title: Comparison of visual outcomes, spectacles dependence and patient satisfaction of multifocal and accommodative intraocular lenses: innovative perspectives for maximal refractive-oriented cataract surgery.
abstract: BACKGROUND
  The aim of this study was to evaluate visual outcomes for different working distances (far, 60 cm and 33 cm) and impact on vision quality of multifocal IOLs AcrySof ResTOR SN6AD1 and SN6AD3 (Alcon, Inc., Fort Worth, Texas, USA) as well as REVIEW FIL611PV multifocal and OPTOFLEX FIL618 accommodative IOLs (Soleko, Ltd., Rome, Italy) in patients undergoing bilateral phacoemulsification.
  
  
  METHODS
  In this observational prospective study 63 patients undergoing binocular cataract surgery were divided into four groups for implantation of one of the IOLs under evaluation. Visual outcomes were evaluated at 1 day, 7 days, 1 month, 3 months and 6 months after surgery. Patients' satisfaction and spectacle independence were evaluated with questionnaires administered at the 6-months follow-up.
  
  
  RESULTS
  Improvements in visual acuity for the three working distances were statistically significant in all cases compared to the preoperative status, especially after binocular implantation. The AcrySof ReSTOR SN6AD1 multifocal IOL provided the best visual acuity results and tolerability for all working distances. While performing worse than SN6AD1, FIL611PV and FIL618 provided better uncorrected visual acuity and spectacles independence for intermediate/close-up and far distances respectively, in comparison with the SN6AD3 group.
  
  
  CONCLUSIONS
  SN6AD1 was confirmed the best choice for all working distances. However, FIL611PV IOL may represent a valid and more cost-effective alternative, especially if surgeons intend to prioritize spectacle independence and patient autonomy at intermediate and close-up distances, in accordance to specific needs and requests.
  
  
  BACKGROUND
  Trial retrospectively registered in ISRCTN Registry on 02/02/2017. TRN: ISRCTN14145737 .
authors.affiliation: Institute of Ophthalmology, Department of Surgical Sciences, University of Turin, Via Juvarra 19, 10100, Turin, Italy. prof.nuzzi_raffaele@hotmail.it.|Unit of Ophthalmology, San Luigi Gonzaga University Hospital, University of Turin, Regione Gonzole 10, Orbassano, 10043, Turin, Italy. prof.nuzzi_raffaele@hotmail.it.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Nuzzi
authors.affiliation: Institute of Ophthalmology, Department of Surgical Sciences, University of Turin, Via Juvarra 19, 10100, Turin, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Tridico
mesh_terms: D000065:Accommodation, Ocular; D000368:Aged; D002387:Cataract Extraction / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011474:Prosthesis Design; D019591:Pseudophakia / Q000503:physiopathology*; D011788:Quality of Life; D054140:Refractive Surgical Procedures / Q000379:methods*; D011795:Surveys and Questionnaires; D015348:Vision, Binocular; D014792:Visual Acuity
keywords: Accommodative IOLs; Cataract surgery; Multifocal IOLs; Refractive surgery