Introduction
Materials and methods
Results
Contrast sensitivity (CS) and age
Study | Subjects (age) | Parameter analyzed | Results |
---|---|---|---|
Karatepe et al. 2017 [7] | 37 individuals (aged 7–65 years) | CS at 0.5, 1.5, 3.0, 6.0, 12.0, and 24.0 cpd at illumination levels of 0–30 dB (dB) | Increasing age, small pupil diameter, hyperopia, and photopic conditions were associated with lower contrast sensitivity in healthy individuals |
Sia et al. 2013 [8] | 472 adults aged 35–80 years | CS at 3, 6, 12, and 18 cpd | CS decreases with age at all spatial frequencies and is greatest at highest spatial frequencies. Posterior subcapsular cataract causes reduction at all frequencies, while cortical cataract does not. Nuclear cataract decrease CS at intermediate (12 cpd) and high (18 cpd) frequencies |
Hohberger et al. 2007 [9] | 61 subjects (categorized in age groups < 30 years, 30–39 years, 40–49 years, 50–59 years, > 60 years) | CS at 1.5, 3, 6, 12, and 18 cpd, under day (85 cd/m2) and night (3.0 cd/m2) conditions, with and without glare | Contrast sensitivity was significantly reduced under night conditions with glare, whereas glare had less influence under daylight illumination. Regression analyses showed a highly significant influence of age, but the variance of the measurement values is not explained by age alone |
Nomura et al. 2003 [10] | 2267 subjects (aged 40–79 years) | CS at 1.5, 3, 6, 12, and 18 cpd | The age-related decrease in CS was found at all frequencies, even when adjusted for visual acuity |
Nio et al. 2000 [11] | 100 subjects (20–69 years of age | CS at 1, 2, 4, 8, and 16 cpd; pupil size 2, 4, and 6 mm; defocus −1 to +2 D | At optimal focus, integrated contrast sensitivity and log CS at 8 cpd showed a significant age-related decline. The log CS at 1 cpd was independent of age |
Klein et al. 1996 [6] | 5926 individuals (43–84 years of age) | CS measured with a perimeter in the 25° central field | Visual sensitivity was inversely associated with age and was lower in women in each age stratum |
Burton et al. 1993 [12] | 35 young (aged 17–29 years) and 29 older (aged 60–80 years) subjects | CS at 2, 4, 8, 12, 16, 20, 24, 28, and 32 cpd | Older adults in good eye health exhibited on average a small loss (0.1–0.2 log unit) in contrast sensitivity across the spatial frequency range tested |
Nameda et al. 1989 [13] | 19 individuals (aged 24–63 years) | CS at 1.5, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 30, 40, 50, 60, and 70 cpd | Losses at high spatial frequencies up to 40 years of age. After 40 years of age, there were losses at all spatial frequencies |
Tulunay-Keesey et al. 1988 [14] | 63 adults (13–67 years of age) | CS at spatial frequencies of 0.5, 1, 2, 3, 4, 6, 8, and 12 cpd and temporal frequencies of 0, 1, 5, and 15 Hz | Sensitivity for low spatial frequencies modulated at 0 to 15 Hz was not affected by age, but a progressive age-related elevation of threshold was found for combinations of high spatial and temporal frequencies |
Crassini et al. 1988 [15] | 8 young (average age 20.4 years) and 8 elderly (average age 64.4 years) subjects | CS (central an 10 deg temporally) at 0.2, 0.8, 2.0, and 5.0 cpd | Young observers had better contrast sensitivities than older observers but only at higher spatial frequencies (2.0 and 5.0 cpd) |
Sloane et al. 1988 [16] | 12 young (19–35 years) and 11 older (68–89 years) subjects | CS as a function of target luminance at 0.5, 2, 4, and 8 cpd | When gratings were flickered at 0.5 Hz, functions for older adults were displaced downward on the sensitivity axis across all luminance levels, and the slopes of these functions were steeper than those for younger adults, suggesting that optical mechanisms alone cannot account for the vision loss in older adults. |
