Kelava Lidija, Barić Hrvoje, Bušić Mladen, Čima Ivan, Trkulja Vladimir
Department of Ophthalmology, Clinical Hospital "Sveti Duh", Zagreb, Croatia.
Department of Neurosurgery, University Hospital Centre Zagreb, Zagreb, Croatia.
Adv Ther. 2017 Aug;34(8):1815-1839. doi: 10.1007/s12325-017-0579-7. Epub 2017 Jul 3.
Refractive surgery in presbyopia tends to achieve spectacle independence with minimal optical disturbances. We compared monovision to multifocality procedures regarding these outcomes.
We conducted a systematic review of published (till November 21, 2016) randomized controlled trials (RCTs) comparing any monovision to any multifocality method or comparing different monovision/multifocality methods to each other that enabled direct or indirect comparisons between particular monovision and particular multifocality procedures in presbyopic patients undergoing cataract-related or unrelated surgery in respect to spectacle independence, unaided binocular visual acuity (VA), contrast sensitivity (CS), and adverse events.
Three trials comparing monovision (monofocal lenses, LASIK) to multifocal intraocular lenses (MFIOLs; Isert refractive or Tecnis diffractive) and 6 comparing other MFIOLs to Tecnis were included (1-12 months duration). Spectacle independence. All reporting trials were of sufficient quality. Directly, pseudophakic monovision was inferior to Isert (1 trial, N = 75, RR = 0.49, 95% CI 0.28-0.80) and Tecnis (1 trial, N = 211, RR = 0.36, 95% CI 0.25-0.52) in cataract patients, and LASIK was comparable to Tecnis (1 trial, N = 100, RR = 0.93, 0.78-1.10) in refractive surgery. In network meta-regression (6 trials, 14 arms) pseudophakic monovision in cataract patients was inferior to Tecnis. Indirect data suggest also that it is inferior (ReZoom refractive, TwinSet diffractive) or tends to be inferior (Array refractive) to other MFIOLs. LASIK was comparable to Tecnis in refractive surgery. Indirect data suggest also that it tends to superiority vs. ReZoom or Array refractive MFIOLs. Adverse events. No pooling was possible (heterogeneity of assessment and reporting). One quality direct RCT indicated less glare/dazzle with pseudophakic monovision vs. Tecnis in cataract patients. Unaided VA and CS data were burdened with heterogeneity (assessment, reporting) and insufficient quality.
Randomized comparisons of monovision to multifocality are scarce. Existing estimates regarding spectacle independence (imprecision, indirectness) and particularly regarding unaided VA and CS (assessment/reporting heterogeneity, bias, imprecision, indirectness) are burdened with uncertainty. Dysphotopsia is less common with monovision, but estimate uncertainty is high (bias, imprecision).
老花眼屈光手术倾向于在最小光学干扰的情况下实现摆脱眼镜。我们比较了单眼视与多焦点手术在这些结果方面的差异。
我们对已发表的（截至2016年11月21日）随机对照试验（RCT）进行了系统评价，这些试验比较了任何单眼视与任何多焦点方法，或相互比较不同的单眼视/多焦点方法，从而能够在接受白内障相关或不相关手术的老花眼患者中，就摆脱眼镜、裸眼双眼视力（VA）、对比敏感度（CS）和不良事件，对特定的单眼视和特定的多焦点手术进行直接或间接比较。
纳入了3项比较单眼视（单焦点镜片、准分子激光原位角膜磨镶术[LASIK]）与多焦点人工晶状体（MFIOL；Isert屈光性或Tecnis衍射性）的试验，以及6项比较其他MFIOL与Tecnis的试验（持续时间1 - 12个月）。摆脱眼镜。所有报告的试验质量都足够。直接来看，在白内障患者中，假晶状体单眼视不如Isert（1项试验，N = 75，RR = 0.49，95%CI 0.28 - 0.80）和Tecnis（1项试验，N = 211，RR = 0.36，95%CI 0.25 - 0.52），在屈光手术中LASIK与Tecnis相当（1项试验，N = 100，RR = 0.93，0.78 - 1.10）。在网状meta回归（6项试验，14个组）中，白内障患者的假晶状体单眼视不如Tecnis。间接数据也表明，它不如其他MFIOL（ReZoom屈光性、TwinSet衍射性）或倾向于不如（Array屈光性）其他MFIOL。在屈光手术中LASIK与Tecnis相当。间接数据还表明，它相对于ReZoom或Array屈光性MFIOL往往更具优势。不良事件。无法进行合并分析（评估和报告的异质性）。一项高质量直接RCT表明，白内障患者中假晶状体单眼视的眩光/耀光比Tecnis少。裸眼VA和CS数据存在异质性（评估、报告）且质量不足。
单眼视与多焦点的随机比较很少。关于摆脱眼镜的现有估计（不精确性、间接性），特别是关于裸眼VA和CS的估计（评估/报告异质性、偏差、不精确性、间接性）存在不确定性。单眼视的不良视觉感受较少见，但估计的不确定性很高（偏差、不精确性）。
