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.
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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.