View of COMPARISON OF CONTRAST SENSITIVITY BETWEEN MONOFOCAL AND MULTIFOCAL INTRA-OCULAR LENS IMPLANTATION AFTER PHACOEMULSIFICATION CATARACT SURGERY

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ACCENT JOURNAL OF ECONOMICS ECOLOGY & ENGINEERING

Peer Reviewed and Refereed Journal IMPACT FACTOR: 2.104(INTERNATIONAL JOURNAL) ISSN-2456-1037

Vol.04,Special Issue 04, ²^nd Conference (ICIRSTM) April 2019, Available Online: www.ajeee.co.in/index.php/AJEEE

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COMPARISON OF CONTRAST SENSITIVITY BETWEEN MONOFOCAL AND MULTIFOCAL INTRA-OCULAR LENS IMPLANTATION AFTER PHACOEMULSIFICATION CATARACT SURGERY

Pinaki Adak,^1,3,5 Parikshit Gogate,^1,2 Nilesh Thite^3,4Soumitra Adak⁶ Shikha Paliwal⁷

1Community Eye Care Foundation, Dr. Gogate’s Eye Clinic, Kumar Garima, Tadiwala Road, Pune

2Department of Ophthalmology, Padmashri D.Y.Patil Medical College, Pimpri, Pune

3School of Optometry, Bharati Vidyapeeth Deemed University Medical College, Pune, India.

4Director of Education Programs, International Association of Contact Lens Educators (IACLE).

5Assistant Professor, Department of Optometry, Teerthankar Mahaveer University, Moradabad

6Assistant Professor, Department of Engineering, Mallabhum Institute of Technology, West Bengal

7Assistant Professor, Department of Optometry, Teerthankar Mahaveer University, Moradabad

Abstract:

Purpose: To compare the contrast sensitivity of mono focal and multifocal intraocular lens implanted eyes after phacoemulsification cataract surgery.

Methods: All the cataractous eyes underwent a complete ocular evaluation (Refraction, Slit Lamp examination, Keratometry, Biometry, Tonometry and Ophthalmoscopy) before surgery. Post- operative unaided and aided, distance and near, visual acuity was recorded after 1 month and spectacles prescribed. Post-operative contrast sensitivity was taken in photo pic condition one time after 3month with best corrected visual acuity.

Results: Fifty eyes of forty one subjects underwent cataract extraction, 17 were multifocal patients and 24 were mono focal patients, each group having 25.Monofocal group’s age range was 40-83year (mean 61.92 ±12.03), 15 male, 9 female. Multifocal group age range was 40-65year (mean 53.24 ± 8.65),5 male, 12 female. Unaided near N6 visual acuity was 64% in multifocal group, none in mono focal group (P value<0.0001).The contrast sensitivity shows no significant difference between mono focal and multifocal IOL eyes (P value >0.05).

Conclusion: Multifocal intra ocular lens implanted patients had high rate of spectacle independency. There is no significant changes of contrast sensitivity occurred after three months of phacoemulsification between mono focal and multifocal IOL implanted patient.

Keywords:- Mono focal IOL, Multifocal IOL, Phacoemulsification Surgery, Contrast Sensitivity 1. INTRODUCTION

The aim of the study is to assess and compare contrast sensitivity of mono focal and multifocal intraocular lens implanted after phacoemulsification cataract surgery.

2. METHODS

This was a prospective clinical based study. Ethical clearance was obtained from the ethical committee of the Bharti Vidyapeeth Medical College, School of Optometry, and Pune, India. The study was conducted at Dr. Gogate’s eye clinic Pune, India for 6 months. Only those patients who underwent phacoemulsification cataract surgery with mono focal or multifocal intraocular lens implanted and had ages between 40-83 years were selected. Small incision cataract surgeries were excluded. Patients who had any history of ocular and systemic diseases, who had irregular corneal astigmatism, corneal degenerative diseases or corneal edema, subluxated lenses, astigmatism >one diopter before surgery, high ametropia before surgery were excluded. The preoperative examination performed including refraction, slit lamp and dilated fundus examination.

Axial length was measured by Quantel Medical (Axis II) immersion biometry. Patients were examined postoperatively on the day and next day after surgery and the follow up done after one week, one month, and three month. All patients undergone basic slit lamp examination, visual acuity estimation and pinhole acuity at every eye visit. Final glass prescription and dilated fundus examination taken after one month. The patients were divided into two groups--a group with mono focal IOL implanted patient and a group of multifocal IOL implanted patient. The type of lens material of IOL--PMMA or hydrophobic acrylate had been implanted. Contrast sensitivity was assessed one time after three month postoperative visit by using Peli-Robson charts in photo pic condition.

The test distance was one meter. The luminance of the white areas in between the chart letters is within the acceptable range of 60 and 120 cd/m. Visual acuity was recorded with and without correction using Snellen’s self-illuminated visual acuity chart both for distance at 6m and near at 33cm using near visual acuity chart with over head lamp at standard room illumination.

Objective refraction was done by Grand Seiko auto refracts to meter and mean of three readings was recorded for each eye.

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Subjective refraction was done with trial frame and trial set by Homi and Baliwala and confirmed by duo chrome test in each eye. Patients underwent phacoemulsification cataract surgery under topical anesthesia. Pre-operative papillary dilation was done using flurbiprofen, plain tropic amide (0.5%) and phenylephrine (5%) eye drops. Statistical analysis was done by SSPS version 16. The pre and post-operative distance visual acuity was compared across both groups using the decimal denotation. The contrast sensitivity was compared at post-operative 3rd month follow-up by using unpaired t-test.

