Visual Performance in the Long Term With Secondary Add-on Versus Primary Capsular Bag Multifocal Intraocular Lenses

To compare the long-term results of a secondary sulcus-placed, multifocal add-on intraocular lens (IOL) with those of a multifocal IOL implanted in the capsular bag.In this prospective clinical trial, 30 pseudophakic eyes were treated with a multifocal add-on IOL and 30 cataractous eyes with a standard multifocal IOL. The main outcome measures comprised manifest refraction, visual acuity, defocus curves, and contrast sensitivity. Patients who had bilateral implantation of the same lens type were asked to complete a questionnaire.One year postoperatively, all eyes from the multifocal add-on IOL group (add-on group) and 97% from the standard multifocal IOL group (standard group) were within ±0.50 diopters (D) of emmetropia. In both groups, median uncorrected distance and intermediate visual acuity were 20/20 and 20/25, respectively. Median uncorrected near visual acuity was 20/20 in the add-on group and 20/25 in the standard group. The survey analysis resulted in a slightly higher patient satisfaction in the standard group regarding distance and near vision without glasses. Contrast sensitivity measures were comparable in both groups. Halos were the most commonly reported visual disturbance, but the perceived impairment by light effects was minimal even in the early postoperative period and the majority of patients got used to it relatively quickly.Secondary multifocal add-on IOL implantation provides the opportunity for multifocal imaging in already pseudophakic eyes. The functional outcomes are comparable to those achieved after primary multifocal IOL implantation in the capsular bag. [J Refract Surg. 2016:32(11):742-747.].