Functional assessment of accommodating intraocular lenses versus monofocal intraocular lenses in cataract surgery: Metaanalysis
Presented at the annual meeting of the Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida, USA, May 2009.
Received 18 February 2009; received in revised form 29 September 2009; accepted 30 September 2009.
Purpose
To compare accommodating intraocular lens (IOLs) and monofocal IOLs in restoring accommodation in cataract surgery.
Setting
Dartmouth Medical School and Department of Ophthalmology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Methods
In this metaanalysis, 2 researchers independently extracted data, assessed trial quality, and contacted authors for missing information. Because of measurement-scale variations, outcomes were pooled for distance-corrected near visual acuity (DCNVA) as standardized mean differences with 95% confidence intervals [CIs] and anterior displacement of the lens as weighted mean differences (95% CI).
Results
The metaanalysis comprised 12 randomized controlled studies of 727 eyes. Based on 10 studies that compared DCNVA, accommodating IOLs were favored but failed the test of heterogeneity (I2 = 94%). Pooling the 6 homogeneous trials (I2 = 43%) showed no difference (standardized mean difference, −0.16; 95% CI, −0.56 to 0.25). Heterogeneity could not be explained by any characteristic of the study population or methodology. Based on 4 studies that evaluated pilocarpine-induced IOL shift, there was a significant anterior compared with the control (weighted mean difference, 95% CI, −0.36 − 0.47 to −0.24]), although the studies were heterogeneous (I2 = 58%). Three of 5 studies mentioning posterior capsule opacification (PCO) reported increased rates in the accommodating IOL group postoperatively.
Conclusions
There was no clear evidence of near acuity improvement despite statistically significant pilocarpine-induced anterior lens displacement. Further randomized controlled studies with standardized methods evaluating adverse effects (eg, PCO) are needed to clarify the tradeoffs.
Financial Disclosure
No author has a financial or proprietary interest in any material or method mentioned.
From the Dartmouth Institute for Health Policy and Clinical Practice (Takakura, Iyer, Adams), Dartmouth Medical School (Takakura, Adams, Pepin), and the Department of Ophthalmology (Pepin), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
Corresponding author: Ako Takakura, MPH, 57 Drake Lane, West Lebanon, New Hampshire 03784, USA.
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