Effect of residual sphere on uncorrected visual acuity and satisfaction in patients with monofocal and multifocal intraocular lenses.

Abstract

Purpose: To assess the effect of residual sphere on vision and satisfaction in pseudophakic patients. Setting: Private clinics, United Kingdom Design: Retrospective case series. Methods: A multivariate model evaluated the effect of one-month residual sphere on outcomes of pseudophakic patients. Odds ratios (ORs) were calculated to assess the relative risk of not achieving ≥20/20 monocular uncorrected distance visual acuity (UDVA), ≥20/50 near visual acuity (UNVA), and not being satisfied with vision. ORs were assessed for residual sphere -1.00D to +1.00D in quarter-diopter steps, using 0.00D as a reference. Results: The analysis included 38,828 multifocal and 11,571 monofocal IOLs. The residual myopic sphere ≤-0.25D and hyperopic sphere ≥+0.50D had a clinically meaningful effect on UDVA. While monofocal IOLs had an improvement in UNVA with every additional 0.25D of myopia, the change in ORs with increasing myopia was not significant for multifocal IOLs. The mean improvement in UNVA comparing eyes with 0.00D and -1.00D sphere was 0.26 logMAR for monofocal and 0.03 logMAR for multifocal IOLs. Low near-addition IOLs had a slightly higher gain in UNVA with increasing myopia, but the gain was not as substantial as with monofocal IOLs. The effect of ametropia on satisfaction was more pronounced for multifocal IOLs. For every 0.25D of residual myopia, there was >25% increase in dissatisfied patients. Conclusions: While myopia improved UNVA in eyes with monofocal IOL, multifocal IOLs did not benefit from residual myopia. Multifocal IOL patients desiring distance vision should be targeted closest to emmetropia, even if it means targeting slight hyperopia.