Multifocal IOLs can be used in glaucoma patients with care

SAN FRANCISCO — Patients with glaucoma can be candidates for multifocal IOL implantation, but surgeons must select the patients with care, according to Richard A. Lewis, MD.

Speaking at the American Society of Cataract and Refractive Surgery meeting, Dr. Lewis said diffractive and refractive multifocal IOLs can be used effectively in glaucoma patients, but there are special considerations for these patients.

New baseline visual fields and disc images should be obtained following multifocal IOL implantation in glaucoma patients, Dr. Lewis advised. Factors to be considered in patient selection include the degree of IOP control, the presence and health of a bleb, and the proximity of visual field defects to central fixation.

Patients should be told about all considerations concerning their disease and the surgery prior to IOL implantation, Dr. Lewis said.

“Counseling the patients is important so they know what the risks are,” he said.

He said it is important to counsel glaucoma patients about the procedure because they could have unrealistic expectations. Patients should be told that the surgery will most likely reduce reliance on glasses but not eliminate them. Halos and blur may also occur, Dr. Lewis said, which may be a consideration for some patients.

“There are certain patients who like wearing glasses, especially those with night vision occupations,” Dr. Lewis said.

He noted that trabeculectomy can induce astigmatism, and this can play a “very important role” in visual results.

Exclusion criteria for multifocal IOLs include more than 1 D of corneal astigmatism, pre-existing ocular pathology and previous refractive surgery, Dr. Lewis said.

After patients are counseled and cleared for the surgery, the surgery itself must be meticulous and the IOL well centered, he said.