Multifocal IOLs-Adverse Visual Effects and Their Treatment

Multifocal IOLs-Adverse Visual Effects and Their Treatment

Monofocal intraocular lenses (IOLs) have long been the standard in lens replacement after cataract removal.  However, in the last few years multifocal IOLs have established a firm presence in the marketplace.  Monofocal IOLs can only be used to give a single defined focusing point.  This allows a patient the choice to either see distance or close up. Therefore glasses must be used to correct either the presbyopia or myopia.  Multifocal IOLs, of course, allow for multiple areas of focus and allows for spectacle independence.  Although multifocal intraocular lenses appear to be an easy choice for a patient, there have been problems associated with these types of IOLs such as halos, reduced contrast sensitivity, and blurred vision.  These symptoms, though troubling to the patient and the surgeon, have been shown to be resolved the majority of the time.

OSN Super Site recently cited a study in which it was shown, that of 43 eyes included in the study approximately 81% achieved improved vision after a conservative treatment regimen, 7% improved after IOL exchange, and only 12% showed no improvement.  The treatments included excimer, drug therapy, laser iridioplasty, and YAG laser capsulotomy.  The authors of the study, as well as Dr. Jay Pepose in the review of the OSN article stated that YAG capsulotomy should be one of the last treatment choices.  This is due to the possibility the YAG not being effective and if an IOL exchange needs to be done the capsular bag is now compromised and it makes for a much more difficult procedure.  Further studies have shown that patients that have had multifocal IOL implantation may need a 6 month neuroadaption period.  This simply means that the brain needs adequate time to develop or alter neural pathways to improve visual function after the IOL has been implanted.

Although Multifocal IOLs have been shown to have certain post op adversity, one can’t deny the success they have had in freeing a patient from being tied to their glasses.  Nearly all patients either receive treatment or neuroadaptation takes place to accommodate for the multifocal IOL and the adverse visual effect are resolved.  Patient satisfaction and positive outcomes are always the wishes of the surgeons implanting these IOLs.  Proper patient education in the rewards, possible adverse effects, and the treatments of these adverse effects are essential when planning to implant a multifocal IOL.

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