Laird Harrison

May 07, 2017

LOS ANGELES — The accommodative Crystalens intraocular lens (IOL) (Bausch + Lomb) achieved better intermediate visual acuity but not as good near visual acuity compared with the ReStor +3 multifocal IOL (Alcon) and the acrylic Tecnis Multifocal IOL (Abbot) in a 5-year study.

The rate of posterior capsule opacification (PCO) was lowest with the ReStor, followed by the Tecnis. Conversely, there were fewer halos and less glare with the Crystalens than with the two multifocals.

However, regardless of which IOL was used, the overall results were good and all patients said they would recommend the IOLs.

"The important thing is that there is not good or bad lens," said Robert Edward T. Ang, MD, from Asian Eye Institute Rockwell, Makati City, the Philippines, in an interview with Medscape Medical News. "All the lenses are good."

He presented the finding here at the American Society of Cataract and Refractive Surgery (ASCRS) 2017 Annual Congress.

Multifocal and accommodative lenses both allow patients with presbyopia and cataracts to see clearly at multiple distances. Multifocal lenses work by providing multiple types of refraction at the same time. Accommodative lenses change in shape in response to movement of the ciliary body. The Crystalens changes its focus by moving forward and backward on flexible, hinged haptics.

The two approaches have both produced good effects in short-term studies, Dr Ang said, but he was not aware of any long-term comparisons. "We need to do a long-term follow-up of everything we put in the eye," he said. "It's always a question of whether it lasts a lifetime."

With that goal in mind, he tracked 156 eyes in 78 patients for 5 years. The patients had a mean age of 65 years at baseline. Dr Ang randomly assigned patients to one of the three types of lens.

"It was a lot of work," he said. At times his center had to provide transportation for elderly patients so he could review them at 1-year intervals. After 5 years, 67 patients (134 eyes) remained in the study: 44 eyes in the Crystalens group, 48 in the ReStor group, and 42 in the Tecnis group.

PCO occurred more slowly in the ReStor than in the other two lenses. "The posterior part of the ReStor lens has a square edge design that prevents the cells from growing," said Dr Ang.

On the other hand, there were fewer haloes and starbursts in the Crystalens group than in the other two groups.

IOL Manifest refractive spherical equivalence (D) Binocular high-contrast uncorrected distance visual acuity Mean binocular high-contrast uncorrected intermediate visual acuity Mean binocular high-contrast uncorrected near visual acuity YAG capsulotomy for posterior capsule opacification (%) Haloes and starbursts
Crystalens -0.30 20/21 20/22 20/24 55 22
ReStor -0.09 20/22 20/27 20/22 18 30
Tecnis -0.04D 20/23 20/24 20/23 36 28
D=diopter

European ophthalmologists have stopped implanting the Crystalens because it sometimes moves in the wrong direction. When that happens a YAG laser capsulotomy is necessary, Dr Ang said. "It's inconvenient for the doctor and the patient."

In the United States, where public transportation is less available, ophthalmologists have continued using the Crystalens because its lower rate of haloes and glare make it more suitable for driving at night, Dr Ang said.

In the discussion that followed, moderator Thomas Kohnen, MD, PhD, from the University of Frankfurt, Germany, asked if Dr Ang had performed all of the capsulotomies himself. He had.

A panelist noted a slight trend toward hyperopia. Dr Ang acknowledged that trend but said that his reading of the statistics led him to view the eyes as stable.

The panel of three experts named Dr Ang's study the best of the 14 presented in their session. "The important thing is that it was a long-term study," Dr Kohnen told Medscape Medical News. "We don’t have long-term data."

He said the PCO rates stood out for him in the presentation. He was impressed with the superiority of the ReStor in this respect. "Crystalens is not a good choice in terms of PCO," he said.

Dr Ang reported financial relationships with Bausch + Lomb. Dr Kohnen reported financial relationships with multiple ophthalmic companies.

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American Society of Cataract and Refractive Surgery 2017 Annual Congress. May 6, 2017; Los Angeles, California.

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