100% patient satisfaction in mix and match study

Mixing and matching multifocal IOLs can produce excellent visual acuity across near, intermediate and far distances and can generate a very high degree of patient satisfaction, Dr Scipione Rossi told delegates.

Drawing on the results from two studies using the ReZoom and Tecnis multifocal IOLs (AMO), Dr Rossi said there were excellent results for the right candidate. "Careful patient selection is vital," he said.

The rewards for careful patient selection can be impressive. One of the studies Dr Rossi presented recorded patient satisfaction of 100%.

In his talk, Dr Rossi presented a flow chart representing inclusion and exclusion factors. At the top comes desire for spectacle independence or to work on computer without glasses.

Next is eye health and attitude. Finally, the flow chart indicates the best multifocal IOL for the individual patient. Those who want near vision dominance require bilateral use of the Tecnis multifocal IOL. For dominance in intermediate and distance vision a bilateral ReZoom is necessary, and people who want good all-round vision should mix and match.

The ReZoom is a refractive multifocal IOL that favours distance and intermediate vision at the expense of near, while the Tecnis multifocal IOL favours near and distance but is not so strong on intermediate vision.

Dr Rossi cited two multicentre studies, one European, the other Italian. In the first study, patients sought excellent distance and intermediate vision and a good near vision, and in this case the ReZoom was implanted in the dominant eye. In the Italian series, the patients sought excellent near and far and the Tecnis was implanted in the dominant eye.

The Italian study followed 48 mix and match patients who received the Tecnis in the dominant eye, with follow up at one day, three months and six months. The study used the Eyevispod near vision analysis system to test reading speed.

At the end of the study, average near visual acuity was J1.2, average intermediate was J3.3 and average distance was 0.9, with 95% spectacle independence, haloes in 8% and an average reading speed of 130 words/minute ±10.

The study concluded that there was good vision at all distances, high patient satisfaction and spectacle independence. Dr Rossi noted that biometry was crucial, and that there was some astigmatism postop, which was refined by laser.

The European multicentre trial included 195 patients from the cases of 12 surgeons across Europe. Patients were examined at one day, three months and six months postop, and Dr Rossi presented the results of the first 90 cases to complete the study.

Preop BCVA for distance was mean 0.7 logMAR with a range of 0.1 to 1.5 logMAR. Optical visual symptoms like day glare, night glare, halos and function of acuity presented in 25% of patients preop. The Tecnis ZM900 was implanted in the dominant eye for 6% of patients, the other 94% were ReZoom dominant, and lens power ranged from 7 to 32D for a mean of 22 D.

At six months, mean uncorrected distance vision was 0.97 logMAR, 0.58 for intermediate and 0.85 logMAR for near. BCDVA was 1.05 at six months. There were day glare issues in four patients, two mild and two moderate. Night glare presented in seven patients; five mild and two moderate, and 35 cases of haloes; 27 mild, seven moderate and one severe, but patients didn't mind.

Functional reading speed was excellent and spectacle independence was achieved in 92.5% of patients, with glasses prescribed for five patients; one for distance and two each for near and bifocals.

"In the European study, 100% of patients said they would undergo the procedure again and 98% said they would recommend the procedure to their friends," Dr Rossi said.

Dr Rossi concluded that the Tecnis and the ReZoom mix and match multifocal technique was an excellent solution for patients with healthy eyes who desired spectacle independence with excellent vision at near intermediate and far distances. Dr Rossi emphasized that he had no financial connection to AMO.