Comparison of near vision, intraocular lens movement, and depth of focus with accommodating and monofocal intraocular lenses

PURPOSE: To compare visual acuity, intraocular lens (IOL) movement, and depth of focus with the Crystalens HD single-optic accommodating IOL and the Tecnis ZCB00 aspheric monofocal IOL. SETTING: St. Thomas' Hospital, London, United Kingdom. DESIGN: Prospective randomized controlled trial. METHODS: Patients with bilateral symptomatic cataract had bilateral sequential cataract surgery within 6 weeks with randomized implantation of the accommodating or monofocal IOL in both eyes. Exclusion criteria included other ocular conditions and corneal astigmatism greater than 2.00 diopters. The primary outcome was uniocular distance-corrected near visual acuity (DCNVA). Secondary measures were IOL movement, depth of focus, intermediate and distance vision, objective refraction, and pupil size at distance and near fixation. Results from 3 months postoperatively are presented. RESULTS: Three months postoperatively, 64 patients (32 in each group) were available for study. The distance vision was not statistically significantly different between the accommodating IOL and monofocal IOL (mean 0.05 logMAR versus 0.06 logMAR). The mean DCNVA (0.48 logMAR +/- 0.15 [SD] versus 0.61 +/- 0.13 logMAR) and intermediate visual acuity (0.08 +/- 0.1 logMAR versus 0.20 +/- 0.09 logMAR) were significantly better with the accommodating IOL (P<.001). Neither IOL had clinically significant movement, and near vision did not directly correlate with movement of the accommodating IOL. The accommodating IOL provided greater depth of focus. CONCLUSIONS: Near and intermediate acuities were better with the accommodating IOL. This effect was not directly linked to IOL movement but was at least partly due to depth of focus. (C) 2013 ASCRS and ESCRS