Functional assessment of accommodating intraocular lenses versus monofocal intraocular lenses in cataract surgery: metaanalysis.

Purpose: To compare accommodating intraocular lens (IOLs) and monofocal IOLs in restoring accommodation in cataract surgery.

Setting: Dartmouth Medical School and Department of Ophthalmology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.

Methods: In this metaanalysis, 2 researchers independently extracted data, assessed trial quality, and contacted authors for missing information. Because of measurement-scale variations, outcomes were pooled for distance-corrected near visual acuity (DCNVA) as standardized mean differences with 95% confidence intervals [CIs] and anterior displacement of the lens as weighted mean differences (95% CI).

Results: The metaanalysis comprised 12 randomized controlled studies of 727 eyes. Based on 10 studies that compared DCNVA, accommodating IOLs were favored but failed the test of heterogeneity (I(2) = 94%). Pooling the 6 homogeneous trials (I(2) = 43%) showed no difference (standardized mean difference, -0.16; 95% CI, -0.56 to 0.25). Heterogeneity could not be explained by any characteristic of the study population or methodology. Based on 4 studies that evaluated pilocarpine-induced IOL shift, there was a significant anterior compared with the control (weighted mean difference, 95% CI, -0.36 - 0.47 to -0.24]), although the studies were heterogeneous (I(2) = 58%). Three of 5 studies mentioning posterior capsule opacification (PCO) reported increased rates in the accommodating IOL group postoperatively.

Conclusions: There was no clear evidence of near acuity improvement despite statistically significant pilocarpine-induced anterior lens displacement. Further randomized controlled studies with standardized methods evaluating adverse effects (eg, PCO) are needed to clarify the tradeoffs.