Comparison of Depth-of-Focus and Mesopic Contrast Sensitivity in Small-Aperture Corneal Inlay, Accommodating IOL, and Multifocal IOL Patients
Purpose
Evaluation of binocular mesopic contrast sensitivity and monocular defocus curves with a small-aperture intracorneal inlay versus three premium IOLs.
Methods
A retrospective comparison of 6-month data from a prospective three-arm study on the Crystalens AO (Bausch + Lomb), Acrysof ResTOR 3.0 (Alcon) and Tecnis Multifocal (Abbott Medical Optics) that were bilaterally implanted to 6-month data from a prospective clinical trial on the KAMRA inlay (AcuFocus) that was monocularly implanted in the non-dominant eye. Monocular defocus curves were measured from +5.0D to -5.0D in 0.50D steps for the inlay and +4.0D to -4.0D in 0.50D steps for the IOLs. For all patient groups, binocular mesopic contrast sensitivity was measured with and without glare for 1.5, 3, 6, and 12 cycles/degree using the OPTEC 6500 contrast sensitivity tester (Stereo Optical Co.).
Results
Crystalens AO (N=26) and KAMRA inlay (N=327) patients had continuous functional vision of 20/40 or better over 3.0D and 4.0D, respectively. ReSTOR 3.0 (N =25) and Tecnis MF (N =22) IOLs had non-continuous functional vision over 4.5D and 4.0D, respectively. KAMRA and Crystalens AO patients were superior to multifocal IOLs at intermediate. For binocular mesopic CS without glare, KAMRA patients were better than Crystalens AO and Tecnis MF at all tested spatial frequencies (p < 0.05) and were better than ReSTOR +3.0 at 3, 6 and 12 cpd (p< 0.001). For binocular mesopic glare, the inlay patients showed significantly better contrast sensitivity at all spatial frequencies (all p< 0.001) versus the three IOLs. Crystalens AO was significantly better than Tecnis MF at 3, 6 and 12 cycles/degree (p< 0.05).
Conclusion
Monocular implantation of a small aperture inlay resulted in improved visual performance across all distances. The inlay patients showed significantly better binocular mesopic contrast sensitivity compared to either accommodating or multifocal IOLs.