Prospective randomised double-masked trial of bilateral multifocal, bifocal or monofocal intraocular lenses. Effectiveness of multifocal intraocular lenses to correct presbyopia after cataract surgery: a randomized controlled trial. Comparing the 1CU accommodative, multifocal, and monofocal intraocular lenses: a randomized trial. A prospective, randomized, double-masked comparison of a zonal-progressive multifocal intraocular lens and a monofocal intraocular lens. Quality of life evaluation after implantation of 2 multifocal intraocular lens models and a monofocal model. Visual function after monocular implantation of apodized diffractive multifocal or single-piece monofocal intraocular lens Randomized prospective comparison. Quality of vision after AMO Array multifocal intraocular lens implantation. Cataract extraction with multifocal intraocular lens implantation: a multinational clinical trial evaluating clinical, functional, and quality-of-life outcomes. One-year outcomes with new-generation multifocal intraocular lenses.
To evaluate the functional effect of bilateral implantation of two different multifocal intraocular lenses (IOL) compared with the standard monofocal IOL.
                Sixty-nine patients were recruited into a prospective, double-masked, randomised, controlled trial at a single hospital in the United Kingdom. Sixty completed follow-up; 16 implanted with monofocal IOLs, 29 with AMO 'ARRAY' multifocal IOLs and 15 with Storz 'TRUEVISTA' bifocal IOLs. Phacoemulsification and IOL implantation was performed to a standardised technique in both eyes within a 2-month period. The main outcome measures were distance and near visual acuity, depth of field and validated assessment of subjective function (TyPE questionnaire).
                naided distance acuity was good, and equivalent across the three groups. Corrected distance acuity was significantly lower in the bifocal group. Patients with multifocal and bifocal IOLs could read smaller absolute print size than those in the monofocal group (P = 0.05), but at a closer reading distance such that mean unaided near acuity was equal in the three groups. Corrected near acuity was significantly higher in the monofocal control group (P < 0.05). Depth of field was increased in multifocal (P = 0.06) and bifocal (P = 0.004) groups. Overall visual satisfaction was equal in the three groups, while near visual satisfaction was higher in the multifocal group than the monofocal (P = 0.04). Spectacle independence was not seen in the monofocal group, but was achieved in 28% of multifocal IOL patients and 33% of bifocal patients (P < 0.001). Adverse symptoms such as glare and haloes were significantly more bothersome with multifocal (not bifocal) IOLs than monofocals (P = 0.01).
                Multifocal and bifocal IOLs improved unaided near vision performance, with around one in three patients becoming spectacle-independent. The main adverse effect was an increased incidence of subjective glare and haloes in the multifocal IOL group. Although monofocal intraocular lenses (IOLs) are effective in improving vision after cataract surgery, the loss of accommodation is not restored by implantation of these IOLs. Because multifocal IOLs may improve uncorrected distance and near vision, we compared the clinical outcome and patient satisfaction after implantation of monofocal and multifocal IOLs. Sociodemographics, eagerness for spectacle independence (ESI), and neuroticism were tested as predictors of satisfaction.
                Randomized controlled trial.
                Cataract patients with no ocular comorbidity were operated from August 1999 to January 2001; 75 patients were implanted with monofocal IOLs, and 78 with multifocal IOLs.
                Assessments were made preoperatively (t1), 3 months after first-eye surgery (t2), and 3 months after second-eye surgery (t3). Primary outcomes were obtained by ophthalmic tests, whereas secondary outcomes were examined by interviews.
                Primary outcomes consisted of near and distance visual acuity (VA). Secondary outcomes related to spectacle dependence, vision-related functioning, and patient satisfaction.
                At t3, multifocal IOLs showed significantly better uncorrected near VA than monofocal IOLs (P<0.01) and an increase in quality ratings of unaided near vision between t1 and t3 (on a scale of 1-5: 1.6 at t1 vs. 2.9 at t3, P<0.001). At t2 and t3, patients with multifocal IOLs were more likely to "never" or "only now and then" wear spectacles for near and distance than patients with monofocal IOLs (at t3, 42.7% multifocal vs. 21.6% monofocal for near [P = 0.002] and 75.0% multifocal vs. 46.2% monofocal for distance [P = 0.001]). On a 0- to 15-point scale, monofocal IOL patients showed fewer complaints from cataract symptoms, including halos and distorted vision, at t3 (1.2 monofocal vs. 2.1 multifocal [P = 0.002]). Satisfaction related to preoperative expectations was similar in the monofocal and multifocal groups. The perceived quality of corrected near vision had the strongest relationship with patient satisfaction (beta = 0.22; 95% confidence interval: 0.060-0.523). Sociodemographics, ESI, and neuroticism did not predict patient satisfaction.