3. RESULTS

Fifty eyes of forty one subjects underwent cataract extraction, 17 were multifocal patients and 24 were mono focal patients, each group having 25.Monofocal group’s age range was 40-83year (mean 61.92 ±12.03), 15 male, 9 female. Multifocal group age range was 40-65year (mean 53.24 ± 8.65),5 male, 12 female. The mean age of multifocal group is less than mono focal group (P=0.08). Patient in the mono focal group received a cry fold (Appasamy Inc) or Rayner C-flex intra-ocular lenses (IOL), whereas patients in the multifocal group received Rayner M-flex IOL.

The pre-operative visual acuity in mono-focal eyes was0.23 ± 0.17, while in the multifocal operated eyes it was 0.40 ± 0.26(P=0.008 by independent sample t-test). The post-operative unaided distance visual acuity was0.52 ± 0.23 in the mono focal and 0.75 ± 0.27 in the multifocal group (P=0.002).The postoperative unaided 6/6 to 6/9 visual acuity was more in multifocal group (80%), than mono focal group (48%).By using independent sample t-test, p-value < 0.05.

Figure 1 shows unaided N6 near visual acuity in multifocal group (64%) is as compared to none than mono focal group. So there was a higher rate of spectacle independency in multifocal group as

compared to the mono focal group.

The range of contrast sensitivity value of Pelli-Robson chart 0.00 to 2.25, higher value indicates better contrast. The normal range of contrast sensitivity of human eye is 1.20 to 1.35 under photo pic condition at the distance one meter. The contrast sensitivity in the mono-focal group was 1.27 ± 0.09, while in the multi-focal group it was 1.26 ± 0.11(P=0.85).

4. DISCUSSION

This study demonstrates that there is no significant difference between mean contrast sensitivity in both groups at the three month after phacoemulsification cataract surgery (P=0.85). The unaided visual acuity for distance was 6/6 to 6/9 with Snellen’s chart in multifocal group (80%) was better than mono focal group (48%). Unaided near (N6) visual acuity in (64%) multifocal IOL implanted patients was better than mono focal IOL implanted patients. Multifocal IOLs had a higher preponderance of younger age group and women. The younger age group patients were all in the presbyopia age and were working and would need the unaided visual acuity for near and were willing to pay extra for it.

Similarly women may have desired greater spectacle independence, for cosmetic and/or functional reasons and were more eager for the multi-focal implants. The great advantage of the multifocal IOL is the ability of the patient to use near vision without additional rectification. Most patients succeeded in doing this before long after operation. This feature is likely more acknowledged by more youthful patients, who are still working, than by older, inactive

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patients4.The truth that this advantage might influence the indication for IOL implantation (embedding an IOL at the presbyopia age with nearly no cataract or none at all) will likely be a matter for talk about in future. The Mini mono vision formula (the dominant eye of between Plano and -0.50 spherical equivalents and -0.50 to -1.25 in the no dominant eye).

Ming C. et.al found that mono focal A cry’s of recipients with the same pre-op selection criteria as for Restore can achieve 6/9 and N8 without glasses post cataract surgery. It can be a good alternative for those patients who cannot afford Restore IOL and yet desire some degree of freedom from glasses. However, the Restore IOLs recipients had a significantly higher percentage of glasses independence compared to mono vision formula Cary’s of IOL recipients10.Lubiński W et.al showed bilateral multifocal IOL implantation was successful and secure in chosen cataract patients, giving exceptionally good uncorrected distance and near visual acuity 12. Beatrice C et al.

found that the Restore IOL implantation for the treatment of cataract or presbyopia conferred good distance and near vision, a high rate of spectacle freedom, and significant patient satisfaction.

‘Bother to wear spectacles’ and ‘self-image without spectacles’ are two components related with spectacles independence 11 Javitt MD et al. compared between 100 patients embedded with the Array lens in both eyes after bilateral cataract surgery with 100 patients with a standard mono focal IOL implanted bilaterally. They found that 41% of patients with the Array lens did not wear spectacles compared to 12% of patients with mono focal IOLs. For close tasks, 38% of multifocal patients did not wear spectacles compared to 10% of mono focal patients. In expansion, 85% of those with multifocal IOLs did not wear spectacles for remove compared to 52% with mono focal IOLs.8 The European metacentric study (EMS) (56 eyes) also did not find any distinction in contrast sensitivity levels between the two types of IOLs.17.

Montés-Micó et al found that with ideal near spectacle additions (i.e., using the distance correction of the multifocal IOL), there were no significant differences between the photo pic near contrast sensitivity values for the multifocal and mono focal groups. When the luminance was diminished, near contrast sensitivity at all spatial frequencies were diminished in both groups16.

Ventruba J Show after the cataract surgery, the visual functions tested by implies of psychophysical methods of contrast sensitivity significantly progress and are steady 2 month after the surgery. There was no impact of the type of IOL on last state of Visual acuity, Contrast sensitivity15 Dick et al18 found no statistically significant differences in contrast sensitivity between mono focal IOL and multifocal IOL patients but found that halo measure was greater in patients older than 70 a long time in the multifocal group.

They concluded that in addition to IOL design, age and corneal surface quality play a vital part in scatter values. Another study comparing visual outcomes of mono focal IOLs and multifocal diffractive IOLs19 found no significant difference in distance high-contrast visual acuity; in spite of the fact that contrast sensitivity was significantly superior in the mono focal IOL group. Concerning contrast sensitivity comparison between mono focal IOLs and multifocal IOLs to our knowledge very few studies has been performed in India. On the other hand, our results confirm those of Bonnet et al.14 who showed a change for distant and near visual acuity. The study is limited by the fact that it is not a randomized study and that contrast sensitivity was measured in photo pic, not meso pic, conditions. Also papillary size was not considered while measuring contrast sensitivity.

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