Higgins et al. 1988 [17] | 50 subjects in five age groups (20–29, 30–39, 40–49, 50–59, 60–69 years) | CS at nine spatial frequencies from 0.75 to 16 cpd | Decline in sensitivity with age at all spatial frequencies |
Elliot 1987 [18] | 16 young (mean age 21.5 ± 2.7 years) and 16 older (mean age 72 ± 4.3 years) subjects | CS at 1, 2, 4, 10.6, and 16.5 cpd | Lower contrast sensitivity at medium (4 cpd) and high (10.6, 16.5 cpd) spatial frequencies in older group |
Yates et al. 1987 [19] | 103 adults (21–40 years of age) | CS at 1, 2, 4, 8, 12, 16, 20, and 24 cpd | The age-related decrease in CS was found only at 16 cpd |
Ross et al. 1985 [20] | 17 young (aged 20–30 years) and 53 older (aged 50–87 years) subjects | CS at 0.4, 0.95, 2.88, 6.73, 12.70, and 19.23 cpd | Lower performance in older group compared to younger group at all spatial frequencies In the older group, linear decline in CS with age for medium and high spatial frequencies |
Morrison and McGrath 1985 [21] | 45 observers (including 4 elderly) | CS 8–40 cpd (10–15 different frequencies within this range) | With increasing age, CS remained steady until the sixth decade when they declined |
Kline et al. 1983 [22] | 16 young (18–25 years) and 16 old (55–70 years) subjects | CS at 0.5, 2, 4, 6, 8, and 12 cpd | An age-related loss in contrast sensitivity was observed primarily for stimuli of intermediate and high spatial frequency |
Owsley et al. 1983 [23] | 91 adults aged 19–87 years | CS at 0.5, 1, 2, 4, 8, and 16 cpd | At higher spatial frequencies. Sensitivity decreased with age around 40 to 50 years |
McGrath and Morrison 1981 [24] | 66 subjects (5–94 years old) | CS at 1, 2, 3, 5, 10, 20, and 25 cpd | With advancing age, there was an overall decrease in contrast sensitivity. The loss of CS was greater for middle range spatial frequencies than for higher spatial frequencies |
Sekuler et al. 1980 [25] | 25 young (mean age 18.5 ± 0.7 years) and 10 old (73.2 + 3.8 years) individuals | CS at 0.5, 1, 2, 4, 8, and 16 cps flickered at 0.3 or 6 Hz | Older and younger observers did not differ in ability to see targets with fine structure (high spatial frequencies); older observers were only one-third as sensitive to targets with coarse structure (low spatial frequencies) as were younger observers. Older observers were also less able than younger observers to see moving targets |
Derefeldt et al. 1979 [26] | 10 children (aged 6–10 years), 12 adults (aged 20–40 years), 5 adults (aged 40–60 years), 11 adults (aged 60 years or older) | CS at 0.5, 1.0, 2.0, 4.0, 10, 20, and 40 cpd | No significant difference between young- and middle-aged subjects with regard to contrast sensitivity. For higher ages studied (above 60 years), there was a loss of sensitivity in the middle and high frequency regions |
Arden & Jacobson 1978 [4] | 50 healthy adults aged 17–64 years, 7 eyes with ocular hypertension, 43 eyes with glaucoma | CS at 0.4, 0.8, 1.6, 3.2, and 6.4 cpd | The variation in the test results with age in normals is only slight. |
CS and MIOLs
Study | IOLs (number of eyes) | Parameter analyzed | Results |
---|---|---|---|
Altermir-Gomez et al. 2019 [34] | Tecnis ZCB00 (AMO, n = 44) vs. Tecnis ZMB00 (AMO, n = 78) | CS at 3, 6, 12, and 18 cpd (mesopic and photopic) | No difference in CS |
Menucci et al. 2018 [35] | PanOptix IQ (Alcon, n = 40), AT LISA tri 839MP (Carl Zeiss Meditec, n = 40), Tecnis Symfony (AMO, n = 40) | CS at 1.5, 3, 6, 12, and 18 cpd (mesopic and photopic) | The Tecnis Symfony MIOLs provided significantly better photopic and mesopic CS outcomes than the other MIOL models |
Dyrda et al. 2018 [36] | OptiVis (Aaren Scientific, n = 64) vs. AR40E (AMO, n = 64) vs. M-Flex (Rayner, n = 64) vs. ReZoom (AMO, n = 64) vs. ReSTOR (Alcon, n = 64) | CS at 1.5, 3, 6, 12, and 18 cpd | Only under mesopic conditions without glare, distance CS with the MIOL was significantly lower than with the monofocal IOL at any tested frequencies |