                Overall, patient satisfaction did not differ between the groups of monofocal and multifocal IOLs. Independent of ESI or neuroticism scores, success of both IOLs depends on preoperative expectations and postoperative quality of aided near vision. This article contains additional online-only material available at . To compare the binocular near vision performance in patients implanted with the 1CU accommodating intraocular lens (IOL) with a multifocal and monofocal IOL.
                Prospective, randomized, double-masked clinical trial.
                Ninety patients presenting for cataract surgery to the Department of Ophthalmology, Hillingdon Hospital were randomized to receive the 1CU accommodative IOL, a multifocal IOL, or a monofocal IOL (control group).
                Patients underwent bilateral sequential phacoemulsification with implantation of 1 of the 3 IOL types and were assessed at 3 and 18 months after second-eye surgery.
                Logarithm of the minimum angle of resolution distance and near visual acuities (VAs) (unaided and distance corrected), contrast sensitivity, and accommodative amplitude (near point and defocusing) were measured at 3 and 18 months. Reading speed was assessed at 18 months, and glare symptoms and spectacle independence were compared using a standardized questionnaire.
                Mean unaided and distance-corrected binocular near VAs were similar in the 1CU and multifocal and were significantly higher than the control group's (P<0.02). There was no significant difference in reading speed between any of the groups, but critical print sizes were similar in the 1CU and multifocal groups and significantly better than the control group's (P = 0.02). The accommodative range was highest in the multifocal group and lowest in the control group, and there was no significant difference between the 1CU and control groups for defocus or near point at 18 months. Of the 1CU group and control group, 71.4% and 63.2%, respectively, experienced no glare at 18 months, compared with only 25% of the multifocal group (P = 0.01). Of the 1CU group and multifocal group, 19% and 27.3%, respectively, were completely spectacle independent at 18 months; none of the control group was (P = 0.05).
                The 1CU accommodating IOL provides improved near vision compared with a monofocal IOL. There is a discrepancy between the near function and accommodative amplitude measured in the 1CU. The multifocal provides excellent near acuity, but photopic phenomena remain a problem inherent in the lens design. Multifocal intraocular lenses (IOLs) have been designed to provide improved near visual acuity without spectacles compared with monofocal IOLs. Early studies have reported variables amounts of decreased visual acuity and contrast sensitivity with multifocal IOLs, and some patients have experienced halos and glare.
                The authors performed a prospective, double-masked, multicenter evaluation of 62 patients randomized between a new zonal-progressive optic multifocal IOL and a monofocal IOL.
                Mean postoperative spherical equivalent, astigmatism, and uncorrected and best-corrected distance visual acuity were similar between the two groups. Patients with a multifocal IOL achieved significantly better uncorrected near visual acuity than patients with monofocal IOLs (J3+ versus J7; P less than 0.0001). With distance correction only, mean near visual acuity was J2 versus J5- (P = 0.0001). Best-corrected near visual acuity was J1 for both groups, with 1.36 diopters (D) for the multifocal group versus 2.37 D for the monofocal group (P less than 0.0001). Regan contrast sensitivity was lower for the multifocal patients at all contrast levels, and achieved statistical significance at very low contrast (11% contrast; P = 0.0024). Fifty-two percent of patients with a multifocal IOL reported that they did not need spectacles at all or used them only for their fellow eye, compared with 25% of the patients with monofocal IOLs.
                Both monofocal and multifocal implant patients were very satisfied with the results of their cataract extraction and IOL implant surgery. A small loss of contrast sensitivity with the multifocal IOL was demonstrated, consistent with theoretical predictions. The functional significance of the loss of contrast sensitivity appears to be small and counterbalanced by the advantage of improved uncorrected near visual acuity. To compare vision-related quality of life using the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) in patients with 1 of 3 types of intraocular lenses (IOLs) and to correlate it with postoperative visual outcomes.
                Vissum Corporation-Instituto Oftalmológico de Alicante, Alicante, Spain.
                Comparative case series.
                This study comprised eyes having cataract surgery with bilateral implantation of a monofocal IOL (Group A), apodized multifocal IOL (Group B), or full diffractive multifocal IOL (Group C). Distance and near visual acuities, contrast sensitivity, and quality of life were evaluated preoperatively and postoperatively.
