Outcomes of cataract extraction with multifocal intraocular lens implantation: Functional status and quality of life

Objective: The authors measured functional status after bilateral implantation of a multifocal versus a monofocal intraocular lens (IOL). Methods: A retrospective, case-control study was done on 100 subjects implanted bilaterally with a silicone-optic foldable zonal progressive IOL under United States Food and Drug Administration Investigational Device Exemption protocol and 103 control subjects implanted bilaterally with a monofocal IOL of similar design who were matched on age and postoperative corrected distance acuity. The Cataract TyPE specification, a 17-item functional status instrument, was modified, validated, and administered via telephone interview. The measures of vision, functional status, and quality of life were compared between patients and controls. Results: The instrument was valid (Cronbach's α = 0.94) and correlated moderately (Pearson's r = 0.34) with Snellen acuity. Multifocal subjects were more likely than monofocal controls to never wear spectacles (41% vs. 11.7%; P <0.001). Multifocal subjects rated their vision without spectacles significantly better than those with monofocal IOLs (9.0 vs. 7.9; P <0.001). The difference was most significant in rating of near vision without spectacles (7.8 vs. 5.0; P <0.001). Multifocal subjects reported less limitation in specific visual tasks without spectacles (0.3 vs. 0.8; P <0.001, where 1.0 represents 'slightly' limited). This difference was consistently observed in subscales related to distance vision activities (0.1 vs. 0.4; P <0.001), near vision activities (0.6 vs. 1.4; P <0.001), and social activities (0.1 vs. 0.6; P <0.001). Conclusions: In this study, subjects with bilateral multifocal IOLs reported better overall vision, less limitation in visual function, and less spectacle usage than monofocal controls.