Pedrotti et al. 2018 [30] | Tecnis (AMO, n = 30), vs. Tecnis Symfony (AMO, n = 55), vs. ReSTOR +2.5 (Alcon, n = 50), vs. ReSTOR +3.0 (Alcon, n = 50) | CS at 6, 12, and 18 cpd (85 cd/m2 at 4 m) | No differences in photopic CS between the monofocal IOL and the EDOF Tecnis Symfony in any spatial frequency. In contrast, all contrast sensitivity values for these two lenses were significantly better than those obtained with both apodized diffractive refractive ReSTOR MIOLs |
Pedrotti et al. 2018 [37] | Comfort LS-313 MF 15 (Lentis, n = 11) vs. monofocal Tecnis (AMO, n = 12) | CS at 3, 6, 12, and 18 cpd | no differences in CS |
Maxwell et al. 2017 [38] | Monofocal Acrysof SN60WF (Alcon) vs. Acrysof IQ Restor +2.5 | CS at 3, 6, 12, and 18 cpd (photopic); mesopic 1.5, 3.0, 6.0, and 12.0 cpd with and without glare | No relevant differences in binocular CS under photopic or mesopic conditions, with or without glare |
Plaza-Puche et al. 2016 [39] | AT LISA tri 839MP (Carl Zeiss Meditec, n = 30), FineVision (Physiol, n = 30), MPlus-LS313 (Lentis, n = 30), AcriLisa 366D (Carl Zeiss Meditec, n = 30), ReSTOP SN6AD1 (Alcon, n = 30), monofocal spherical Acri.Smart 48S (Carl Zeiss Meditec, n = 30) | CS at 1.5, 3, 6, 12, and 18 cpd in low mesopic levels | No differences in CS in low mesopic conditions at 1.5, 3, 6, and 12 cpd but only at 18 cpd. In pair comparison found better values for monofocal than ReSTOR at 18 cpd |
Labiris et al. 2015 [40] | multifocal Isert PY60MV (Hoya, n = 37) vs. monovision SN60WF (Alcon, n = 38) | CS with Pelli-Robson chart | No differences in CS |
Gil et al. 2014 [41] | Acrysof ReSTOR SN6AD1 (Alcon, n = 35) vs. Acrysof ReSTOR SN60D3 (Alcon, n = 36) vs. Tecnis ZMA00 (AMO, n = 38) vs. ReZoom NXG (AMO, n = 33) vs. Tecnis ZA9003 (AMO, n = 38) | distance CS at 3, 6, 12, and 18 cpd (8 levels of contrast), near CS at 1.5, 3, 6, 12, and 18 cpd (8 levels of contrast) | Monofocal better at all spatial frequencies. Diffractive optics and aspheric profiles showed a non-statistically significant trend to perform better in mesopic conditions. Near CS was lower for refractive, distance dominant lens designs, particularly at medium to high spatial frequencies |
Tan et al. 2014 [42] | Akreos AO (Bausch & Lomb) vs. ZMA00 (AMO) vs. Tetraflex (Lenstec) (total n = 128 eyes) | CS visual acuity was measured at contrast levels: 100%, 25%, 10%, and 5% | No significant differences of the CS visual acuity were present among the three groups at 3 months after surgery |
Yamauchi et al. 2013 [43] | Tecnis ZA9003/ZCB00 (AMO) vs. ZMA00/ZMB00 (AMO) | CS with optotype size 0.7, 1, 1.6, 2.5, 4, and 6.3 degree with and without glare | CS (with and without glare) was better in the monofocal group |
Ji et al. 2013 [44] | monofocal Acrysof Natural (Alcon, n = 27) vs. Acrysof ReSTOR (Alcon, n = 24) | CS at 0.7, 1.0, 1.6, 2.5, 4.0, and 6.3 cpd; scotopic (80 cd/m2) and mesopic (5 cd/m2) conditions | Monofocal presented better CS at all spatial frequencies and conditions |
Wilkins et al. 2013 [45] | Tecnis ZM900 (AMO, n = 106) vs. monovision Akreos AO (Bausch & Lomb, n = 105) | CS with Pelli-Robson chart | Monovision better than multifocal (p = 0.009) |
Zhao et al. 2010 [46] | Acrysof ReSTOR SA60D3 (Alcon, n = 72) vs. Acrysof SA60AT (Alcon, n = 89) | CS at 1.5, 3, 6, 12, and 18 cpd | Better CS at 3 cpd in monofocal IOL |
Martínez Palmer et al. 2008 [47] | Tecnis Z9000 (AMO, n = 48) vs. Tecnis ZM900 (AMO, n = 52) vs. ReZoom (AMO, n = 64) vs. TwinSet (AcriTec, n = 64) | CS at 1.5, 3, 6, 12, and 18 cpd in mesopic and scotopic conditions, with and without glare | Mean contrast sensitivity was better for the monofocal IOL group than for the MIOLs. Patients assigned to TwinSet had less favorable contrast sensitivity scores compared to newer design multifocals |
