Diffractive multifocal intraocular lens compared to pseudo-accommodative intraocular lens implant for unilateral cataracts in pre-presbyopic patients

PURPOSE: To evaluate the efficacy of diffractive multifocal and pseudo-accommodative IOLs in pre-presbyopes with cataract. MATERIALS AND METHODS: A prospective randomized control study was performed on patients with cataract in the pre-presbyopic age group. Patients were randomly allocated to 2 groups: Group 1 comprised 12 patients who underwent implantation of a diffractive multifocal IOL and Group 2 comprised 13 patients who underwent implantation of a pseudo-accommodative IOL after standard phacoemulsification. Efficacy was measured by postoperative distance and near uncorrected visual acuity, contrast sensitivity, spectacle independence, and glare and halo. RESULTS: The study patients were aged 22-35 years and included 14 females and 11 males. All examinations were performed 6 months postoperatively by a second observer unaware of the study objectives. Mean uncorrected distance visual acuity was 0.125 ± 0.1 LogMAR in Group 1 and 0.1385 ± 0.1 in Group 2 (P = 0.7993). Near visual acuity was 0.0917 ± 0.1 in Group 1 and 0.386 ± 0.2 in Group 2 (P < 0.0001). Contrast sensitivity was good in both groups based on the Pelli-Robson chart (P = 0.3919). Night-time glare was present in 3 (25%) patients in Group 1 and in 2 (15.4%) patients in Group 2. No patients in either group had difficulty driving during the day or night. Ten patients in Group 1 (83.3%) and 7 patients in Group 2 (53.85%) had spectacle independence (P = 0.1249). CONCLUSION: Greater proportions of patients who underwent diffractive multifocal implantation achieved functional distance and near vision as compared to those in the pseudo-accommodative IOL group. There was greater variability in near vision in patients who received the pseudo-accommodative IOL as compared to those in the multifocal IOLs. Contrast sensitivity remained adequate in both the groups. There were more glare and halos in the multifocal group as compared to those in the pseudo-accommodative group. More patients achieved spectacle independence with multifocal IOLs.