Wang Sophia Y, Stem Maxwell S, Oren Gale, Shtein Roni, Lichter Paul R
Department of Ophthalmology, Kellogg Eye Center, University of Michigan, Ann Arbor, MI - USA.
Eur J Ophthalmol. 2017 Jun 26;27(4):387-401. doi: 10.5301/ejo.5000978. Epub 2017 Apr 24.
Over 8 million cataract surgeries are performed in the United States and the European Union annually, with many patients choosing to pay out of pocket for premium options including premium intraocular lens implants (IOLs) or laser-assisted cataract surgery (LACS). This report provides a systematic review evaluating patient-centered and visual quality outcomes comparing standard monofocal IOLs to premium cataract surgery options.
PubMed and EMBASE were searched for publications published between January 1, 1980, and September 18, 2016, on multifocal, accommodative, and toric IOLs, monovision, and LACS, which reported on 1) dysphotopsias, 2) contrast sensitivity, 3) spectacle independence, 4) vision-related quality of life or patient satisfaction, and 5) IOL exchange.
Multifocal lenses achieved higher rates of spectacle independence compared to monofocal lenses but also had higher reported frequency of dysphotopsia and worse contrast sensitivity, especially with low light or glare. Accommodative lenses were not associated with reduced contrast sensitivity or more dysphotopsia but had only modest improvements in spectacle independence compared to monofocal lenses. Studies of monovision did not target a sufficiently myopic outcome in the near-vision eye to achieve the full potential for spectacle independence. Patients reported high levels of overall satisfaction regardless of implanted IOL. No studies correlated patient-reported outcomes with patient expectations.
Studies are needed to thoroughly compare patient-reported outcomes with concomitant patient expectations. In light of the substantial patient costs for premium options, patients and their surgeons will benefit from a better understanding of which surgical options best meet patients' expectations and how those expectations can be impacted by premium versus monofocal-including monovision-options.
在美国和欧盟，每年进行超过800万例白内障手术，许多患者选择自掏腰包选择高级选项，包括高级人工晶状体植入物（IOL）或激光辅助白内障手术（LACS）。本报告提供了一项系统评价，评估以患者为中心的和视觉质量结果，比较标准单焦点IOL与高级白内障手术选项。
检索PubMed和EMBASE中1980年1月1日至2016年9月18日期间发表的关于多焦点、可调节和散光IOL、单眼视力和LACS的出版物，这些出版物报告了1）眩光、2）对比敏感度、3）无需眼镜、4）与视力相关的生活质量或患者满意度，以及5）IOL置换。
与单焦点晶状体相比，多焦点晶状体实现无需眼镜的比率更高，但报告的眩光频率也更高，对比敏感度更差，尤其是在低光或眩光情况下。可调节晶状体与对比敏感度降低或更多眩光无关，但与单焦点晶状体相比，在无需眼镜方面只有适度改善。单眼视力研究没有在近视力眼中实现足够近视的结果，以充分发挥无需眼镜的潜力。无论植入何种IOL，患者报告的总体满意度都很高。没有研究将患者报告的结果与患者期望相关联。
需要进行研究，以彻底比较患者报告的结果与患者的伴随期望。鉴于高级选项给患者带来的巨大成本，患者及其外科医生将受益于更好地了解哪种手术选项最能满足患者的期望，以及高级选项与单焦点选项（包括单眼视力选项）如何影响这些期望。
