Comparing the 1CU Accommodative, Multifocal, and Monofocal Intraocular Lenses: A Randomized Trial
Presented in part at: American Society of Cataract and Refractive Surgery Congress, April 2005, Washington, DC; United Kingdom and Ireland Society of Cataract and Refractive Surgeons Congress, September 2005, Chester, United Kingdom; and European Society of Cataract and Refractive Surgeons Congress, September 2006, London, United Kingdom.
Received 31 December 2006; received in revised form 23 August 2007; accepted 28 August 2007. published online 22 November 2007.
Objective
To compare the binocular near vision performance in patients implanted with the 1CU accommodating intraocular lens (IOL) with a multifocal and monofocal IOL.
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).
Methods
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.
Main Outcome Measures
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.
Results
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).
Conclusions
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.
Available online: November 26, 2007.
1Department of Ophthalmology, Hillingdon Hospital, Uxbridge, United Kingdom.
ABSTRACT