Over 8 million cataract surgeries are performed in the United States and the European Union annually, with many patients choosing to pay out of pocket for premium options including premium intraocular lens implants (IOLs) or laser-assisted cataract surgery (LACS). This report provides a systematic review evaluating patient-centered and visual quality outcomes comparing standard monofocal IOLs to premium cataract surgery options.
Methods
PubMed and EMBASE were searched for publications published between January 1, 1980, and September 18, 2016, on multifocal, accommodative, and toric IOLs, monovision, and LACS, which reported on 1) dysphotopsias, 2) contrast sensitivity, 3) spectacle independence, 4) vision-related quality of life or patient satisfaction, and 5) IOL exchange.
Results
Multifocal lenses achieved higher rates of spectacle independence compared to monofocal lenses but also had higher reported frequency of dysphotopsia and worse contrast sensitivity, especially with low light or glare. Accommodative lenses were not associated with reduced contrast sensitivity or more dysphotopsia but had only modest improvements in spectacle independence compared to monofocal lenses. Studies of monovision did not target a sufficiently myopic outcome in the near-vision eye to achieve the full potential for spectacle independence. Patients reported high levels of overall satisfaction regardless of implanted IOL. No studies correlated patient-reported outcomes with patient expectations.
Conclusions
Studies are needed to thoroughly compare patient-reported outcomes with concomitant patient expectations. In light of the substantial patient costs for premium options, patients and their surgeons will benefit from a better understanding of which surgical options best meet patients’ expectations and how those expectations can be impacted by premium versus monofocal—including monovision—options.
Prevent Blindness America. Vision Problems in the U.S. Prevalence of Adult Vision Impairment and Age-Related Eye Diseases in America.http://visionproblemsus.org.
WilkinsMRAllanBRubinGSpectacle use after routine cataract surgery.Br J Ophthalmol200993(10)1307–1312
4.
MaxwellWAWaycasterCRD'SouzaAOMeissnerBLHilemanKA United States cost-benefit comparison of an apodized, diffractive, presbyopia-correcting, multifocal intraocular lens and a conventional monofocal lens.J Cataract Refract Surg200834(11)1855–1861
CalladineDEvansJRShahSLeylandMMultifocal versus monofocal intraocular lenses after cataract extraction.Cochrane Database Syst Rev2012(9)Cd003169.
9.
LeylandMPringleEMultifocal versus monofocal intraocular lenses after cataract extraction.Cochrane Database Syst Rev2006(4)Cd003169.
10.
CochenerBLafumaAKhoshnoodBCourouveLBerdeauxGComparison of outcomes with multifocal intraocular lenses: a meta-analysis.Clin Ophthalmol2011(5)45–56
11.
LeylandMZinicolaEMultifocal versus monofocal intraocular lenses in cataract surgery: a systematic review.Ophthalmology2003110(9)1789–1798
12.
CillinoSCasuccioADi PaceFet al.One-year outcomes with new-generation multifocal intraocular lenses.Ophthalmology2008115(9)1508–1516
13.
PengCZhaoJMaLQuBSunQZhangJOptical performance after bilateral implantation of apodized aspheric diffractive multifocal intraocular lenses with +3.00-D addition power.Acta Ophthalmol201290(8)e58693
14.
ShahSPeris-MartinezCReinhardTVinciguerraPVisual Outcomes After Cataract Surgery: Multifocal Versus Monofocal Intraocular Lenses.J Refract Surg201531(10)658–666
15.
ZhaoGZhangJZhouYHuLCheCJiangNVisual function after monocular implantation of apodized diffractive multifocal or single-piece monofocal intraocular lens: Randomized prospective comparison.J Cataract Refract Surg201036(2)282–285
16.
Martinez PalmerAGomez FainaPEspana AlbeldaAComas SerranoMNahra SaadDCastilla CespedesMVisual function with bilateral implantation of monofocal and multifocal intraocular lenses: a prospective, randomized, controlled clinical trial.J Refract Surg200824(3)257–264
17.
SenHNSarikkolaAUUusitaloRJLaatikainenLQuality of vision after AMO Array multifocal intraocular lens implantation.J Cataract Refract Surg200430(12)2483–2493
18.
