to Dr. Hovanesian, the monovision procedure has several advantages over the use of multifocal IOLs in cataract surgery, Including:

• A “trial run” of monovision with contact lenses prior to cataract surgery rarely is needed.
• High-quality vision at all distances can be achieved with only a mild amount of nearsightedness in the non-dominant eye, making adaptation to monovision quite easy.
• Monovision typically does not cause depth perception problems.
• Monovision can yield better contrast sensitivity than monofocal IOLs for activities like driving at night.
• Monovision allows cataract surgeons to choose from a variety of premium monofocal IOLs, including aspheric lenses designed to reduce glare.
• Monovision typically is less expensive than cataract surgery with multifocal IOLs, which can require thousands of dollars in out-of-pocket costs for patients.

For the best results with monovision, it’s important that the distance vision of the dominant eye is perfect. In some cases, this means enhancement refractive procedures (i.e. LASIK or PRK) may be required after cataract surgery.

Dr. Hovanesian said that after considering its advantages, he plans to offer surgical monovision to more of his cataract patients in the future.

Crystalens currently is the only accommodating IOL approved by the FDA for use in cataract surgery performed in the United States. The lens is designed to restore vision at all distances after cataract removal, including near vision lost to age-related presbyopia.

Joining the celebration will be Broadway, film and television actress Florence Henderson. Best known for her role as Carol Brady in the iconic television series “The Brady Bunch,” Ms. Henderson will be at the Bausch & Lomb booth at the ASCRS meeting on Sunday, April 11 at 1 p.m. to discuss her experience as a Crystalens patient.

“I’m very pleased to have experienced such a dramatic improvement in my vision since my Crystalens surgery,” she said in a press release issued today by Bausch & Lomb.

During the Crystalens 10-year anniversary celebration, Bausch & Lomb also will honor 12 cataract surgeons who have implanted more than 1,000 Crystalens accommodating IOLs.

With modern refractive cataract surgery and the use of multifocal intraocular lenses (IOLs), that’s beginning to change.

In a study published in this month’s American Journal of Ophthalmology, researchers report the results of 1-year study that evaluated the safety and effectiveness of the new Tecnis ZM900 multifocal IOL designed to restore vision at all distances after cataract surgery.

The lens is manufactured and sold by Abbott Medical Optics (AMO), based in Santa Ana, California.

The study evaluated the outcomes of 125 patients who underwent cataract surgery in both eyes with bilateral implantation of the Tecnis ZM900 multifocal IOL and 123 patients who underwent the same bilateral procedure with implantation of a conventional monofocal IOL (CeeOn 911A, also made by AMO) in both eyes.

The surgeries were performed at multiple eye surgery centers across the country by cataract surgeons who agreed to participate in the FDA study.

At the end of the 1-year study period, results included:

• 84 percent of patients receiving the Tecnis multifocal IOL achieved the combination of binocular uncorrected distance visual acuity of 20/25 and binocular uncorrected near visual acuity of 20/32, compared with only 6.2 percent of patients receiving the monofocal IOL.
• Visual acuity for reading and reading speed were significantly better among patients receiving the Tecnis multifocal IOL compared with those receiving the monofocal IOL.
• 96 percent of those receiving the Tecnis multifocal IOL reported being able to see comfortably at near without reading glasses, compared with 30 percent of those receiving the monofocal IOL.
• 85 percent of those receiving the Tecnis multifocal IOL in both eyes reported being free from wearing glasses throughout the day, compared with only 5.2 percent of those receiving the monofocal IOL.

The researchers concluded that the Tecnis multifocal IOL provided enhanced near vision, reading visual acuity and speed, depth of focus and spectacle independence compared with a conventional monofocal IOL.

SOURCE:  Evaluation of the aspheric Tecnis multifocal intraocular lens: One-year results from the first cohort of the Food and Drug Administration clinical trial. American Journal of Ophthalmology. April 2010.

In most cases, patients who undergo cataract surgery regain their vision once the cataract is removed and an intraocular lens (IOL) is implanted in its place. With modern refractive cataract surgery, many patients are able to see 20/20 without glasses or contact lenses after surgery.

However, particularly among younger patients who undergo surgery for cataracts, blurred vision can return due to the development of what’s called a “secondary cataract.”

A secondary cataract is a clouding of the posterior portion of the natural lens capsule that is purposely left inside the eye during cataract surgery.

The posterior lens capsule is left in place during cataract surgery so the gel-like material (vitreous) that fills the posterior portion of the eye does not leak from the eye during the procedure. Loss of vitreous from the eye could cause serious cataract surgery complications, including a detached retina.

