Multifocal Intraocular Lenses in Special Cases

Abstract

Though the use of multifocal intraocular lenses is rapidly increasing, in some cases special considerations about the efficacy, safeness, and patient’s well-being should be taken into account. Using these lenses in children can be of benefit because of the possibility for rapid rehabilitation of far, intermediate, and near vision; improved chance of binocularity; reduced risk of amblyopia; no need for bifocals; and a better self-estimation of the child. On the other hand, implanting multifocal intraocular lenses, we might reduce contrast sensitivity and intermediate vision and exacerbate amblyopia. Another special case is when treating glaucoma patients. Glaucoma patients, with no or slight visual field damage and controlled intraocular tension, may be also considered today as candidates for multifocal intraocular lens implant. However, patients with advanced glaucoma, significant visual field defects, or uncontrolled intraocular tension as well as patients with a glaucomatous damage in the other eye are not adequate candidates for this operation. As with glaucoma patients, patients that suffer from maculopathy should be carefully selected and preoperative assessed for multifocal intraocular lens implant. Some of these patients, dependent on their retinal status, will benefit from multifocal intraocular lenses. In patients that suffer from amblyopia, implanting multifocal intraocular lenses does not exacerbate amblyopia though there is a reduction in contrast sensitivity. Another situation to consider is the ocular surface health and integrity as well as the function of the lacrimal system and all its components. A healthy ocular surface is a key factor in achieving a successful result in multifocal intraocular lenses implant. Since the corneal tear film is actually the first refractive plane of the eye, its healthiness and integrity is important in reaching the aim of having the light rays uninterrupted focusing on the retina. Dry eye and ocular surface problems should be diagnosed and treated preoperatively but should not prevent multifocal intraocular lens implant and the patients to benefit from it. In treating unilateral cataract, some difficulties may arise, though bilateral multifocal intraocular lenses implant is favorable; in cases of unilateral cataract, patients gain more from these lenses compared to monofocal lenses, overcoming the reduction in contrast sensitivity. Though neuroadaptation might be more difficult or take longer even in unilateral cases, multifocal intraocular lenses implant is favorable.