A Comparison Of Patient Satisfaction With Modified Monovision

A Comparison Of Patient Satisfaction With Modified Monovision Versus The Re. STOR® Intraocular Lens Neeti Parikh, MD Fuxiang Zhang, MD Department of Ophthalmology Henry Ford Hospital *The authors have no financial interest in the material presented

PURPOSE To compare patient satisfaction of visual function with modified monovision vs. with Re. STOR® lens implantation ¡ Monovision: a type of presbyopic correction in which one eye is corrected for distance and the other eye for near ¡ Modified monovision: smaller refractive difference between the two eyes (Between 1. 00 - 2. 25 D anisometropia) ¡ Re. STOR® Re. STOR : a multifocal intraocular lens that provides patients with a range of vision, near through distance

METHODS Part 1: Retrospective Chart review ¡ Charts for patients who had cataract surgery between January 2005 and January 2007 from one clinical practice in the Henry Ford Health System reviewed l l ¡ ¡ Inclusion criteria: Bilateral cataract extraction and implantation of either a conventional intraocular lens with the goal of modified monovision or an Acry. Sof® Re. STOR® lens Exclusion criteria: Other ocular co-morbidities (moderate to severe diabetic retinopathy, glaucoma with significant visual field defects or optic nerve damage, ARMD) or Toric IOL implantations Minimum of 1 month follow up post operative visit Preoperative refraction , keratometry, IOL calculations All patients underwent conventional phacoemulsification and in the bag implantations with Alcon SN 60 WF or SA 60 AT lens or Re. STOR® : SN 60 D 3 Re. STOR Postoperative uncorrected visual acuity (distance and near), postoperative refraction Part 2: Patient satisfaction survey ¡ ¡ ¡ Visual function questionnaire- 25 (VFQ-25), validated by the National Eye Institute Amended to include questions about glare, halos, intermediate vision, and use of glasses after surgery Completed by patients 3 - 24 months postoperatively

RESULTS Modified Monovision Re. STOR® ¡ 67 charts reviewed, 1 surgeon ¡ 76 charts reviewed, 8 surgeons ¡ 57 completed survey (85%) ¡ 68 completed survey (89%) ¡ 31% male ¡ 40% male ¡ 69% female ¡ 60% female ¡ 94% Caucasian, 6% other ¡ 97% Caucasian, 3% other ¡Mean ¡ Age: 73 (SD =7 years) modified monovision= 1. 00 - 2. 25 D anisometropia Mean=1. 4 D, standard deviation=. 3 D ¡Mean Age 68 (SD =12 years)

VFQ-25 Results. Mean Satisfaction scores for Distance, Near, Driving P>. 05 for all

VFQ-25 Results-Intermediate vision How much difficulty do you have………? No difficulty at all. . . 1 A little difficulty. . . 2 Moderate difficulty. . . 3 Extreme difficulty. . . 4 Stopped doing this because of your eyesight. . . 5 ¡ Computer vision: l Re. STOR® : 1. 82 ±. 92 l Modified Monovision 1. 42 ±. 59 l p=. 036

VFQ-25 Results-Halos/Glare I am bothered by glare/halos …. All of the time…………………. …. 1 Most of the time………………. …. 2 Some of the time………………. . . 3 A little of the time………………… 4 None of the time…………………. . 5 Glare: Re. STOR® : 3. 74 ± 1. 21 Modified Monovision: 3. 98 ± 1. 03 p=. 339 Halos: Re. STOR® : 3. 39 ± 1. 42 Modified Monovision: 4. 66 ±. 72 p <. 001

Uncorrected Visual Acuity at 1 month p=. 002 p=. 162

Freedom from glasses Modified Monovision: 14% of patients (who completed survey) never wear glasses Re. STOR® : 84% of patients (who completed survey) never wear glasses Use of glasses among “satisfied” patients (% pts who had little to no difficulty with driving, distance, intermediate, or near activities but still used glasses for these activities): Distance Modified Monovision Re. STOR® 61% 8% Intermediate 67% 19% Near 62% 18% Driving 53% 9% p<. 001 for all

CONCLUSIONS/DISCUSSION ¡ Uncorrected distance visual acuity better in Re. STOR® group (20/40 or better) ¡ No statistical difference in uncorrected near acuity (J 3 or better) between the two groups ¡ Modified monovision patients have more dependence on glasses (for all activities) l Modified monovision falls short of correcting for full monovision ¡ ¡ ¡ l Average of only 1. 4 D difference between 2 eyes May not be enough to achieve high rate of glasses independence No preoperative tolerance test performed for this group l This is the reason for the modified approach to monovision in these patients Astigmatism ¡ ¡ ¡ Re. STOR ® patients with ≥ 1 D of astigmatism treated with limbal relaxing incisions 26% of modified monovision patients had ≥ 1 D of preoperative astigmatism that was not corrected Patients with toric implants who had monovision were excluded from this study

CONCLUSIONS/DISCUSSION ¡ Monovision patients more likely to wear glasses, but still very satisfied l No statistical difference in satisfaction scores for driving, distance, or reading between 2 groups l Statistically significant higher satisfaction score in modified monovision group for intermediate (computer) vision l Modified monovision patients had no out of pocket costs for the surgery (Re. STOR® cost to patient = $1895 per eye ) ¡ Modified monovision patients more likely to be willing to pay for glasses

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