Visual function and change in quality of life after bilateral refractive lens exchange with the ReSTOR multifocal intraocular lens.

PURPOSE: To evaluate vision and quality of life and explore the correlation between vision and change of quality of life after bilateral refractive lens exchange of the Acrysof SA60D3 ReSTOR multifocal intraocular lens (IOL) for correction of ametropia in presbyopic populations. METHODS: Pre- and postoperatively, the National Eye Institute Refractive Error Quality of Life Instrument (NEI-RQL) was self-administered by 30 consecutive refractive lens exchange patients, including 19 myopes and 11 hyperopes. The change of NEI-RQL scores was determined for each subscale covering a specific aspect of quality of life. Refraction, visual acuity, and contrast sensitivity function were evaluated 3 and 6 months postoperatively. RESULTS: Postoperatively, all patients achieved binocular uncorrected distance and near visual acuity of 20/30 or better. Photopic contrast sensitivity function decreased significantly at high spatial frequencies (P < .05). Overall scores of expectations, activity limitations, dependence on correction, appearance, and satisfaction were significantly higher postoperatively (P < .05). Greater improvement in near vision and dependence on correction was achieved in hyperopes. However, glare scores were significantly lower postoperatively (P < .001). Lower preoperative uncorrected near visual acuity was associated with higher scores for dependence on correction in myopes (r = 0.51, P = .027), and overall patient satisfaction correlated significantly with postoperative uncorrected distance visual acuity (r = -0.44, P = .015). CONCLUSIONS: Refractive lens exchange with the ReSTOR IOL in presbyopic patients provided good visual function and better patient satisfaction compared with preoperative corrections. Improvement in vision-related quality of life was most evident in hyperopes. A slight reduction in contrast sensitivity function appears to have no influence on quality of life.

Visual and refractive status at different focal distances after implantation of the ReSTOR multifocal intraocular lens.

PURPOSE: To evaluate the visual acuity and determine the refraction in emmetropic pseudophakic eyes at different focal distances after implantation of the AcrySof SA 60D3 ReSTOR multifocal intraocular lens (IOL) (Alcon Laboratories). SETTING: Private clinical practice. METHODS: Thirty-seven eyes of 20 patients received the ReSTOR IOL. Visual acuity was measured at several distances, and best distance corrected, best intermediate corrected (60 cm), and best near corrected (33 cm) visual acuities were determined 3 months after surgery. Subjective outcomes were assessed by a questionnaire. RESULTS: Postoperatively, 36 of 37 eyes (97.3%) were within +/-1.00 diopter (D) of the manifest refraction spherical equivalent and cylinder. Monocularly, the mean best distance corrected, best distance corrected intermediate, and best distance corrected near visual acuities were 20/20, 20/46, and 20/23, respectively. The best distance corrected acuities at 40, 50, 60, and 70 cm were significantly worse than the best distance corrected and best distance corrected near acuities (P<.05). On the questionnaire, all patients noted intermediate blur, but 75% had little or no difficulty seeing and were bothered by the blur occasionally or never. The mean additional add to best distance correction for best intermediate corrected visual acuity was +1.20 diopters (D) +/- 0.27 D or -1.68 +/- 0.24 D and for best near corrected visual acuity, -0.26 +/- 0.24 D. CONCLUSIONS: Implantation of the ReSTOR IOL offered excellent visual acuity at distance and near distance and functional visual acuity in the intermediate range. For patients who need excellent vision at intermediate range, leaving 1 eye with distance myopia or hyperopia to compensate for intermediate vision may provide consistent good binocular vision over the full range in cases of bilateral implantation.

Distribution of thrombospondin-4 in the bovine eye.

PURPOSE: The purpose of this study was to analyze the distribution of thrombospondin-4 (TSP-4) in the bovine eye. METHODS: Anterior and posterior segments of the bovine eyes were sectioned and stained by the indirect immunofluorescence method with an anti-TSP-4 antibody. The tissues were analyzed by reverse-transcription-polymerase chain reaction (RT-PCR) to determine where the TSP-4 mRNA is produced. RESULTS: Immunohistochemical staining for TSP-4 indicated the presence of TSP-4 in the cornea (epithelium, basement membrane, and keratocytes), conjunctiva (epithelium and stroma), aqueous ducts, sclera, iris (stroma), ciliary processes and muscle, trabecular meshwork, Bruch's membrane, retina, lamina cribrosa, and optic nerve, and in all blood vessel walls. TSP-4 mRNA was expressed by the cells in all structures. CONCLUSIONS: TSP-4 is widely distributed in the bovine eye where it may play a role in the functions of basement membranes in various tissues. It is abundant in the trabecular and uveo-scleral pathways and may play a role in the regulation of aqueous outflow resistance.

Intermediate optimization of vision with bilateral nonaspheric multifocal intraocular lens implantation.

PURPOSE: To evaluate binocular visual function, refraction, and subjective outcomes of intermediate optimization of vision after simultaneous bilateral implantation of the nonaspheric AcrySof SA60D3 ReSTOR multifocal intraocular lens (IOL). SETTING: Private clinic, Abbotsford, British Columbia, Canada. METHODS: Intermediate optimization was performed by overcorrection of 1.00 diopter (D) to induce mild myopia in the nondominant eye in patients having bilateral implantation of the multifocal IOL. Distance manifest refraction and visual acuity at several distances were determined; contrast sensitivity function (CSF), near-point stereo acuity, and subjective outcomes were assessed postoperatively at 2 weeks and 1, 3, 6, and 12 months. RESULTS: Thirty-two patients with intended intermediate optimization and 5 patients with unintended intermediate optimization were prospectively evaluated. The mean manifest refraction spherical equivalent was stable from 2 weeks (-0.94 D+/-0.22 [SD]) to 12 months (-0.93+/-0.23 D) in the intermediate optimization eyes. Overall, postoperative mean binocular uncorrected near, intermediate, and distance visual acuities were 20/23, 20/23, and 20/22, respectively. No significant differences were found between best distance-corrected and uncorrected stereo acuity or between best distance-corrected and uncorrected binocular CSF under most conditions (P> .05). On questioning, 97% of patients had little or no difficulty seeing and were bothered occasionally or never by the visual fluctuation between the near range and intermediate range. CONCLUSION: Intermediate optimization with slight myopia in 1 eye after bilateral implantation of the multifocal IOL offered consistent good vision at all ranges, indicating it a safe option for patients who require good vision at intermediate ranges.