Keiichiro Minami, Hiroko Bissen-Miyajima, Mami Yoshino, Kunihiko Nakamura

Keiichiro Minami, Hiroko Bissen-Miyajima, Mami Yoshino, Kunihiko Nakamura

Department of Ophthalmology Tokyo Dental College Suidobashi Hospital, Tokyo, Japan

All authors have no financial interests

Early Postoperative Contrast Sensitivity After Diffractive Multifocal IOL Implantation

Purpose

Recent diffractive multifocal intraocular lenses (MF-IOL)

have provided good uncorrected visual acuities for both

distance and near visions. In contrast, loss of contrast

sensitivity has been a concern in diffractive MF-IOL.1-3)

To our knowledge there has been no study that observed the

change of contrast sensitivity during the early postoperative

period.

In this retrospective study, changes of contrast sensitivity

from 1 day to 1 month after implanting diffractive MF-IOLs

were evaluated.

Subjects

Fifty-six eyes of 40 patients who received diffractive MF-IOL

by a surgeon (HBM) were enrolled. The following diffractive

MF-IOLs were implanted.

ZM900 (AMO) SA60D3 (Alcon)

No. of eyes (patients) 36 (27) 18 (11)

Male : Female 11:16 2:9

Age, mean±SD 55.4±13.5 66.4±5.1

1 month post-op CDVA,mean±SD logMAR

-0.09±0.06 -0.10±0.08

At preoperative, and 1 day, 1 week and 1 month postoperatively,

the following items were evaluated:•Manifest spherical equivalent refraction for distance vision

• Visual acuities (UDVA, CDVA, UNVA, DCNVA, CNVA)

• Contrast sensitivity measured with CSV-1000 (Vector Vision)

at 5 m under 85 cd/m2.

Statistical analysis• Change of refraction and VA were examined with Kruskal-

Wallis test.

• Contrast sensitivity at each spatial frequency were examined

with one-way ANOVA following Bonferroni/Dunnett test.

Methods

UDVA: Uncorrected Distance VA; CDVA: Corrected Distance VA; UNVA: Uncorrected Near VA; DCNVA: Distance-Corrected Near VA, CNVA: Corrected Near VA

Results: Distance Vision, Refraction & VA

-2.0

-1.5

-1.0

-0.5

0.0

1D 1W 1M

Man

ifes

t SE

(D)

No significant change in the early postoperative period.

-0.4

-0.2

0.0

0.2

0.4

1D 1W 1M

Vis

ual a

cuit

y lo

gMA

R

UDVA

CDVA

Results: Near Visual Acuity

-0.4

-0.2

0.0

0.2

0.4

1D 1W 1M

Vis

ual a

cuit

y lo

gMA

R

UNVA

CNVA

DCNVA

UNVA was significantly improved during 1 month (P=0.03,

Kruskal Wallis). Significant difference between 1 day and 1

month (P=0.04, Steel-Dwass test)

P=0.04, Steel-Dwass

Results: Distance Contrast Sensitivity

Significant changes in 6

and 18 cpd (P=0.05, 0.007,

ANOVA), but no significant

change in 3, 12 cpd.

Post-operative contrast

sensitivity was improved

between 1 day and 1 month

at 6 and 18 cpd (P=0.017,

0.002, Dunnet ad-hoc test)

0.0

0.5

1.0

1.5

2.0

2.5

3 cpd 6 cpd 12 cpd 18 cpd

1D

1W

1M

†

†: P<0.05 ANOVA

†

log

cont

rast

sen

sitiv

ity

cpd: cycle per degree

Results: Distance Contrast Sensitivity

ZM900 only (N=36)

Significant changes in 18

cpd (P=0.05, ANOVA), but

no significant change in 3,

6, and 12 cpd.

Post-operative contrast

sensitivity was improved

between 1 day and 1 month

at 18 cpd (P=0.015, Dunnet

test)

0.0

0.5

1.0

1.5

2.0

2.5

3 cpd 6 cpd 12 cpd 18 cpd

1D

1W

1M

†: P<0.05 ANOVA

†

log

cont

rast

sen

sitiv

ity

Results: Distance Contrast Sensitivity

SA60D3 only (N=18)

No significant change in

the early period.

But, there were significant

improvements between 1

day and 1 week at 3 and 6

cpd, and 1 day and 1 month

at 18 cpd (P<0.05, Dunnet

test)

0.0

0.5

1.0

1.5

2.0

2.5

3 cpd 6 cpd 12 cpd 18 cpd

1D

1W

1M

log

cont

rast

sen

sitiv

ity

No significant change in CDVA and CNVA, but UDVA,

DCNVA, and UNVA became stable in 1 month. A previous

study reported distance VA shows stabilization after 1 month

postoperatively.4) Between 1 day and 1 week, acute reactions

to cornea and intraocular inflammation due to surgery would

affect the VA as well as contrast sensitivity. Visual function

of MF-IOL implanted eyes need 1 week to 1 month to

stabilize.

Discussion

Visual function of MF-IOL implanted eyes would need 1

week to 1 month to stabilize.

Recovery of contrast sensitivity was slightly lower

at 6 (SA60D3) and 18 (ZM900) cpd at 1 day. Lower contrast

sensitivity found in MF-IOL1,4) could be caused by

multifocality (shown below), or straylight inherent with

diffractive MF-IOL,3) so that the patient may require time to

adapt.

Discussion

Recovery of contrast sensitivity would require increase in

visual acuity as well as adaptation to the multifocality.

Sharp image with

the distance focus

Blurred by the near focus

Conclusion

After the implantation of diffractive multifocal IOL, contrast

sensitivity was stabilized between 1 week to 1 month.

However, there was a tendency to require a longer time to

stabilize at 18 cpd.

References1. Zhao G, Zhang J, Zhou Y, Hu L, Che C, Jiang N. Visual function after monocular implantation of apodized diffractive

multifocal or single-piece monofocal intraocular lens Randomized prospective comparison. J Cataract Refract Surg. 2010;36:282-5

2. Yoshino M, Bissen-Miyajima H, Oki S, Minami K, Nakamura K. Two-year follow-up after implantation of diffractive aspheric silicone multifocal intraocular lenses. Acta Ophthalmol, in press.

3. de Vries NE, Franssen L, Webers CA, Tahzib NG, Cheng YY, Hendrikse F, Tjia KF, van den Berg TJ, Nuijts RM. Intraocular straylight after implantation of the multifocal AcrySof ReSTOR SA60D3 diffractive intraocular lens. J Cataract Refract Surg. 2008; 34:957-62

4. Lyle WA, Jin GJ. Prospective evaluation of early visual and refractive effects with small clear corneal incision for cataract surgery. J Cataract Refract Surg. 1996;22:1456-60.