NijkampMDDoldersMGde BrabanderJvan denBorne BHendrikseFNuijtsRMEffectiveness of multifocal intraocular lenses to correct presbyopia after cataract surgery: a randomized controlled trial.Ophthalmology2004111(10)1832–1839
19.
JavittJCSteinertRFCataract extraction with multifocal intraocular lens implantation: a multinational clinical trial evaluating clinical, functional, and quality-of-life outcomes.Ophthalmology2000107(11)2040–2048
20.
RossettiLCarraroFRovatiMOrzalesiNPerformance of diffractive multifocal intraocular lenses in extracapsular cataract surgery.J Cataract Refract Surg199420(2)124–128
21.
JavittJBrauweilerHPJacobiKWet al.Cataract extraction with multifocal intraocular lens implantation: clinical, functional, and quality-of-life outcomes.Multicenter clinical trial in Germany and Austria. J Cataract Refract Surg200026(9)1356–1366
22.
Kamlesh, Dadeya S, Kaushik S. Contrast sensitivity and depth of focus with aspheric multifocal versus conventional monofocal intraocular lens.Can J Ophthalmol200136(4)197–201
23.
DickHBKrummenauerFSchwennOKristRPfeifferNObjective and subjective evaluation of photic phenomena after monofocal and multifocal intraocular lens implantation.Ophthalmology1999106(10)1878–1886
24.
HaringGDickHBKrummenauerFWeissmantelUKronckeWSubjective photic phenomena with refractive multifocal and monofocal intraocular lenses.Results of a multicenter questionnaire. J Cataract Refract Surg200127(2)245–249
25.
SteinertRFAkerBLTrentacostDJSmithPJTarantinoNA prospective comparative study of the AMO ARRAY zonal-progressive multifocal silicone intraocular lens and a monofocal intraocular lens.Ophthalmology1999106(7)1243–1255
26.
GimbelHVSandersDRRaananMGVisual and refractive results of multifocal intraocular lenses.Ophthalmology199198(6)881
27.
JavittJCWangFTrentacostDJRoweMTarantinoNOutcomes of cataract extraction with multifocal intraocular lens implantation: functional status and quality of life.Ophthalmology1997104(4)589–599
28.
SunYZhengDLingSSongTLiuYComparison on visual function after implantation of an apodized diffractive aspheric multifocal or monofocal intraocular lens.Eye Sci201227(1)5–12
29.
ChiamPJChanJHAggarwalRKKasabySReSTOR intraocular lens implantation in cataract surgery: quality of vision.J Cataract Refract Surg200632(9)1459–1463
30.
LehmannRWaycasterCHilemanKA comparison of patient-reported outcomes from an apodized diffractive intraocular lens and a conventional monofocal intraocular lens.Curr Med Res Opin200622(12)2591–2602
31.
PuellMCPerez-CarrascoMJHurtado-CenaFJAlvarez-RementeriaLDisk halo size measured in individuals with monofocal versus diffractive multifocal intraocular lenses.J Cataract Refract Surg201541(11)2417–2423
32.
HayashiKOgawaSManabeSHirataAVisual outcomes in eyes with a distance-dominant diffractive multifocal intraocular lens with low near addition power.Br J Ophthalmol201599(11)1466–1470
33.
HayashiKManabeSYoshimuraKHirataABinocular visual function with a diffractive multifocal intraocular lens in patients with unilateral cataract.J Cataract Refract Surg201339(6)851–858
34.
MesciCErbilHHOlgunAYaylaliSAVisual performances with monofocal, accommodating, and multifocal intraocular lenses in patients with unilateral cataract.Am J Ophthalmol2010150(5)609–618
35.
ArensBFreudenthalerNQuentinCDBinocular function after bilateral implantation of monofocal and refractive multifocal intraocular lenses.J Cataract Refract Surg1999253399–404
36.
AllenRHo-YenGOBeckingsaleABFitzkeFWSciscioAGSalehGMPost-capsulotomy dysphotopsia in monofocal versus multifocal lenses.Clin Exp Optom200992(2)104–109
37.
ChenTYuFLinHet al.Objective and subjective visual quality after implantation of all optic zone diffractive multifocal intraocular lenses: a prospective, case-control observational study.Br J Ophthalmol2016
38.
