Intermediate optimization of vision with bilateral nonaspheric multifocal intraocular lens implantation

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To evaluate binocular visual function, refraction, and subjective outcomes of intermediate optimization of vision after simultaneous bilateral implantation of the nonaspheric AcrySof SA60D3 ReSTOR multifocal intraocular lens (IOL). Private clinic, Abbotsford, British Columbia, Canada. Intermediate optimization was performed by overcorrection of 1.00 diopter (D) to induce mild myopia in the nondominant eye in patients having bilateral implantation of the multifocal IOL. Distance manifest refraction and visual acuity at several distances were determined; contrast sensitivity function (CSF), near-point stereo acuity, and subjective outcomes were assessed postoperatively at 2 weeks and 1, 3, 6, and 12 months. Thirty-two patients with intended intermediate optimization and 5 patients with unintended intermediate optimization were prospectively evaluated. The mean manifest refraction spherical equivalent was stable from 2 weeks (-0.94 D+/-0.22 [SD]) to 12 months (-0.93+/-0.23 D) in the intermediate optimization eyes. Overall, postoperative mean binocular uncorrected near, intermediate, and distance visual acuities were 20/23, 20/23, and 20/22, respectively. No significant differences were found between best distance-corrected and uncorrected stereo acuity or between best distance-corrected and uncorrected binocular CSF under most conditions (P> .05). On questioning, 97% of patients had little or no difficulty seeing and were bothered occasionally or never by the visual fluctuation between the near range and intermediate range. Intermediate optimization with slight myopia in 1 eye after bilateral implantation of the multifocal IOL offered consistent good vision at all ranges, indicating it a safe option for patients who require good vision at intermediate ranges.