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Post operative visual outcome in multifocal versus monofocal IOL

Medrech

ISSN No. 2394-3971

Original Research Article

POST OPERATIVE VISUAL OUTCOME IN MULTIFOCAL VERSUS MONOFOCAL
IOL
Dr Ravi Chauhan, Dr Sandesh Sonarkhan, Dr Satish Solanke, Dr. Anup Mandal

Dept. Of Ophthalmology, Indira Gandhi Govt. Medical College,

Nagpur, India

Abstract
Purpose: To study and compare the postoperative visual outcome and contrast sensitivity in
multifocal versus monofocal IOL
Method
Study Design: Randomized control trial; Study period: 12 months; Sample size: 60 eyes of 60
patients
The study included 33 males and 27 females distributed randomly among the two study groups.
There was no statistical difference between two groups in term of sex distribution of patients. The
patient belonged to the age group of 56 to 65 years of age. The patients were divided into groups
according to the age. One group of patients ranged from 56-60 years and the other group ranged
from 61 to 65 years. Thus there is no significant difference between the two groups in term of age
distribution. (BCDVA) best corrected distance visual acuity of more than 6/9 was noted in 28/30
patient with multifocal and 29/30 patient with monofocal. There was no statistically significant
difference between the two IOLS. (UCNVA) Uncorrected near visual acuity of more than N8 was
noted in 25 patients with multifocal IOL and only 1 patient with monofocal IOL. Thus there was a
statistically significant difference between the two IOL with multifocal providing a better near
visual acuity. Both the groups exhibited similar levels of contrast sensitivity at higher or moderate
levels of contrast sensitivity (100% - 34%) but at lower level of contrast sensitivity (34.2%-5%)
there was significant difference in the two groups with monofocal IOL being better than the
multifocal IOL.
Conclusion
In our study we found that patient with multifocal IOL obtained same UCDVA and BCDVA as
the monofocal IOL
The near visual acuity was significantly better in the multifocal group than the monofocal
group.
No significant difference in contrast sensitivity between the two groups.
Keywords: Monofocal, Multifocal, Contrast Sensitivity
Chauhan R. et al., Med. Res. Chron., 2015, 3 (1), 76-81

Medico Research Chronicles, 2016

Submitted on: February 2016

Accepted on: February 2016
For Correspondence
Email ID:

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Introduction
Cataract is defined as the presence of visually
impairing opacity in the lens that causes it to
lose its transparency and/or scatter light.
Cataract is a most common cause of blindness
in India.
With the practice of cataract extraction
surgery and IOL implantation good unaided
distance visual acuity is now a realistic
expectation post-surgery. Near vision,
however, still requires additional refractive
power, usually in the form of reading glasses.
This is because the replacement lens had one
point of focus, for distance only.
Monovision does not allow full advantages of
binocularity, including stereopsis at near and
bilateral stimulation of visual cortex for
enhancement of distance visual acuity.
However, with recent advances in technology
and newer development in the field of
intraocular lens good unaided distance and
near vision has become a reality.
Multifocal lenses provide multi point of
focuses and thus provides a good distance
and near visual acuity. These are designed to
avoid the need for glasses.
With heightened patient expectation, the
scenario of cataract surgery
no more
remains like what it was a few years ago.
Multifocal IOL implants have almost
revolutionized the field by providing
excellent visual outcome and spectacle
independence. But then there are
drawbacks inherent to multifocal IOLs.
With implantation of these IOLs some
patients complain of decreased contrast
sensitivity
Hence, there is a need to study whether
the benefit of the multifocal IOLs
outweighs this optical compromise
inherent to multifocal IOL. Hence, there is
a need to carry out a comparative study of
the multifocal versus monofocal IOL.
Aims and Objective
This study was undertaken with the following
aims and objectives

To compare the outcome of visual acuity

in multifocal versus monofocal IOL
postoperatively.
To compare effect of monofocal and
multifocal IOL with respect to contrast
sensitivity.
Material and Methods
Study Design : Randomized control trial
Study period : 12 months
Sample size : 60 eyes of 60 patients
Inclusion criteriaPatients with senile cataract without any
other ocular pathology and only patients were
included who has no intra and post-operative
complications and having good in the bag
centration of Intra Ocular Lens
Exclusion criteria patients with ocular
pathology other than cataract i.e. high myopia,
diabetic retinopathy, hypertensive retinopathy,
uveitis, macular degeneration,
History of past ocular surgery or trauma.
patients with amblyopia
astigmatism greater than 0.5D
pupil size less than 2.5mm
All the participants had signed an informed
consent
Implication
At the end of the study we were be able to
asses and compare the multifocal IOL with
the monofocal IOL with respect to the visual
acuity achieved for near and distance, contrast
sensitivity with the two IOLS
History, assessment of uncorrected and
best corrected visual acuity and refraction,
measurement of intraocular pressure and
anterior
and
posterior
segment
examination were done preoperatively.
All cataracts were extracted by the
standard phacoemulsification technique
using a clear corneal 2.8mm incision.
A 5.5 mm rhexis was made and IOL
centration achieved.
All surgeries were performed by a single
surgeon.

