Ask Dr. Nick Tarantino: Premium IOL and Refractive Technology Options

Q: The Tecnis^®multifocal IOL is relatively new to the market. How soon will we know how well it functions under real world, rather than clinical trial, conditions?

A: Since late 2007, Tecnis^® multifocal IOLs have been distributed outside the United States in more than 50 countries requiring regulatory approval, including Japan, China, Korea, Taiwan, the European Union and Canada. More have been distributed in countries without regulatory requirements. As of March 2008, approximately 60,000 Tecnis^® multifocal lenses have been sold outside the United States.¹ The Tecnis^® multifocal IOL has a good track record in all of the countries in which it has been launched, with high rates of patient satisfaction.

Q: What is a premium IOL and how does that differ from a monofocal IOL?

A: The term “premium IOL” refers to IOLs that provide visual function over and above standard monofocal IOLs. In this case, the term is applied to multifocal intraocular lenses because of the extended range of vision available compared to monofocal IOLs.

Q: A recent report came out on LASIK and patient satisfaction. What was the outcome?

A: A research team from Storm Eye Institute did a comprehensive search of the worldwide clinical literature and identified 19 peer-reviewed, well-designed studies specific to patient quality of life and satisfaction after primary (original) LASIK.² All were randomized, controlled clinical trials, or cohort or case-controlled studies. The studies covered the period from 1995 to 2003 and included 2,198 subjects. The review found an overall patient satisfaction rate of 95.4% (2,097 of 2,198 subjects), ranging from 87.2% to 100%. This is an elective procedure, so patient satisfaction is an important measurement of whether the patients' physical, emotional and financial expectations were met.

Q: Is the cost of multifocal IOLs really worth it?

A: Yes, according to research reported in the November 2008 issue of the Journal of Cataract and Refractive Surgery.³ A total of 495 patients participated in a cost-benefit study, 339 with multifocal IOLs and 156 with monofocal IOLs. The net benefit for the multifocal group, after the cost of two multifocal IOLs, was $11,670 compared to $155 for the monofocal group. Eighty percent of the 495 participants were willing to pay at least $5 a day to be spectacle independent, although multifocal vision was considered not medically necessary by third-party payers. As fair-balance, the researchers didn't include any postsurgical complications, which would be expected to be similar with multifocal and monofocal lenses, or a comparison with monovision, which approximates depth of vision but isn't multifocal vision.

Nicholas Tarantino, OD, FAAO, is head of global clinical research & development at Abbott Medical Optics, Inc.

References

1. Tecnis^® multifocal intraocular lens, package insert, 2009.
2. Solomon KD, Fernández de Castro LE, Sandoval H P, et al. LASIK world literature review: quality of life and patient satisfaction. Ophthalmology. 2009;116:691–670.
3. Maxwell WA, Waycaster CR, D'Souza AO, Meissner BL, Hileman K. A United States cost-benefit comparison of an apodized, diffractive, presbyopia-correcting, multifocal intraocular lens and a conventional monofocal lens. J Cataract Refract Surg. 2008;34:1855–1861.