Usually, the posterior lens capsule remains clear after cataract surgery. But in some cases, the capsule becomes cloudy, affecting vision. The technical term for secondary cataract is posterior capsular opacification (PCO).

In most cases, secondary cataract can be successfully treated with a non-invasive procedure called a laser capsulotomy. A special type of infrared laser called a Nd:YAG laser is used for this procedure, which is sometimes called a YAG capsulotomy.

The laser creates a clear hole in the center of the cloudy lens capsule to restore clear vision. A YAG capsulotomy takes only a few minutes, and there are no restrictions after the procedure.

Recently, researchers in Sweden conducted a 10-year study to determine the long-term risk of secondary cataracts among patients younger than age 65 who underwent cataract surgery at a single surgical center (Norrlands University Hospital in Umea, Sweden).

A total of 116 patients were included in the study, and 94 percent of them received an acrylic IOL implant during the cataract removal procedure.

Results of the study showed that 10 years after cataract surgery, 37 percent of the patients who were younger than 65 years of age at the time of surgery later developed PCO or secondary cataract that required laser capsulotomy treatment to restore vision.

Though the study reveals a significant risk for the development of visually significant PCO among patients who have cataract surgery when they are younger than age 65 at the time of surgery, advances in cataract surgery technique and IOL design since the time of the cataract surgery performed in this long-term study may have reduced this risk.

SOURCE:  Ten-year longitudinal visual function and Nd:YAG laser capsulotomy rates in patients less than 65 years at cataract surgery. American Journal of Ophthalmology. February 2010.

Also, the new multifocal IOL has received “presbyopia-correcting IOL” status by the Centers for Medicare and Medicaid Services (CMS), giving Medicare beneficiaries the option to receive the Tecnis Multifocal IOL during cataract surgery for an additional fee to cover the extra cataract surgery cost.

“With this approval, Medicare cataract patients have a new opportunity to enjoy near, intermediate and distance vision without needing glasses,” said Jim Mazzo, senior vice president, Abbott Medical Optics (AMO), in a press release issued by the company on March 10.

According to the company, nearly 9 out of 10 patients undergoing cataract surgery and receiving the one-piece Tecnis Multifocal IOL in clinical trials reported never needing glasses after surgery.

Abbott has begun shipping the new multifocal IOL to cataract surgeons in select markets and plans for full commercial release beginning in April 2010.

More information about the new one-piece Tecnis Multifocal IOL, including important safety information, is available at www.abbottmedicaloptics.com.

SOURCE: Abbott receives U.S. FDA approval for new cataract multifocal intraocular lens. Abbott Medical Optics press release. March 10, 2010.

The surgeons presented their findings at the 2010 winter meeting of the European Society of Cataract and Refractive Surgeons, held February 12-14 in Budapest, Hungary.

Mark Tomalla, MD, of Duisburg, Germany, said he has implanted the Crystalens HD accommodating IOL in a series of 48 patients. At the time of his presentation, 17 of these patients had been monitored for a period of 6 months after surgery.

At the 6-month follow-up visit:

• All patients could see clearly in the distance and at arm’s length without glasses.
• 71 percent reported they did not need reading glasses.
• The remaining 29 percent said they needed reading glasses only occasionally.

Patient satisfaction with the Crystalens HD accommodating IOL was “well above the average,” according to Dr. Tomalla.

Angel Lopez-Castro, MD, (Madrid, Spain) reported similar results for 42 of his patients receiving the Crystalens HD IOL. He said 80 percent of these patients exhibited the equivalent of 20/25 or better reading vision without glasses, and all patients had distance vision of 20/20 or better without glasses.

Kristien Vanhoucke, MD, of Mol, Belgium, reported implanting the Crystalens HD in eyes of 26 patients. At 6 months after surgery, 90 percent of these patients reported having very good vision at all distances and not needing glasses for any reason.

Crystalens HD is the fourth-generation accommodating IOL produced by Bausch & Lomb (Rochester, NY). The company received approval from the U.S. Food and Drug Administration (FDA) in June 2008 to market Crystalens HD in the United States.

The FDA approved the first Crystalens accommodating IOL in November 2003. In January 2010, Bausch & Lomb announced the introduction of Crystalens AO, its latest accommodating IOL that is designed to reduce higher-order aberrations.

At present, Crystalens is the only brand of accommodating IOL approved by the FDA for use in refractive cataract surgery in the United States.

SOURCE:  Multiple European clinics report promising accommodating IOL visual outcomes. Ocular Surgery News. Published online February 15, 2010.