Peer-reviewed publications from around the world: The AcrySof IQ ReSTOR IOL +3.0 D

“The U.S. trial
probably represents
the truest out comes in the real
world, since it was
a multicenter and
multi-investigator
study
”
W. Andrew Maxwell,M.D.,Ph.D.

Table 1. Peer-reviewed studies about AcrySof IQ ReSTOR +3.0 D IOLs


Figure 1. Distance-corrected binocular visual acuity of patients with bilateral AcrySof IQ ReSTOR +3.0 D IOLs (bars are mean ± standard error of the mean)


Figure 2. Uncorrected binocular intermediate visual acuity at 6 months post-op at 50, 60, and 70 cm (bars are mean ± standard error of the mean)

In the year that has passed since the launch of the AcrySof IQ ReSTOR +3.0 D IOL (model SN6AD1, Alcon, Fort Worth, Texas) at the 2009 American Society of Cataract and Refractive Surgery meeting, four peer-reviewed articles have been published about this IOL, as shown in Table 1.
All four articles were published in the Journal of Cataract and Refractive Surgery. The multicenter study, which was led by W. Andrew Maxwell, M.D., Ph.D., Fogg, Maxwell, Lanier & Remington EyeCare, Fresno, Calif., presented the first results about the SN6AD1 in the U.S. According to Dr. Maxwell, the peer-reviewed literature indicates that the AcrySof IQ ReSTOR +3.0 D IOLs provide a full range of vision—near, intermediate, and distance. Dr. Maxwell said, “I think all the other papers confirm the outstanding results obtained in the U.S. clinical trial. Obviously there are some small differences in the results from our study, but the manuscripts confirm the excellent visual outcomes at all distances, making this IOL meet the functional needs of most patients.”

Near, intermediate, and far vision

Three of the four peer-reviewed studies reported binocular distance corrected visual acuity at near (30 or 40 cm), intermediate (70 cm), and far distances (4 or 5 m), as shown in Figure 1. In all three studies, at all three distances, mean distance-corrected visual acuities were approximately 20/32 or better.
“Obviously there are some differences between studies, but these all represent one Snellen line or less,” Dr. Maxwell said. “This is very good, considering there is the potential for differences in testing techniques. The U.S. trial probably represents the truest outcomes in the real world, since it was a multi center and multi-investigator study.”

Intermediate vision

Good distance and near visual acu ity can be expected with bifocal IOLs, but intermediate visual acuity is a variable of special interest. Three studies reported binocular uncorrected intermediate visual acuity (VA) at 50, 60, and 70 cm, as shown in Figure 2. In all three stud ies, those mean uncorrected inter mediate visual acuities were approximately 20/32 or better for patients with the +3.0 D IOLs.
Dr. Maxwell thought it was interesting that the Alfonso paper reported slightly better visual acuity at 50 cm than the other papers. He thought this difference might be due to variations in testing tech niques.
His experience with the inter mediate distance vision of his own patients matches the results report ed in the literature. “My patients express satisfaction with intermedi ate vision without glasses,” he said.
“This includes tasks such as com puter work, playing cards, and read ing with material at their lap. For some extremely demanding inter mediate vision tasks, such as read ing music at an increased distance, this IOL may not meet those needs.” He is glad that good inter mediate visual acuity was achieved without compromising near vision.“Patients do not feel their near vision is inadequate, and many still hold reading material at a fairly near point, almost equal to the +4 D add IOL.”

Spectacle independence

Two of the four manuscripts report ed spectacle independence out comes. Kohnen et al reported that 88% of patients with +3.0 D IOLs were completely spectacle inde pendent, and Maxwell et al reported that more than 78% of patients in both IQ ReSTOR IOL groups were completely spectacle independent. Dr. Maxwell felt that the difference“might reflect how freely a surgeon offers a spectacle prescription to patients, as opposed to telling them they are OK. Most of my patients are spectacle independent, as evi denced in study results.” Regarding patients who did use spectacles, he said, “I believe most patients use their spectacles to a minimal degree. I found that many patients like a simple prescription for tasks such as night driving. I was liberal in offering spectacle prescriptions to patients for their convenience.”

Summary and conclusion

Four peer-reviewed manuscripts about IQ ReSTOR IOLs with +3.0 D of near addition have recently been published, describing outcomes for a total of 252 patients in seven countries on three continents. All four manuscripts demonstrated excellent range of vision for patients with SN6AD1 IOLs.

Contact information

Maxwell: 559-449-5010

References

1. Alfonso JF , Fernandez-Vega L, Amhaz H, Montes-Mico R, Valcarcel B, Ferrer Blasco T. Visual function after implanta tion of an aspheric bifocal intraocular
lens. J Cataract Refract Surg 2009;35:885-92.
2. Kohnen T, Nuijts R, Levy P, Haefliger E, Alfonso JF . Visual function after bilateral implantation of apodized diffractive aspheric multifocal intraocular lenses with a +3.0 D addition. J Cataract Refract Surg 2009;35:2062-9.
3. Maxwell WA, Cionni RJ, Lehmann RP, Modi SS. Functional outcomes after bilateral implantation of apodized diffrac tive aspheric acrylic intraocular lenses
with a +3.0 or +4.0 diopter addition power randomized multicenter clinical study. J Cataract Refract Surg 2009;35:2054-61.
4. Hayashi K, Manabe S, Hayashi H. Visual acuity from far to near and contrast sen sitivity in eyes with a diffractive multifo cal intraocular lens with a low addition power. J Cataract Refract Surg 2009;35:2070-6.