                The study enrolled 106 eyes (53 patients; age range 49 to 80 years). All groups had significant improvement in uncorrected and corrected distance visual acuities postoperatively (P ≤.05). Near vision outcomes were significantly better in Groups B and C (P ≤.01). Groups B and C had significantly less difficulty in some near tasks, such as reading the newspaper (A-B, P=.02; A-C, P=.02) or reading bills (A-B, P=.04; A-C, P=.004). Group C also had significantly less difficulty driving at night than Group B (P<.01). Near visual acuity and contrast sensitivity were significantly correlated with difficulty in near visual tasks in Groups B and C. Night-driving difficulty correlated significantly with contrast sensitivity in Group B.
                Patients with multifocal IOLs could perform several daily tasks at near and intermediate distances, with less night-driving limitation with the full diffractive IOL than with apodized multifocal and monofocal IOLs.
                No author has a financial or proprietary interest in any material or method mentioned.
                Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved. To compare visual function after phacoemulsification with implantation of a multifocal intraocular lens (IOL) or a monofocal IOL.
                Department of Ophthalmology, Affiliated Hospital of Qingdao University Medical College, Qingdao, Shandong, China.
                This study comprised patients with unilateral cataract who had phacoemulsification with implantation of an AcrySof ReSTOR SA60D3 multifocal IOL (multifocal group) or an AcrySof SA60AT single-piece monofocal IOL (monofocal group). Postoperative visual function, including uncorrected (UDVA) and corrected (CDVA) distance visual acuity; uncorrected (UNVA), corrected (CNVA), and distance-corrected near visual acuity; and contrast sensitivity were evaluated 1 week, 1 month, and 6 months postoperatively. Patient-reported vision and spectacle independence in the 2 groups were also compared.
                Of the 161 eyes, 72 were in the multifocal group and 89 were in the monofocal group. The multifocal group had statistically significant better UNVA than the monofocal group from 1 week postoperatively to the final follow-up and statistically significant better CNVA at 6 months (both P<.05). There were no statistically significant differences in UDVA or CDVA between the 2 groups over the 6-month follow-up. The multifocal group had statistically significantly better pseudoaccommodation than the monofocal group; the monofocal group had significantly better contrast sensitivity (both P<.05). Patients with the multifocal IOL reported being more satisfied than those with the monofocal IOL.
                The multifocal IOL provided better near visual acuity and more spectacle independence than the monofocal IOL.
                Copyright 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved. To evaluate safety and efficacy of Array SA40N multifocal intraocular lens (IOL) (AMO) implantation in cataract surgery.
                Helsinki University Eye Hospital, Helsinki, Finland.
                In this prospective randomized comparative trial, 80 patients scheduled for cataract surgery were selected based on preoperative counseling and randomized to have multifocal or monofocal IOL implantation. Fifty-three eyes of 35 patients received a multifocal IOL and 67 eyes of 40 patients, a monofocal IOL. The incidence of complications and visual outcome in the multifocal and monofocal IOL groups were compared. Quality of vision was measured by comparing the severity of visual symptoms (glare, halos, and cataract symptoms score), changes in functional impairment measured by a 7-item visual function test (VF-7), changes in global measures of vision (trouble and satisfaction with vision), and range of accommodation and contrast sensitivity.
                Intraoperative and postoperative complications and adverse events were few and required no further surgical intervention. Both distance and near visual acuities were significantly better in the multifocal group than in the monofocal group; the difference was most prominent in distance corrected near acuity (P<.001). Thirty-five eyes (67.3%) in the multifocal group and 10 eyes (14.9%) in the monofocal group achieved a distance corrected near acuity of J6 (20/40) or better; 30 eyes (56.6%) and 19 eyes (28.4%), respectively, achieved a best corrected distance acuity of 20/20 or better. Glare symptoms decreased postoperatively in both groups but were slightly more common in the multifocal group. In contrast, halos were significantly more common at 1 month in the multifocal group (P<.001). Contrast sensitivity values were slightly lower with multifocal IOLs at almost all spatial frequencies, but the difference was not significant. The change in the quality of life postoperatively, measured with the VF-7, was significant and identical in both groups.
                Pseudophakic eyes with multifocal IOLs had better distance and near acuity and range of accommodation than eyes with a monofocal IOL. Slightly lower contrast sensitivity and increased perception of halos by subjects with the multifocal IOL appear to be an acceptable compromise to enhanced near and distance vision. Two million cataract extractions are performed annually in the United States. The procedure is nearly always accompanied by implantation of a monofocal intraocular lens (IOL), which corrects the patient's distance vision. The authors' objective was to measure visual function and quality-of-life outcomes associated with bilateral implantation of a multifocal IOL, which corrects distance and near vision, and to compare the outcomes with those of the standard therapy.
                A prospective, randomized, double-masked, clinical trial was conducted at eight sites in the United States, seven sites in Germany, and one site in Austria.
