A new term, gender medicine, has been established. Based on academic and administrative suggestions (gender mainstreaming), this field has now begun to be generally accepted. The knowledge that the appearance and development of diseases as well as the effects of medicinal drugs on women and men is different is already being introduced into research more and more and also into teaching and further education.

When considering glasses for reading, women, on average, tend to request prescriptions between +0.25 and +0.5 higher addition than men of the same age group.

Dr Rau and her team compared the desired optimum distance for reading books or magazines favoured by women in the 28-50 age bracket with the distance preferred by men of the same age. They also examined the optimal desired reading distance of a group of 100 men (average age of 38) and 100 women (average age 36). The results were 43 cm for the men and 38 cm for the women, which was statistically significant. Apparently younger women as well as older women tend to hold reading texts closer to their face. For the purposes of their study Dr Rau's team maintain that women are smaller as a rule and that they have shorter arms.

"To verify our many years of experience in difference expectations of MFIOls between men and women," explained Dr Rau, "we evaluated and compared the satisfaction of both after implantation of various multifocal IOLs to those in our previous studies from 1999-2007."

The M4 lens

Published in the Klinische Monatsblätter for Opththalmology 2002 the team obtained results following implantation of 80 MF4 lenses (Carl Zeiss Meditec) into the eyes of 40 patients with an average age of 72.

The MF4 is a refractive multifocal lens with four optical zones. The central zone is for near vision, with a 4 0 addition. A one-piece, foldable, acrylic IOL its mean UCVA for distance was 0.63, for the near 0.82.

"We found," explained Dr Rau, "that 30% of all patients were very happy with the result and they were all women. 64% of the patients questioned were satisfied with the implantation and 6% were not satisfied.

"The 6% unhappy patients were all men complaining about inadequate far vision (4%) and about halos and glare (2%). The results of this study appeared to confirm that women tend to attach great importance to excellent visual acuity at near distance and appreciate the fact that they are no longer dependent on reading glasses."

AMO Array

"In order to meet the requirements of male patients I began to use an AMO Array lens. This is a three-piece, foldable, silicon refractive MFIOL with five optical zones, in which the central zone is for far vision, the addition is 3.5D. From 1999 - 2001 we implanted 80 AMO Array in the eyes of 40 patients with a mean age of 64 years. 22 patients in the study were male and 18 female.

"The mean UCVA for distance was 0.72, for near 0.72 and 45% of the patients were very satisfied with the achieved results, 10% were not satisfied – of that 10%, 6% was due to poor near vision for the women and 4% were all men due to halos and glare."

As some of the male patients opted for better visual acuity at close range, Dr Rau started combining the AMO Array with the MF4 in the other eye of the same patient (EuroTimes, Volume 8, Issue 3, March 2003). With male patients, the AMO Array was implanted first and where dissatisfaction with near vision occurred, the MF4 was implanted in the other eye.

In conjunction with a prospective study performed between December 1999 and January 2001, Dr Rau compared a population of AMO Array Silicon patients fitted with a + Rezoom, which is a second-generation multifocal IOL. The optical results were comparable. The average visual acuity obtained with the AMO Array was 0.72 at far distances, while the + Rezoom achieved a far vision of 0.73. The average near visual acuity was 0.72 in the AMO Silicon group and 0.68 in the + Rezoom group. Contrast sensitivity was comparable; 70% of the patient in the AMO group observed halos but only 36% of the Rezoom group mentioned halos. Thirty five percent of all subjects in the AMO Array group complained about glare, while only 11% of the patients in the Rezoom group had problems with this. Eighty eight percent of all subjects in the AMO Array group and 92% of all Rezoom patients expressed their satisfaction. Eight percent of the 4% of unsatisfied AMO Array patients had problems with poor visual acuity when reading, while 4% complained about glare and halos (all male subjects). Dissatisfaction in the Rezoom group was attributed to inferior near visual acuity (7%), while only 1% of the patients complained about glare and halos. Male satisfaction after Rezoom implantation was concluded to be higher because of less glare and halos.

Figure 1: The optimal desired reading distance is different for men and women.

Between August 2005 and June 2007, we implanted the multifocal refractive Rezoom into 160 eyes of 80 patients. The mean UCVA for the distance was 0.78, for the intermediate 0.68 and for the near 0.72. The results this time were that 45% were very satisfied – 15% were women and 30% men. Eight percent were not satisfied – of which 6% were women who experienced poor near vision and 2% were men who experienced glares and halos.