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Multifocal versus monofocal intraocular lenses after cataract extraction

  • Review
  • Intervention

Authors

  • M Leyland,

  • E Pringle


Mr Martin Leyland, Consultant Ophthalmologist, Royal Berkshire Hospital NHS Trust, London Road, Reading, Berkshire, RG1 5AN, UK. Martin.Leyland@rbbh-tr.nhs.uk.

Abstract

Background

Good unaided distance visual acuity is now a realistic expectation following cataract surgery and intraocular lens implantation. Near vision however still requires additional refractive power usually in the form of reading glasses. Multiple optic (multifocal) intraocular lenses are available which claim to allow good vision at a range of distances. It is unclear whether this benefit outweighs the optical compromises inherent in multifocal intraocular lenses.

Objectives

The objective of this review was to assess the effects of multifocal intraocular lenses, including effects on visual acuity, subjective visual satisfaction, spectacle dependence, glare and contrast sensitivity, compared to standard monofocal lenses.

Search strategy

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which includes the Eyes and Vision Group Trials Register) on The Cochrane Library (2005, Issue 3), MEDLINE (1966 to Sept 2005) and EMBASE (1980 to Sept 2005), National Research Register (2005, Issue 3), PubMed (searched on 13 Sept 2005 for last 90 days). We searched the reference lists of relevant articles and contacted investigators of included studies and manufacturers of multifocal intraocular lenses for information about additional published and unpublished studies.

Selection criteria

All randomised controlled trials comparing a multifocal intraocular lens of any type with a monofocal intraocular lens as control were included. Both unilateral and bilateral implantation trials were included.

Data collection and analysis

Data were collected and trial quality was assessed. Where possible, statistical summary measures were calculated otherwise data were tabulated.

Main results

Eight trials were identified. There was significant variability between the trials in which outcomes were reported. Unaided distance acuity was similar in multifocal and monofocal intraocular lenses (Peto odds ratio (OR) 1.21, 95% Confidence Interval (CI) 0.75 to 1.96). There was no statistical difference between multifocal IOLs and monofocals with respect to the proportion of participants achieving 6/6 best corrected visual acuity (OR 1.43, 95% CI 0.99 to 2.09). Unaided near vision was improved with the multifocal intraocular lenses. Total freedom from use of glasses was achieved more frequently with multifocal than monofocal IOLs (OR for spectacle dependence 0.15, 95% CI 0.11 to 0.22). Adverse effects included reduced contrast sensitivity and the subjective experience of haloes around lights.

Authors' conclusions

Multifocal intraocular lenses are effective at improving near vision relative to monofocal intraocular lenses. Whether that improvement outweighs the adverse effects of multifocal intraocular lenses will vary between patients. Motivation to achieve spectacle independence is likely to be the deciding factor.

Plain language summary

Plain language summary

Multifocal intraocular lens implants reduce spectacle dependence after cataract surgery but at the expense of clarity

Cataract surgery is frequently accompanied by the implantation of an intraocular lens (IOL). Standard monofocal IOLs focus at one fixed distance - either near or distant. This means that most people will require spectacles in addition to monofocal IOLs. New IOLs allow the person to focus at more than one distance (multifocal IOLs). This review of trials comparing monofocal IOLs with multifocal IOLs found that multifocal IOLs decrease dependence on spectacles. This is at the expense of sharpness of vision and increased glare. It will be up to each individual person to decide which type of lens they would prefer.