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Mixing and matching multifocal IOLs has advantages over using a single lens, surgeon says
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BARCELONA — Implanting a different multifocal IOL in each eye of patients after cataract surgery may be the better approach to using such lenses for correcting presbyopia, particularly in patients who desire good intermediate vision, according to a surgeon speaking here.
At the European Society of Cataract and Refractive Surgeons Winter Refractive Surgery meeting, John Chang, MD, said that since the end of 2003 he has implanted 500 eyes with multifocal IOLs. Half were Tecnis IOLs (Advanced Medical Optics); the rest were about equally distributed between the Array (AMO), ReZoom (AMO) and ReSTOR (Alcon).
"As we know, all these lenses are good, but [they] also have limitations. With bilateral diffractive lenses, patients have good distance and near [vision] but poor intermediate vision. With bilateral refractive lenses, patients have fairly weak near vision," Dr. Chang said.
"But by implanting a diffractive lens in one eye and a refractive lens in the other eye, the best of both worlds can be achieved," he said.
Dr. Chang's strategy for using multifocal IOLs involves a two-step approach, which begins with determining patients' predominant activities of their day-to-day lives.
"In patients who read a lot, I implant a diffractive lens in the nondominant eye. If they are happy with their near vision, I offer a refractive IOL in the dominant eye to give them better distance and some intermediate vision for computer work," he said.
"If they are not satisfied with their near vision, I implant a diffractive [IOL] in the dominant eye," he said.
Conversely, in patients who predominantly drive and use computers but do not frequently read, Dr. Chang implants a refractive lens in the dominant eye.
"If they complain of poor near vision, I offer a diffractive lens in the other eye," he said.
Dr. Chang has treated 27 patients so far with the mix-and-match approach. All patients tolerated the different lenses well and had a fairly high degree of satisfaction, with only minor complaints of night vision disturbances, he said.
No patients require spectacle correction for distance vision, 95% read and use computers without needing spectacles, and the remaining 5% use spectacles only occasionally, he noted.