Cillino et al. 2008 [48] | AR40 (AMO, n = 15) vs. Array SA40N (AMO, n = 16) vs. ReZoom (AMO, n = 15) vs. ZM900 (n = 16) | CS at 1.5, 3, 6, 12, and 18 cpd | All groups behaved similarly. At 3 cpd, the monofocal IOL (AR40) and diffractive pupil-independent MIOL (ZM900) groups exhibited a higher sensitivity than the refractive MIOL groups (ReZoom and ZM900) (P = 0.038) |
Harman et al. 2008 [49] | 1CU (n = 28) vs. Array SA40N (AMO, n = 27) vs. Clariflex (AMO, n = 27) | CS with Pelli-Robson chart | CS slightly higher in 1CU than in array at 3 months, No differences at 18 months |
Zeng et al. 2007 [50] | Z9001 (AMO, n = 40) vs. SA60AT (Alcon, n = 45) vs. SA40N (AMO, n = 39) | CS at 6, 12, and 18 cpd (85 cd/m2 at 4 m) with and without glare | Z9001 showed better CS than SA40AT, while SA60AT better than SA40N (significant at all spatial frequencies) |
Sen et al. 2004 [51] | SI-40NB (AMO, n = 67) vs. Array SA-40 N (AMO, n = 53) | CS at 1.5, 3, 6, 12, and 18 cpd | CS was slightly lower with MIOLs at all spatial frequencies; the difference was not significant and decreased over time |
Montés-Micó et al. 2004 [52] | SI-40NB (AMO, n = 32) vs. Array SA-40 N (AMO, n = 32) | CS at 1.5, 3, 6, 12, and 18 cpd | As low luminances, distance CS for MIOL worse than monofocal IOL for highest spatial frequencies (12 and 18 cpd). Under bright conditions no difference – CS within normal limits |
Leyland et al. 2002 [53] | S140 N (AMO) vs. Array SA40NB (AMO) vs. TrueVista 68STUV (Storz) | CS with Pelli-Robson chart at 1 m | Mean binocular contrast sensitivity was 1.74 (SD 0.15) for the monofocal IOL, 1.67 (0.13) for the multifocal, and 1.65 (0.20) for the bifocal (unclear in statistically significant) |
Kamlesh et al. 2001 [54] | Progres 3 (Domilens, n = 20) vs. Flex 65 (Domilens, n = 20) | CS with Pelli-Robson chart at 90 cd/m2 | Mean CS was lower in patients with MIOLs than those with a monofocal IOL (1.38 vs. 1.56 log units; p < 0.001) |
Haaskjold et al. 1998 [55] | Diffractive bifocal PMMA 808X (Pharmacia, n = 115) vs. monofocal 808D (Pharmacia, n = 106) | CS at 1.5, 3, 6, 12, and 18 cpd at distance and near | Bifocal had lower CS than monofocal IOL at all spatial frequencies |
Allen et al. 1996 [56] | Diffractive bifocal PMMA 808X (Pharmacia, n = 79) vs. monofocal 808D (Pharmacia, n = 70) | CS at 1.5, 3, 6, 12, and 18 cpd at three light levels | Differences in CS at all light levels. Particularly in medium light, bifocal group had reduced CS compared with monofocal IOL but still within normal limits |
Percival et al. 1993 [57] | PC25 (AMO, n = 25) vs. Array (AMO, n = 25) | Regan system | Slightly lower CS in MIOLs than monofocal IOLs at all contrast levels, not statistically significant |
Steinert et al. 1992 [58] | PC-25NB (AMO, n = 30) vs. Array MPC-25NB (AMO, n = 32) | Regan system | MIOL worse than monofocal IOL only at 11% contrast level |
Discussion
Contraindications for MIOLs
Evidence on MIOLs and retinal diseases
Study | IOL | Diseases | Conclusion |
---|---|---|---|
Gayton et al. [63] | Acrysof Restor targeting −2.0D (Alcon) | Dry age-related macular degeneration or macular degeneration associated with disciform scarring. | In cataractous eyes with age-related macular degeneration, replacing the crystalline lens with this myopia-targeted multifocal intraocular lens improved or maintained near vision without severely compromising distance vision |
Kamath et al. [62] | Multifocal array (AMO) vs. monofocal SI-40NB0 (AMO) | Age-related macular degeneration Glaucoma Ocular Hypertension Diabetic Retinopathy Others | The IOLs presented similar distance visual outcomes; however, a proportion of patients benefited from the IOLs’ multifocality |