A Comparison Of Patient Satisfaction With Modified Monovision Versus The ReSTOR ® Intraocular Lens

1. A Comparison Of Patient Satisfaction With Modified Monovision Versus The ReSTOR® Intraocular Lens Neeti Parikh, MD Fuxiang Zhang, MD Department of Ophthalmology Henry Ford Hospital *The authors have no financial interest in the material presented

2. PURPOSE To compare patient satisfaction of visual function with modified monovision vs. with ReSTOR® lens implantation • Monovision: a type of presbyopic correction in which one eye is corrected for distance and the other eye for near • Modified monovision: smaller refractive difference between the two eyes (Between 1.00 - 2.25 D anisometropia) • ReSTOR®: a multifocal intraocular lens that provides patients with a range of vision, near through distance

3. METHODS Part 1: Retrospective Chart review • Charts for patients who had cataract surgery between January 2005 and January 2007 from one clinical practice in the Henry Ford Health System reviewed • Inclusion criteria: Bilateral cataract extraction and implantation of either a conventional intraocular lens with the goal of modified monovision or an AcrySof®ReSTOR® lens • Exclusion criteria: Other ocular co-morbidities (moderate to severe diabetic retinopathy, glaucoma with significant visual field defects or optic nerve damage, ARMD) or Toric IOL implantations • Minimum of 1 month follow up post operative visit • Preoperative refraction , keratometry, IOL calculations • All patients underwent conventional phacoemulsification and in the bag implantations with Alcon SN60 WF or SA60 AT lens or ReSTOR® : SN60D3 ReSTOR • Postoperative uncorrected visual acuity (distance and near), postoperative refraction Part 2: Patient satisfaction survey • Visual function questionnaire- 25 (VFQ-25), validated by the National Eye Institute • Amended to include questions about glare, halos, intermediate vision, and use of glasses after surgery • Completed by patients 3- 24 months postoperatively

4. RESULTS

5. VFQ-25 Results-Mean Satisfaction scores for Distance, Near, Driving • P>.05 for all

6. VFQ-25 Results-Intermediate vision How much difficulty do you have………? No difficulty at all ............................................ 1 A little difficulty................................................ 2 Moderate difficulty........................................... 3 Extreme difficulty............................................. 4 Stopped doing this because of your eyesight ...5 • Computer vision: • ReSTOR® : 1.82 ± .92 • Modified Monovision 1.42 ± .59 • p=.036

7. VFQ-25 Results-Halos/Glare • I am bothered by glare/halos …. • All of the time………………….….1 • Most of the time……………….….2 • Some of the time………………......3 • A little of the time…………………4 • None of the time…………………..5 • Glare: • ReSTOR® : 3.74 ±1.21 • Modified Monovision: 3.98 ± 1.03 • p=.339 • Halos: • ReSTOR®: 3.39 ± 1.42 • Modified Monovision: 4.66 ± .72 • p <. 001

8. Uncorrected Visual Acuity at 1 month p=.002 p=.162

9. Freedom from glasses Modified Monovision: 14% of patients (who completed survey) never wear glasses ReSTOR® : 84% of patients (who completed survey) never wear glasses Use of glasses among “satisfied” patients (% pts who had little to no difficulty with driving, distance, intermediate, or near activities but still used glasses for these activities): p<.001for all

10. CONCLUSIONS/DISCUSSION • Uncorrected distance visual acuity better in ReSTOR® group (20/40 or better) • No statistical difference in uncorrected near acuity (J3 or better) between the two groups • Modified monovision patients have more dependence on glasses (for all activities) • Modified monovision falls short of correcting for full monovision • Average of only 1.4 D difference between 2 eyes • May not be enough to achieve high rate of glasses independence • No preoperative tolerance test performed for this group • This is the reason for the modified approach to monovision in these patients • Astigmatism • ReSTOR ® patients with ≥1 D of astigmatism treated with limbal relaxing incisions • 26% of modified monovision patients had ≥1 D of preoperative astigmatism that was not corrected • Patients with toric implants who had monovision were excluded from this study

11. CONCLUSIONS/DISCUSSION • Monovision patients more likely to wear glasses, but still very satisfied • No statistical difference in satisfaction scores for driving, distance, or reading between 2 groups • Statistically significant higher satisfaction score in modified monovision group for intermediate (computer) vision • Modified monovision patients had no out of pocket costs for the surgery (ReSTOR® cost to patient = $1895 per eye ) • Modified monovision patients more likely to be willing to pay for glasses

12. REFERENCES • Boerner, C.F., Thrasher BH. Results of Monovision Correction in Bilateral Pseudophakia. American Intraocular Implant Society Journal, 10. 1982. 49-50 • Greenbaum S. Monovision Pseudophakia. Journal of Cataract and Refractive Surgery. 28, 2003, 1439-1443 • Handa et al. Ocular Dominance and patient satisfaction after monovision induced by intraocular lens implantation. Journal of Cataract and Refractive Surgery, 30. 2004, 769-774 • Maloney, W.F. Conventional IOL presbyopia correction:six steps to success. Ocular Surgery News U.S. Edition March 1,2006. • Maloney, W.F. 20 years of developing conventional IOL presbyopia correction. Ocular Surgery News U.S. Edition January 1, 2006. • Maloney, W.F. Conventional IOL still offen best choice for presbyopia correction. Ocular Surgery News U.S. Edition November 1, 2005. • Maloney, W.F. Presbyopia success depends on comprehensive preop evaluation. Ocular Surgery News U.S. Edition August 1.2005. • Maloney, W.F. Presbyopia correction will set a new standard for cataract surgery. Ocular Surgery News U.S. Edition July 1,2005. • Mangione, C. M., Lee, P. P., Gutierrez, P. R., Spritzer, K., Berry, S., & Hays, R. D. (2001). Development of the 25 – item National Eye Institute Visual Function Questionnaire (VFQ – 25). Archives of Ophthalmology, 119, 1050-1058 • Mangione, C. M., Lee, P. P., Pitts, J., Gutierrez, P., Berry, S., & Hays, R. D. (1998). Psychometric properties of the National Eye Institute Visual Function Questionnaire, the NEI – VFQ. Archives of Ophthalmology, 116, 1496 – 1504