Patients adapt to complementary presbyopia-correcting IOLs, surgeon finds

NEW YORK — Implanting different optical lens system in each of a patient's eyes can produce a complementary effect and lead to increased depth of focus or improved visual function, according to Richard L. Lindstrom, MD.

"It is really nothing new, but it does require some level of neural adaptation," Dr. Lindstrom said. "My experience is that 100% of patients neuroadapt, and I haven't really found this to be an issue."

Dr. Lindstrom, OSN Chief Medical Editor, discussed the available options for "custom matching" IOLs in a presentation at the OSN New York Symposium.

There are numerous options for ophthalmologists to consider for customized mixing and matching of IOLs, he said. Lens design options include standard monofocal, aspheric monofocal, accommodating and a number of multifocal designs, including zonal aspheric, aspheric diffractive and apodized diffractive/refractive models, he said.

"It's important to understand the strengths and weaknesses of each of the lenses we have," Dr. Lindstrom said. "If we do, I think we can use them properly in a complementary fashion for our patients."

The human visual system, which includes parts of the brain, can adapt to receiving dissimilar optical information from two eyes, he said.

"I think we have known that from years of experience with monovision," he said. "If you do these [combination] systems, whichever you choose, appreciate that neural adaptation does need to occur."

Dr. Lindstrom recommended advising patients to wait at least 1 year after implantation before seeking a lens removal or exchange.

"My long-term experience is that almost no one requests an implant removed once they get out beyond 18 to 24 months," he said.