ABSTRACT: PURPOSE: To evaluate the visual acuity and quality-related satisfaction of patients implanted with a refractive design multifocal intraocular lens (IOL), and evaluate the factors predicting it including angle kappa. SETTING: Dr Agarwal's Eye Hospital and Eye Research Centre, Chennai. METHODS: In this prospective trial, 50 eyes of 44 consecutive patients were included. All patients underwent phacoemulsification with multifocal IOL implantation (Rezoom IOL, Abbott Medical Optics). The preoperative and postoperative assessment included slit lamp biomicroscopy, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA) and kappa angle assessment. At 1 year, 37 patients (43 eyes), who finished follow-up, were asked to rate their symptoms on a graded questionnaire (0-5 for five queries). RESULTS: The decimal scores for UCVA and BCVA were 0.38±0.21 and 0.47±0.17 (preoperative), and 0.75±0.22 and 0.99±0.11 (postoperative), respectively. Symptom scores were haloes 0.98±1.7, glare 0.69±1.48, blurred distance 1.0±1.7, intermediate 1.34±1.6, near 1.06±1.8. On regression analysis haloes depended on angle kappa and distance UCVA (R (2)=0.26, P=0.029), and glare on angle kappa (R (2)=0.26, P=0.033). Poor satisfactions with distance, intermediate, and near vision were linked with distance UCVA (R (2)=0.17, P=2.3 × 10(-4)), distance UCVA (R (2)=0.1, P=0.04), and near UCVA (R (2)=0.12, P=0.03), respectively. The strongest predictor, however, for overall visual discomfort was distance UCVA (R (2)=0.1, P=0.04). CONCLUSIONS: Our study suggests that there may be a role of misalignment between the visual and pupillary axis (angle kappa) in the occurrence of photic phenomenon after refractive multifocal IOL implantation.