                Participants included 245 cataract patients, 127 of whom received the multifocal IOL bilaterally and 118 of whom received a monofocal IOL of nearly identical construction bilaterally.
                Clinical data included visual acuity (VA), complications, and adverse events. Quality-of-life data were collected using a previously validated survey instrument at baseline, after first eye surgery, and after second eye surgery.
                At 3 months after surgery, patients who had received multifocal IOLs had significantly better uncorrected and distance corrected binocular near VA compared with patients who had received monofocal IOLs (mean uncorrected VA, 20/26 multifocal vs. 20/40 monofocal; mean distance corrected VA, 20/28 multifocal vs. 20/45 monofocal; P < 0.0001). Additionally, 96% of patients who had received multifocal IOLs and 65% of patients who had received monofocal IOLs achieved both 20/40 and J3 (Jaeger) or better uncorrected, binocular distance and near visual acuities (P < 0. 0001). Patients who had received multifocal IOLs were more likely than patients who had received monofocal IOLs to never wear glasses overall (32% multifocal vs. 8% monofocal; P < 0.0001). On a 4-point scale, patients who had received multifocal IOLs on average reported having between "a little bit" and "some" glare or halo, whereas patients who had received monofocal IOLs reported between "none" and "a little bit" of glare or halo (1.57 vs. 0.43; P < 0.001). Patients who had received multifocal IOLs rated their vision without glasses better overall at near and at intermediate distances (P < or = 0.002) and demonstrated better visual function for near tasks and social activities.
                Cataract patients who received multifocal IOLs at time of surgery obtained better uncorrected and distance corrected near VA and reported better overall vision, less limitation in visual function, less spectacle dependency, and more glare or halo than those who received traditional monofocal IOLs. To compare new-generation multifocal intraocular lenses (IOLs) with monofocal IOLs.
                Randomized prospective clinical trial.
                Sixty-two consecutive patients with cataract, seen between January of 2005 and January of 2006 at the Department of Ophthalmology of Palermo University Hospital in Italy, were bilaterally implanted with monofocal (AR 40, Advanced Medical Optics [AMO], Santa Ana, CA; 15 patients), multifocal refractive (Array SA40N, AMO; 16 patients), multifocal refractive (ReZoom, AMO; 15 patients), or multifocal diffractive pupil-independent (Tecnis ZM900, AMO; 16 patients) IOLs.
                Bimanual phacoemulsification.
                Primary outcomes were far, near, and intermediate visual acuity of the 4 IOL-implanted groups. Secondary outcomes were defocusing curves, contrast sensitivity, patients' quality of life (7-item visual function questionnaire [VF-7], halos and glare presence, overall satisfaction), and spectacle independence. Snellen visual acuity was measured as uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), uncorrected near visual acuity (UCNVA), best distance corrected near visual acuity (BDCNVA), best corrected near visual acuity (BCNVA), uncorrected intermediate visual acuity (UCIVA), and best distance corrected intermediate visual acuity (BDCIVA).
                UCNVA was 20/50 in the monofocal IOL group, compared with 20/32 or better in the multifocal IOL groups (P<0.0005). The monofocal IOL group exhibited a lower BDCNVA than the multifocal IOL groups (P<0.0005). The diffractive multifocal IOL group performed better than either refractive group (P = 0.007). UCIVA was significantly different (P = 0.001) among the groups: monofocal (AR 40) 20/32; multifocal refractive (Array SA40N) 20/30; multifocal refractive (ReZoom) 20/25; and multifocal diffractive (Tecnis ZM900) 20/30. Defocusing curves with -3.00 diopter lens exhibited a better trend in the diffractive group. The refractive multifocal IOL groups exhibited lower contrast sensitivities at 3 cycles/degree (P = 0.038). The VF-7 mean score was significantly lower in the monofocal than the multifocal IOL groups (P = 0.002). Night halos were more common in the refractive groups (P<0.01). Spectacle independence was 20% in the monofocal IOL group, 43.7% and 53.3% in the refractive multifocal IOL groups, and 87.5% in the diffractive multifocal IOL group (P<0.05).
                Multifocal IOLs provide a greater depth of focus and higher patient satisfaction, and make intermediate and near visual tasks easier than do monofocal lenses. New-generation, diffractive, pupil-independent multifocal IOLs provide better near vision, equivalent intermediate vision, less unwanted photic phenomena, and greater spectacle independence than either monofocal or refractive multifocal IOLs.
Multifocal IOLs are effective at improving near vision relative to monofocal IOLs. Whether that improvement outweighs the adverse effects of multifocal IOLs will vary between patients. Motivation to achieve spectacle independence is likely to be the deciding factor.