LASIK and multifocal IOLs superior to accommodative IOL for treating presbyopia

PresbyLASIK or multifocal IOL implantation yield superior visual outcomes in patients with presbyopia, improving both near and distance vision, as opposed to accommodative IOL implantation, which improves distance vision only, according to a study published in the March 2008 issue of the Journal of Refractive Surgery.

Sudi Patel of the Vissum Instituto Oftalmológico de Alicante, Spain and researchers compared the visual outcomes of a multifocal IOL (Acri.Smart; Acri.Tec/Zeiss) and an accommodative lens (AT-45; Crystalens/Bausch & Lomb) for the correction of distance and near visual acuity (VA) with a LASIK procedure for presbyopia (presbyLASIK) and a control group fitted with a standard distance-correcting monofocal IOL (AcrySof; Alcon).

Distance and near decimal visual acuities were measured under similar conditions pre- and six months postoperatively in 45 patients (87 eyes). All acuity measures were standardized at 20 m (distance, projected chart) and 40 cm (near).

Preoperatively, the team recorded distance mean VAs of 0.15±0.21, 0.31±0.14, 0.35±0.15 and 0.32±0.18 for the Acri.Smart, AT-45, presbyLASIK and control groups, respectively. Postoperatively, this was 0.66±0.35, 0.68±0.28, 0.80±0.33 and 0.59±0.29 for each of the respective groups. In terms of near mean VAs, the team recorded preoperative figures of 0.13±0.21, 0.43±0.22, 0.15±0.20 and 0.40±0.29 for the Acri.Smart, AT-45, presbyLASIK and control groups, respectively. Postoperatively, this was 0.62±0.35, 0.51±0.27, 0.68±0.33 and 0.30±0.13 for each of the respective groups. Distance and near visual acuities improved significantly after surgery (p<0.05) except near acuities for the AT-45 IOL and control groups.

The study demonstrated that distance and near acuities improved with presbyLASIK and Acri.Smart IOLs when compared with monofocal IOLs. In those patients treated with the accommodative AT-45 IOL, average distance VA improved but not near VA.