PedrottiEBruniEBonacciEBadalamentiRMastropasquaRMarchiniGComparative Analysis of the Clinical Outcomes With a Monofocal and an Extended Range of Vision Intraocular Lens.J Refract Surg201632(7)436–442
39.
SteinertRFPostC. T.JrBrintSFet al.A prospective, randomized, double-masked comparison of a zonal-progressive multifocal intraocular lens and a monofocal intraocular lens.Ophthalmology199299(6)853–60discussion 860-1.
40.
AllenEDBurtonRLWebberSKet al.Comparison of a diffractive bifocal and a monofocal intraocular lens.J Cataract Refract Surg199622(4)446–451
41.
HaaskjoldEAllenEDBurtonRLet al.Contrast sensitivity after implantation of diffractive bifocal and monofocal intraocular lenses.J Cataract Refract Surg199824(5)653–658
42.
ZengMLiuYLiuXet al.Aberration and contrast sensitivity comparison of aspherical and monofocal and multifocal intraocular lens eyes.Clin Exp Optom200735(4)355–360
43.
HarmanFEMalingSKampougerisGet al.Comparing the 1CU accommodative, multifocal, and monofocal intraocular lenses: a randomized trial.Ophthalmology2008115(6)993
44.
JiJHuangXFanXLuoMVisual performance of Acrysof ReSTOR compared with a monofocal intraocular lens following implantation in cataract surgery.Exp Ther Med20135(1)277–281
45.
GilMAVaronCCardonaGVegaFBuilJAComparison of far and near contrast sensitivity in patients symmetrically implanted with multifocal and monofocal IOLs.Eur J Ophthalmol201424(1)44–52
46.
KimCYChungSHKimTIChoYJYoonGSeoKYComparison of higher-order aberration and contrast sensitivity in monofocal and multifocal intraocular lenses.Med J200748(4)627–633
47.
PiehSHanselmayerGLacknerBet al.Tritan colour contrast sensitivity function in refractive multifocal intraocular lenses.Br J Ophthalmol200185(7)811–815
48.
HayashiKHayashiHNakaoFHayashiFInfluence of astigmatism on multifocal and monofocal intraocular lenses.Am J Ophthalmol2000130(4)477–482
49.
KaushikSKamlesh.A clinical evaluation of an aspheric multifocal intraocular lens and its implications for the developing world.Ophthalmic Surg Lasers200233(4)298–303
50.
RavalicoGBaccaraFRinaldiGContrast sensitivity in multifocal intraocular lenses.J Cataract Refract Surg199319(1)22–25
51.
KnorzMCSeiberthVRufMLorgerCVLiesenhoffHContrast sensitivity with monofocal and bifocal intraocular lenses.Ophthalmologica1996210(3)155–159
52.
PostCTJrComparison of depth of focus and low-contrast acuities for monofocal versus multifocal intraocular lens patients at 1 year.Ophthalmology199299(11)1658–63
53.
VaqueroMEncinasJLJimenezFVisual function with monofocal versus multifocal IOLs.J Cataract Refract Surg19962291222–1225
SchmitzSDickHBKrummenauerFSchwennOKristRContrast sensitivity and glare disability by halogen light after monofocal and multifocal lens implantation.Br J Ophthalmol200084(10)1109–1112
56.
Winther-NielsenACorydonLOlsenTContrast sensitivity and glare in patients with a diffractive multifocal intraocular lens.J Cataract Refract Surg199319(2)254–257
57.
Montes-MicoREspanaEBuenoICharmanWNMenezoJLVisual performance with multifocal intraocular lenses: mesopic contrast sensitivity under distance and near conditions.Ophthalmology2004111(1)85–96
58.
FeatherstoneKABloomfieldJRLangAJMiller-MeeksMJWoodworthGSteinertRFDriving simulation study: bilateral array multifocal versus bilateral AMO monofocal intraocular lenses.J Cataract Refract Surg199925(9)1254–1262
59.
Montes-MicoRAlioJLDistance and near contrast sensitivity function after multifocal intraocular lens implantation.J Cataract Refract Surg200329(4)703–711
60.
