Binocular implantation of the Tecnis Z9000 or AcrySof MA60AC intraocular lens in routine cataract surgery: Prospective randomized controlled trial comparing VF-14 scores

Abstract

To compare vision-related quality of life after binocular implantation of the Tecnis Z9000 intraocular lens (IOL) (Advanced Medical Optics) or the AcrySof MA60AC IOL (Alcon). Moorfields Eye Hospital, London, United Kingdom. The study was a double-masked prospective randomized controlled trial. The main outcome measure was the percentage of patients achieving a Visual Function-14 (VF-14) score of 90 or higher. Additional outcome measures were dysphotopsia symptom scores, a 5-point subjective grading of overall satisfaction, refraction, photopic and mesopic best corrected visual acuities, uncorrected visual acuity, Pelli-Robson contrast sensitivity, aberrometry, infrared pupillometry, and evaluation of posterior capsule opacification scores. Seventy-nine patients who had bilateral implantation of the Z9000 IOL and 100 patients who had bilateral implantation of the MA60AC IOL were assessed a mean of 7.9 months +/- 2.9 (SD) (range 4 to 16 months) after second-eye surgery. Spherical aberration (mean: Z9000, 0.00 microm +/- 0.06 [SD]; MA60AC, +0.14 +/- 0.09 microm) and root mean square scores for higher-order aberrations combined (mean: Z9000, 0.26 +/- 0.11 microm; MA60AC, 0.32 +/- 0.14 microm) were significantly lower in patients with the Z9000 IOL (P<.001 and P = .007, respectively). The VF-14 scores were 90 or higher in 96.2% of Z9000 patients and 90.0% of MA60AC patients (P = .15). It is unlikely that this weak trend in favor of the Z9000 IOL was clinically significant. The VF-14 scores were heavily skewed toward a perfect outcome and similarly distributed in both groups (median 100; interquartile range 98 to 100). Results for all other outcomes, including measures of acuity, were similarly distributed in Z9000 patients and MA60AC patients. The Z9000 IOL reduced spherical aberration compared with the MA60AC IOL. No improvement in subjective visual function using the VF-14 questionnaire was detected.