Abstract
Purpose :
Multifocal and toric intraocular lenses (IOLs) are classified as advanced technology IOLs and may offer superior visual acuity (VA) outcomes, higher spectacle independence (SI), and greater patient satisfaction when compared with conventional monofocal IOLs. Since rates of cataract surgery are increasing globally, there is an increasing demand for these products. The current study aimed to understand global health technology assessment (HTA) agencies’ perceptions of these IOLs including benefits, limitations, and recommendations for use in their respective jurisdictions.
Methods :
HTA agencies and associated groups (N=129) in 15 countries (Australia [AU], Belgium [BE], Canada [CA], Denmark [DK], Finland [FI], France [FR], Germany [DE], Italy [IT], Luxembourg [LU], Netherlands [NL], Norway [NO], Spain [ES], Sweden [SE], the United Kingdom [UK] and the United States of America [US]) were searched for reviews on multifocal and toric IOLs for cataract surgery. Reports and guidelines published from January 2003 – September 2018 were captured.
Results :
Reports or guidelines for multifocal or toric IOLs were published in 8/15 countries. There were 8 HTAs and 3 guidelines for multifocal IOLs from AU, CA, NL, SE, UK and US, with positive or neutral reviews from 5/6 countries. Compared with monofocal IOLs, multifocal IOLs were found to provide greater SI and near VA outcomes, with visual disturbances considered minor and outweighed by the potential benefit to the patient. There were 4 HTAs and 4 guidelines for toric IOLs from CA, DK, FR, NL, SE and UK. Toric IOLs were widely regarded as clinically effective and safe to treat patients with cataracts and astigmatism, with positive reviews from 5/6 countries. One HTA guideline (UK) did not recommend Toric IOLs due to uncertainty in cost-effectiveness estimates. Reports also expressed uncertainty about the long-term effects of either type of lens on patients’ quality of life and satisfaction, due to limited follow-up.
Conclusions :
IOL technology is rapidly advancing, and HTAs acknowledge the necessity of ongoing reviews upon evidence accumulation. HTA agencies recognize the added value of advanced technology IOLs, but recommend conducting larger, long-term (more than 1 year), controlled trials and generating evidence using standardized clinical and safety outcomes.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.