Comparison of Depth of Focus and Mesopic Contrast Sensitivity in Small-Aperture Inlay, Accommodating IOL, and Multifocal IOL Patients
Narrative Responses:
Purpose
To evaluate the clinical performance of a small-aperture intracorneal inlay (KAMRA, AcuFocus, Inc) to three premium IOLs (Crystalens AO (B&L), ReSTOR 3.0 (Alcon), and Tecnis Multifocal (AMO) designed to improve distance, intermediate, and near vision. Monocular defocus curves and binocular mesopic contrast sensitivity with and without glare will be compared.
Methods
Retrospective comparative analysis of 6-month data from a prospective randomized study on three premium IOLs to 12-month data from a prospective, non-randomized trial on patients implanted monocularly with a KAMRA inlay. Monocular depth-of-focus curves were measured in Crystalens AO (n=52), ReSTOR 3.0 (n=50), Tecnis MF (n=46) and KAMRA (n=114) patients from +5.0D to -5.0D in 0.50D steps. Binocular mesopic contrast sensitivity was measured with and without glare in Crystalens AO (n=26), ReSTOR 3.0 (n=25), Tecnis MF (n=22) and KAMRA (n=270) patients for 1.5, 3, 6, 12 and 18 cycles/degree.
Results
Crystalens AO & KAMRA inlay patients had continuous functional vision of 20/40 or better over 3.0D and 4.0D, respectively. ReSTOR 3.0 and Tecnis MF multifocal IOLs had non-continuous functional vision over a dioptric range of 4.5D each. Inlay patients showed better functional vision at intermediate dioptric ranges when compared to all three IOLs. Compared to the pseudophakes, the inlay patients had better mesopic contrast sensitivity without glare at 3, 6 and 12 cycles/degree and at 1.5, 3 and 6 cycles/degree with glare. There were small, statistically significant differences in mesopic contrast sensitivity between the three IOLs at lower spatial frequencies.
Conclusion
Monocular small-aperture inlay implantation appears to provide the broadest, continuous range of vision without compromising contrast sensitivity, in comparison to accommodative and multifocal IOLs. Multifocal IOLs had better near vision at 40 cm, but at the cost of reduced contrast and increased scatter.