AlioJLPineroDPPlaza-PucheABChanMJVisual outcomes and optical performance of a monofocal intraocular lens and a new-generation multifocal intraocular lens.J Cataract Refract Surg201137(2)241–250
61.
MesciCErbilHHOlgunAAydinNCandemirBAkcakayaAADifferences in contrast sensitivity between monofocal, multifocal and accommodating intraocular lenses: long-term results.Clin Exp Optom201038(8)768–777
62.
MunozGAlbarran-DiegoCCervinoAFerrer-BlascoTGarcia-LazaroSVisual and optical performance with the ReZoom multifocal intraocular lens.Eur J Ophthalmol201222(3)356–362
63.
YamauchiTTabuchiHTakaseKOhsugiHOharaZKiuchiYComparison of Visual Performance of Multifocal Intraocular Lenses with Same Material Monofocal Intraocular Lenses.PLoS One20138(6)
64.
CionniRJChangDFDonnenfeldEDLaneSSMcCulleyJPSolomonKDClinical outcomes and functional visual performance: comparison of the ReSTOR apodised diffractive intraocular lens to a monofocal control.Br J Ophthalmol200993(9)1215–1219
65.
AlioJLPineroDPPlaza-PucheABet al.Visual and optical performance with two different diffractive multifocal intraocular lenses compared to a monofocal lens.J Refract Surg201127(8)570–581
SouzaCEMuccioliCSorianoESet al.Visual performance of AcrySof ReSTOR apodized diffractive IOL: a prospective comparative trial.Am J Ophthalmol2006141(5)827–832
68.
ElgoharyMABeckingsaleABEffect of illumination on visual function after monofocal and multifocal intraocular lens implantation.Eye Lond200620(2)144–149
69.
RekasMZelichowskaBComparison of contrast sensitivity after implantation of diffractive lens SA60D3 and monofocal lens MA60BM.Kin Oczna20061084-6191–194Published October 6, 2006.
70.
HayashiKManabeSHayashiHVisual acuity from far to near and contrast sensitivity in eyes with a diffractive multifocal intraocular lens with a low addition power.J Cataract Refract Surg200935(12)2070–2076
71.
HayashiKYoshidaMHayashiHAll-distance visual acuity and contrast visual acuity in eyes with a refractive multifocal intraocular lens with minimal added power.Ophthalmology2009116(3)401–408
72.
Bissen-MiyajimaHMinamiKYoshinoMTairaYSurface light scattering and visual function of diffractive multifocal hydrophobic acrylic intraocular lenses 6 years after implantation.J Cataract Refract Surg201339(11)1729–1733
73.
PackerMChuYRWaltzKLet al.Evaluation of the aspheric tecnis multifocal intraocular lens: one-year results from the first cohort of the food and drug administration clinical trial.Am J Ophthalmol2010149(4)577
74.
LeylandMDLanganLGoolfeeFLeeNBloomPAProspective randomised double-masked trial of bilateral multifocal, bifocal or monofocal intraocular lenses.Eye (Lond)200216(4)481–490
75.
Intraocular lenses for the treatment of age-related cataracts: an evidence-based analysis.Ont Health Technol Assess Ser20099(15)1–62
76.
VingoloEMGrengaPIacobelliLGrengaRVisual acuity and contrast sensitivity: AcrySof ReSTOR apodized diffractive versus AcrySof SA60AT monofocal intraocular lenses.J Cataract Refract Surg200733(7)1244–1247
77.
HidaWTMottaAFKara-JoseJunior Net al.Comparison between OPD-Scan results and visual outcomes of monofocal and multifocal intraocular lenses.Arq Bras Oftalmol200972(4)526–532
78.
ScialdoneAMerighiMBertuzziABrancatoRBifocal versus monofocal intraocular lenses in bilateral pseudophakia.Ophthalmic Surg199223(3)161–165
79.
DanielYHennekesRAre bifocal intraocular posterior chamber lenses superior to monofocals?Bull Soc Belge Ophthalmol1992(243)109–113
80.
HayashiKMasumotoMTakimotoMComparison of visual and refractive outcomes after bilateral implantation of toric intraocular lenses with or without a multifocal component.J Cataract Refract Surg201541(1)73–83
81.
