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Assessment of Spectacle Independence with Multifocal IOLs utilising Patient Reported Outcomes

School of Health and Life Sciences

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Dr Catriona Hamer , Dr K Bannigan Applications accepted all year round Self-Funded PhD Students Only

About the Project

Ref: SHLS20024 Hamer

In cataract surgery, the assessments, procedure and implants (intraocular lenses, IOLs) have all improved to such an extent, that it is now possible to correct pre-existing refractive error (need for spectacles) [1-4]. Prior to cataract surgery, almost all patients require a correction for some or all visual tasks [5, 6]. Multifocal IOLs (MIOLs) have been designed to reduce spectacle dependence, potentially achieving spectacle independence [4, 7, 8], correcting vision for near, far and intermediate viewing tasks. However, despite the reported successes of MIOLs [2, 4, 9], it is difficult to assess the spectacle dependence post-surgery. Whilst frequently used, terms such as ‘spectacle-free’ vision or independence are not clinically defined and there is no definitive method of assessing or categorising the spectacle dependence of patients [10], particularly after implantation of MIOLs. Previous work has used a variety of measures to assess vision after MIOL implantation, with varied success [10]. Common issues included poorly defined terms or jargon, reducing the accuracy of the results.

This PhD project aims to create an assessment method based on the patient-reported outcomes of specific visual tasks, that determine spectacle dependence post-surgery (with clearly defined criteria) for a range of MIOLs. It will involve consultation with both clinical practitioners as well as patient groups to determine the best assessment of vision and visual correction post- surgery. The project will follow standard FDA recommended processes [11] with the aim of apply for FDA approval at the end of the project.

Applicants should have (at least) a first or upper second-class honours degree in an appropriate subject. Experience with post-operative cataract surgical assessment with a variety of different IOL types is desirable.

This project will run with the Applied Vision Research Group at GCU and will take place with the help of local Optometrists and Ophthalmologists.


[1] Mollazadegan, K. and Lundstrom, M., A study of the correlation between patient-reported outcomes and clinical outcomes after cataract surgery in ophthalmic clinics, Journal/Acta Ophthalmol. 93 (2015) 293-298.
[2] Goldberg, D. G., Goldberg, M. H., Shah, R., Meagher, J. N. and Ailani, H., Pseudophakic mini-monovision: high patient satisfaction, reduced spectacle dependence, and low cost, Journal/BMC Ophthalmol. 18 (2018) 293.
[3] Apple, D., Evolution of Cataract Surgery and Intraocular Lenses (IOLs), Journal/Surv. Ophthalmol. 45 (2000) S53-S69.
[4] Zvornicanin, J. and Zvornicanin, E., Premium intraocular lenses: The past, present and future, Journal/Journal of current ophthalmology. 30 (2018) 287-296.
[5] Hoffmann, P. C. and Hutz, W. W., Analysis of biometry and prevalence data for corneal astigmatism in 23,239 eyes, Journal/J. Cataract Refract. Surg. 36 (2010) 1479-1485.
[6] Khan, M. I. and Muhtaseb, M., Prevalence of corneal astigmatism in patients having routine cataract surgery at a teaching hospital in the United Kingdom., 37 (2011) 1751-1755.
[7] Agresta, B., Knorz, M. C., Donatti, C. and Jackson, D., Visual acuity improvements after implantation of toric intraocular lenses in cataract patients with astigmatism: a systematic review, Journal/BMC Ophthalmol. 12 (2012) 41.
[8] Agresta, B., Knorz, M. C., Kohnen, T., Donatti, C. and Jackson, D., Distance and near visual acuity improvement a... [J Refract Surg. 2012] - PubMed - NCBI, Journal/Journal of refractive …. 28 (2012) 426-435.
[9] Dyrda, A., Martinez-Palmer, A., Martin-Moral, D., Rey, A., Morilla, A., Castilla-Marti, M. and Arones-Santivanez, J., Clinical Results of Diffractive, Refractive, Hybrid Multifocal, and Monofocal Intraocular Lenses, Journal/Journal of ophthalmology. 2018 (2018) 8285637.
[10] Grzybowski, A., Kanclerz, P. and Muzyka-Wozniak, M., Methods for evaluating quality of life and vision
in patients undergoing lens refractive surgery, Journal/Graefes Arch. Clin. Exp. Ophthalmol. (2019)
[11] Health, U. S. D. o., Evaluation, H. S. F. C. f. D., Research, Health, U. S. D. o., Evaluation, H. S. F. C. f. B., Research, Health, U. S. D. o., Devices, H. S. F. C. f. and Health, R., Guidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims: draft guidance, Journal/Health and Quality of Life Outcomes. 4 (2006) 79.

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