The conclusion in my original paper was based on successful implantation of the Array® multifocal IOL (Allergan, Inc.) in an indigent population. The cost of the lens may or may not be more than that of a monofocal lens depending on the market (the differential is $50 in the United States), but the suggestion that the cost of reading glasses is an inexpensive substitute for good near vision is not valid either. For one thing, inexpensive reading glasses do not address astigmatism.
The cost of the lens in our study was borne by the medical center. The cost of reading glasses is borne by the patient and, in an indigent population, may be out of financial reach. In addition, reading glasses are inconvenient to use, easily lost, and more easily damaged than sturdy prescription spectacles. Near vision is needed for most activities of daily living—shaving, brushing teeth, reading, pouring hot water into a cup—and it is easy to assume that reading glasses are an inexpensive answer, but that presumes they are within reach at all times. Some presbyopic people keep readers in the bedroom, bathroom, kitchen, and living room to have a pair nearby when needed. In an indigent population, this may be untenable.
The argument about the economics of multifocal IOLs is multifactorial and not solely dependent on the cost of the multifocal IOL. Economics also takes into consideration the benefit to the patient and the social cost of lost near vision, which is harder to measure than by the cost of reading glasses.
As to the argument about glare and halos, Javitt and Steinert1 found that glare disability was not statistically significantly different between patients with bilateral multifocal IOLs and those with bilateral monofocal IOLs in reading type on shiny paper, driving toward the sun, driving toward oncoming headlights, walking outside on sunny days, or reading signs in supermarkets. In 1997, Javitt and coauthors2 conducted a quality of life study and found that patients with multifocal IOLs reported significantly less limitation in vision-related function overall than those with monofocal IOLs.
Dr. Schipper is correct in pointing out the typographical error in Table 3. The value should be 0.160 ± 0.169.
Jeffrey Sedgewick MD
1. Javitt JC, Steinert RF. Cataract extraction with multifocal intraocular lens implantation: a multinational clinical trial evaluating clinical, functional, and quality-of-life outcomes. Ophthalmology 2000; 107:2040-2048
2. Javitt JC, Wang F, Trentacost DJ, et al. Outcomes of cataract extraction with multifocal intraocular lens implantation: functional status and quality of life. Ophthalmology 1997; 104:589-599