KamppeterBASauderGJonasJBContrast and glare sensitivity after implantation of AcrySof and Human Optics 1CU intraocular lenses.Eur J Ophthalmol200515(4)458–461
82.
AlióJLSimonovAPlaza-PucheABet al.Visual Outcomes and Accommodative Response of the Lumina Accommodative Intraocular Lens.Am J Ophthalmol2016(164)37–48
83.
CummingJSColvardDMDellSJet al.Clinical evaluation of the Crystalens AT-45 accommodating intraocular lens: results of the U.S.J Cataract Refract Surg200632(5)812–825
84.
TanNZhengDYeJComparison of visual performance after implantation of 3 types of intraocular lenses: accommodative, multifocal, and monofocal.Eur J Ophthalmol201424(5)693–698
85.
SandersDRSandersMLUS FDA clinical trial of the Tetraflex potentially accommodating IOL: comparison to concurrent age-matched monofocal controls.J Refract Surg20102610723–730
86.
VisserNBeckersHJBauerNJet al.Toric vs aspherical control intraocular lenses in patients with cataract and corneal astigmatism: a randomized clinical trial.Ophthalmol2014132(12)1462–1468
87.
LaneSSErnestPMillerKMHilemanKSHarrisBWaycasterCRComparison of clinical and patient-reported outcomes with bilateral AcrySof toric or spherical control intraocular lenses.J Refract Surg200925(10)899–901
88.
HollandELaneSHornJDErnestPArleoRMillerKMThe AcrySof Toric intraocular lens in subjects with cataracts and corneal astigmatism: a randomized, subject-masked, parallel-group, 1-year study.Ophthalmology2010117(11)2104–2111
89.
MencucciRGiordanoCFavuzzaEGicquelJJSpadeaLMenchiniUAstigmatism correction with toric intraocular lenses: wavefront aberrometry and quality of life.Br J Ophthalmol201397(5)578–582
90.
LabirisGGiarmoukakisAPatsiamanidiMPapadopoulosZKozobolisVPMini-monovision versus multifocal intraocular lens implantation.J Cataract Refract Surg201541(1)53–57
91.
WilkinsMRAllanBDRubinGSet al.Randomized trial of multifocal intraocular lenses versus monovision after bilateral cataract surgery.Ophthalmology2013120(12)2449
92.
ZhangFSugarAJacobsenGCollinsMVisual function and spectacle independence after cataract surgery: Bilateral diffractive multifocal intraocular lenses versus monovision pseudophakia.J Cataract Refract Surg201137(5)853–858
93.
ChenMAtebaraNHChenTTA comparison of a monofocal Acrysoft IOL using the “blended monovision” formula with the multifocal array IOL for glasses independence after cataract surgery.Ann Ophthalmol (Skokie)200739(3)237–240Published November 21, 2007.
94.
BeikoGHHComparison of visual results with accommodating intraocular lenses versus mini-monovision with a monofocal intraocular lens.J Cataract Refract Surg201339(1)48–55
95.
KimJSJungJWLeeJMSeoKYKimEKKimT-IClinical Outcomes Following Implantation of Diffractive Multifocal Intraocular Lenses With Varying Add Powers.Am J Ophthalmol2015160(4)702
96.
MamalisNComplications of foldable intraocular lenses requiring explanation or secondary intervention–1998 survey.Journal of cataract and refractive surgery200026(5)766–772
97.
MamalisNComplications of foldable intraocular lenses requiring explantation or secondary intervention–2001 survey update.J Cataract Refract Surg200228(12)2193–2201
98.
MamalisNDavisBNilsonCDHickmanMSLeboyerRMComplications of foldable intraocular lenses requiring explantation or secondary intervention–2003 survey update.J Cataract Refract Surg200430(10)2209–2218
99.
MamalisNBrubakerJDavisDEspandarLWernerLComplications of foldable intraocular lenses requiring explantation or secondary intervention–2007 survey update.J Cataract Refract Surg200834(9)1584–1591
100.
PercivalSPSettySSProspectively randomized trial comparing the pseudoaccommodation of the AMO ARRAY multifocal lens and a monofocal lens.J Cataract Refract Surg199319(1)26–31
