Combined implantation of monofocal and multifocal intraocular lenses for presbyopia correction in cataract patients

Background: The purpose of this study was to assess uncorrected far and near vision after implantation of a multifocal intraocular lens (IOL) in the second eye in patients with a unilateral monofocal IOL. Patients and Methods: 13 cataract patients with a monofocal intraocular lens in one eye (SA60AT, Alcon) and postoperative emmetropia received a multifocal lens in the second eye (ReSTOR, Alcon). Two and six months postoperatively the clinical examination, far and near vision, near aniseikonia (AWAYA-New Aniseikonia Test), stereo vision (Lang I test) and the mesopic contrast sensitivity (F. A. C. T) were tested. In addition, the grade of satisfaction without glasses in general, and with far and near vision were noted on a visual analogue scale (0 - 10). Furthermore, independence from glasses and the presence of optical phenomena were assessed. Results: The mean uncorrected far visual acuity 6 months postoperatively was 1.06 +/- 0.28 for the monofocal lens, 0.88 +/- 0.23 for the multifocal lens, and 1.16 +/- 0.24 binocularly. The uncorrected near visual acuity was Nieden 1 binocularly for all patients and ranged from Nieden 1 - 3 for the multifocal lens to Nieden 2 - 11 for the monofocal lens. 77% of the patients received the multifocal lens in their far dominant eye. The mean uncorrected near aniseikonia was < 1%. The mesopic contrast sensitivity showed no significant differences between the two IOL types and compared to binocular values. The satisfaction with the uncorrected Visual acuity was in general 8.88 +/- 1.21, with the far visual acuity 9.42 +/- 1.24, and 7.33 +/- 1.72 with the near visual acuity. After 6 months 67% of the patients used glasses only for periods of prolonged reading. Halos and a low degree of glare were noted by 38.5% of patients 2 months postoperatively. At the 6 months visit 33.3% still had halos and only 8% glare. Conclusions: This first experience with the combined implantation of a monofocal and a multifocal lens revealed a marked improvement of the uncorrected near Visual acuity compared to bilateral monofocal IOL implantation along with a high patient satisfaction.