Spotlight ON TECHNOLOGY & TECHNIQUE

The Tecnis Multifocal: A World of Difference

By Leslie Goldberg, Associate Editor

Any new IOL comes to market with a pedigree of impressive best-corrected acuity results. Unfortunately, patients don't live their lives in an exam room (overworked ophthalmologists, however, may feel that they do). What really matters to patients — particularly those who pay out of pocket for a presbyopia-correcting lens — is functional vision, or performance in the real world. The new Tecnis multifocal from AMO achieves patient satisfaction levels that speak well of its real-world results.

In FDA trials, 94-96% of subjects were able to function comfortably without glasses and 85% achieved complete spectacle independence post-implantation, stats that trump those of other presbyopic lens designs, the manufacturer claims. AMO credits those figures to an aspheric design that compensates for corneal spherical aberrations, pupil independence for better performance in low-light conditions, and intermediate vision that it considers a cut above that of older diffractive lens designs.

The Secret of My Success

Frank Bucci, M.D., of Wilkes-Barre, Pa., who participated in the FDA trials, prefers a staged approach, implanting the Tecnis multifocal in the patient's non-dominant eye first and observing the outcome before selecting an IOL for the fellow eye. This process is easier if the patient can wear a contact lens in the untreated eye or is nearly emme tropic, to avoid anisometropia between procedures. In such cases, he may treat residual astigmatism before performing surgery on the second eye.

All of Dr. Bucci's patients receive at least one Tecnis multifocal, he says, because the lens "provides the near vision our patients have always wanted and does it in all types of lighting, independent of pupil size," without sacrificing intermediate vision, as in other lens designs. He typically implants the lens bilaterally in older patients who do not have critical intermediate vision demands (as may be encountered with long hours of computer use) but notes that 94% of Tecnis patients in the FDA trial were "happy with their visual function at intermediate, even prior to fixing their residual corneal astigmatism" and that 95% of study participants said they would choose a Tecnis multifocal lens again. "The numbers would only go up after residual refractive errors were corrected," he says.

To succeed, Dr. Bucci says, surgeons must provide four things: excellent acuity at all three focal length categories (near, intermediate, distance) and acceptable light phenomena while driving at night. If he determines in the preop interview that a patient may be hypersensitive to halos while driving at night, he may implant the Crystalens HD in the patient's dominant eye. Although its near visual results are patient-specific, he says, Crystalens HD usually provides good distance, good intermediate and almost no light phenomena at night, meeting three out of four of his objectives. "If I put the Tecnis multifocal in the opposite eye, we will almost always achieve J1 vision. So, I've met the fourth objective and have also contributed to intermediate vision and provided aspheric-assisted distance vision," says Dr. Bucci. "They have no haloing at night in their dominant eye and they will gradually neuro-adapt in the Tecnis multifocal eye. This is a very powerful combination, especially in lensectomy and younger cataract patients," he says.

Built for Speed

Near-point reading speed for Tecnis patients is particularly good: 142 words per minute (WPM) in low light and 174 WPM in bright light, speeds that AMO says are substantially better than findings with other lens designs.¹ At intermediate distance, the same study found, reading speed was 170 WPM in photopic light and 130 in mesopic conditions.

"The Tecnis lens is the strongest tool I've ever had for meeting my cataract patient's expectations," Dr. Bucci says. "Patients receive the reading vision that they've always wanted without any significant visual side effects like haze, achieve excellent distance vision, and are reporting no major significant intermediate deficits," he concludes. OM

1. Hutz W, et al. J Cataract Refract Surg. 2006;32:2015-2021.