Abstract
Purpose
To assess the difference in binocular visual fields (VFs) in patients who underwent bilateral cataract surgery with either multifocal (MF; Tecnis ZM900, AMO) intraocular lenses (IOLs) or monofocal IOLs with powers adjusted to give monovision (MV; Akreos AO, Bausch&Lomb).
Setting
St George's & Moorfields Eye Hospital, London.
Methods
Prospective exploratory study. Binocular Esterman VFs (Humphrey Field Analyser II) were compared between 10 participants with MV and 16 participants with MF IOLs. The dominant eye in MV participants had 0 to −0.50DS and the non-dominant eye had between −1.0DS and −1.5DS. Best-corrected Snellen visual acuity for all 52 eyes was six out of nine or better. The main outcome measure was Esterman Efficiency Score. Incidence of suboptimal VF results (⩾1 Unseen Locations—ULs) and mean testing times in the two groups were compared.
Results
There was no statistically significant difference in the incidence of suboptimal VF results in these two groups (P=0.662). Test durations in the two groups were not significantly different (P=0.650). However, 3/10 MV plots (33%) had markedly suboptimal right hemi-fields (distance-dominant eye) compared with 0/15 MF plots. Additionally, the MV group accounted for 79% of total ULs (20/29) and all these ULs were distributed in areas outside or bordering the true binocular VFs.
Conclusions
All included VFs met the UK driving standards criteria. The pattern of VF defects encountered in the MV group is of interest because the majority of ULs (13/20; 65%) corresponded to the monocular VFs of the distance-dominant eye.
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References
Wilkins M, Allan B, Rubin G . A prospective randomized controlled trial comparing monovision with a multifocal implant in patients undergoing bilateral cataract surgery. 2006, Available at: http://www.ioltrial.org.
Leyland M, Zinicola E . Multifocal versus monofocal intraocular lenses in cataract surgery: a systematic review. Ophthalmology 2003; 110: 1789–1798.
Greenbaum S . Monovision pseudophakia. J Cataract Refract Surg 2002; 28: 1439–1443.
Talley-Rostov A . Patient-centred care and refractive cataract surgery. Curr Opin Ophthalmol 2008; 19: 5–9.
Mester U, Hunold W, Wesendahl T, Kaymak H . Functional outcomes after implantation of Tecnis ZM900 and Array SA40 multifocal intraocular lenses. J Cataract Refract Surg 2007; 33: 1033–1040.
Steinert RF, Post CT, Brint SF, Fritch CD, Hall DL, Wilder LW et al A prospective, randomized, double-masked comparison of a zonal-progressive multifocal intraocular lens and a monofocal intraocular lens. Ophthalmology 1992; 99: 853–861.
Babizhayev MA . Glare disability and driving safety. Ophthalmic Res 2003; 35: 19–25.
Rowe F . Visual Fields via the Visual Pathway. Blackwell Publishing Ltd: Oxford, England, 2006; 60–71.
Nijkamp MD, Dolders MGT, de Brabander J, van der Borne B, Hendrikse F, Nuijts RMMA . Effectiveness of multifocal intraocular lenses to correct presbyopia after cataract surgery. Ophthalmology 2004; 111: 1832–1839.
Bi H, Cui Y, Ma X, Cai W, Wang G, Ji P et al Early clinical evaluation of AcrySof ReSTOR multifocal intraocular lens for treatment of cataract. Ophthalmologica 2008; 222: 11–16.
DVLA: at a glance guide to the current medical standards of fitness to drive. September 2009, Available at: http://www.dft.gov.uk/dvla/~/media/pdf/medical/at_a_glance.ashx.
Esterman B . Functional Scoring of the binocular field. Ophthalmology 1982; 89: 1226–1234.
Mills RP, Drance SM . Esterman disability rating in severe glaucoma. Ophthalmology 1986; 93 (3): 371–378.
Jampel HD, Friedman DS, Quigley H . Correlation of the binocular visual field with patient assessment of vision. Invest Ophthalmol Vis Sci 2002; 43: 1059–1067.
Harrington DO, Drake MV . The visual Fields: Text and Atlas of Clinical Perimetry, 6th edition. Mosby Company: St Louis, Missouri, USA, 1990; 102–103.
Haley MJ (ed). The Field Analyser Primer, 2nd edition. Humphrey Systems: Dublin, California, USA, 1993; 6–11.
Henson DB . Visual Fields, 2nd edition. Reed Educational and Professional Publishing Ltd: Oxford, UK, 2000; 2–8: 120–121–150–151.
Spry PGD, Johnson CA . Senescent changes of the normal visual field: an age-old problem. Optom Vis Sci 2001; 78 (6): 436–441.
Koller G, Haas A, Zulauf M, Koerner F, Mojon D . Influence of refractive correction on peripheral visual field in static perimetry. Graefes Arch Clin Exp Ophthalmol 2001; 239: 759–762.
Niederhausen S, Mojon DS . Normal isopter position in the peripheral visual field in goldmann kinetic perimetry. Ophthalmologica 2002; 216: 406–408.
Jain S, Ou R, Azar D . Monovision outcomes in presbyopic individuals after refractive surgery. Ophthalmology 2001; 108: 1430–1433.
Denniston AKO, Murray PI . Oxford Handbook of Ophthalmology, 1st edition, Oxford University Press: UK, 2006; 261.
Mester U, Sauer T, Kaymak H . Decentration and tilt of a single-piece aspheric intraocular lens compared with the lens position in young phakic eyes. March 2009. J Cataract Refract Surg 2009; 35 (3): 485–490.
Acknowledgements
We would like to thank the staff at Moorfields St George's Hospital and the Glaucoma Research Unit at Moorfields City Road which kindly helped with testing arrangements. We would also like to thank the people who volunteered to take part in this study. The Study was sponsored by Moorfields Eye Hospital London, NHS Trust, England, UK.
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This work was presented at the XXVII Congress of the ESCRS Barcelona, Spain, September 2009
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Stanojcic, N., Wilkins, M., Bunce, C. et al. Visual fields in patients with multifocal intraocular lens implants and monovision: an exploratory study. Eye 24, 1645–1651 (2010). https://doi.org/10.1038/eye.2010.104
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DOI: https://doi.org/10.1038/eye.2010.104
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