Chauhan R. et al., Med. Res. Chron., 2015, 3 (1), 76-81

Medico Research Chronicles, 2016

Post operative visual outcome in multifocal versus monofocal IOL

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Post operative visual outcome in multifocal versus monofocal IOL

Post-operatively patient was assessed at 1

month, 3 month, 6 month interval and
unaided visual acuity, best corrected
visual acuity for distance and near and
contrast sensitivity were evaluated.

Contrast sensitivity was evaluated by the

PELLI ROBSON CHART.
Statistical analysis
Data was analyzed using Epi - info 3.4.3
and STATA 10.1 statistical software.

Result
Figure 1: Comparison of sex wise distribution in the two groups

20

16

15

17
14

13
MALES

10

FEMALES

5
MULTIFOCAL MONOFOCAL
GROUP
GROUP
The study included 33 males and 27 females
distributed randomly among the two study
groups. There was no statistical difference
between two groups in term of sex
distribution of patients.
Comparison of age wise distribution in the
two groups: The patient belonged to the age

group of 56 to 65 years of age. The patients

were divided into groups according to the age.
One group of patients ranged from 56-60
years and the other group ranged from 61 to
65 years.
The
patients
were
randomly
distributed among the two study groups.

20
15

16
12

18
14
multifocal
group

10

monofocal
group

5
0
56-60

61-65

Thus there is no significant difference between the two groups in term of age distribution.
Chauhan R. et al., Med. Res. Chron., 2015, 3 (1), 76-81

Medico Research Chronicles, 2016

Figure 2: Comparison of age wise distribution in the two groups

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Post operative visual outcome in multifocal versus monofocal IOL

Comparison of post operative visual acuity

for distance and near
(BCDVA) best corrected distance visual
acuity of more than 6/9 was noted in 28/30
patient with multifocal and 29/30 patient with
monofocal. There was no statistically
significant difference between the two IOLS.

(UCNVA) Uncorrected near visual acuity of

more than N8 was noted in 25 patients with
multifocal IOL and only 1 patient with
monofocal IOL. Thus there was a statistically
significant difference between the two IOL
with multifocal providing a better near visual
acuity.

Figure 3: Comparison of post operative visual acuity for distance and near

40
35
30
25
20
15
10
5
0

28

29
25
Multifocal IOL
Monofocal IOL
1

BCDVA >6/9
UCNVA >N8 according
according to snellens to snellens NV chart
distance of one meter at each visit during
follow up. The contrast sensitivity percentages
at the 6 month follow up were compared.

Table 1: Comparison of post operative contrast sensitivity evaluation between the two IOL groups
Contrast sensitivity score
Multifocal IOL group
Monofocal IOL group
(percentage)
(N=40)
(N=40)
100 % - 67.2%
59.3% - 39.7%
34.2% - 20.0%
15.9% - 12%
8.5% - 5.10%
At the end of 6 months 29/30 subjects in the
monofocal IOL group exhibited a better
contrast sensitivity.

0
0
0
0
15
0
10
1
5
29
In the multifocal IOL group at the end of 6
month only 5/30 patient exhibited better
contrast sensitivity.

Chauhan R. et al., Med. Res. Chron., 2015, 3 (1), 76-81

Medico Research Chronicles, 2016

Comparison of post operative contrast

sensitivity evaluation between the two IOL
groups: Contrast sensitivity of the patient was
evaluated on the PELLI ROBSON chart at the

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Both the groups exhibited similar levels of

contrast sensitivity at higher or moderate
levels of contrast sensitivity (100% - 34%) but
at lower level of contrast sensitivity (34.2%5%) there was significant difference in the
two groups with monofocal IOL being better
than the multifocal IOL.
The p value being less than0.005 hence was
clinically significant.
Conclusion
In our study we found that patient with
multifocal IOL obtained same UCDVA
and BCDVA as the monofocal IOL
The near visual acuity was significantly
better in the multifocal group than the
monofocal group.
No significant difference in contrast
sensitivity between the two groups.
In view of above, it will be up to the
individual to decide which type of lens they
would prefer. Patient that tend to tolerate
multifocal
IOLs
from
psychological
standpoint tend to be older, tend to be
optimistic in general, and do not drive a lot at
night. From a clinical standpoint, those who
are presbyopic with dense cataract tend to be
easier to please because they gain uncorrected
distance vision and near vision. Younger more
active patients have the highest expectation
from their surgery and while they are more
motivated to have decreased dependence on
spectacle after IOL surgery, they are more
difficult to please.
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Post operative visual outcome in multifocal versus monofocal IOL

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