Patient satisfaction after implantation of diffractive designed multifocal intraocular lenses in dependence on objective parameters

BACKGROUND: For optimal patient satisfaction and greatest independence from spectacles after implantation of a diffractive designed multifocal intraocular lens (IOL), emmetropia with a low postoperative astigmatism must be achieved. The aim of this study was to prospectively determine patient satisfaction after implantation of diffractive designed multifocal IOLs in relation to objective parameters. PATIENTS AND METHODS: A total of 69 eyes of 50 patients without additional ocular pathology (mean age 64.8 years) received a diffractive designed multifocal IOL and were examined 12 months postoperatively. Overall patient satisfaction, visual phenomena (halos, glare), and frequency of use of reading spectacles and distance correction were assessed as subjective parameters. As objective parameters, uncorrected and best-corrected distance visual acuity (UCVA, BCVA, respectively), uncorrected, distance corrected and best-corrected near visual acuity, contrast sensitivity (Pelli-Robson charts), pre- and postoperative astigmatism, postoperative spherical equivalent and depth of focus (defocusing curve from +5.0 to -5.0 D) were measured. RESULTS: The mean overall satisfaction on a scale from 5 (excellent) to 1 (poor) was 4.49. Mean postoperative UCVA was 0.85 and BCVA was 1.03. Mean uncorrected near visual acuity was J1.04, distance corrected near visual acuity J1.0 and best corrected near visual acuity J1.0. Postoperative mean spherical equivalent was -0.17 +/- 0.43 D and absolute mean astigmatism was 0.64 D. The use of spectacles was highly correlated with postoperative spherical equivalent and absolute postoperative astigmatism. On a subjective scale from 0 (none) to 4 (very disturbing), a mean halo score of 0.45 and a mean glare score of 0.44 was recorded. Overall satisfaction was significantly correlated with UCVA, age, use of spectacles for distance purposes, contrast sensitivity, postoperative astigmatism, and postoperative spherical equivalent (P<0.05). Linear stepwise regression analysis identified UCVA as the most influential factor for overall patient satisfaction. CONCLUSIONS: For diffractive designed multifocal IOLs, emmetropia and a low astigmatism postoperatively are the most important factors for high patient satisfaction.