Screen patients before doing refractive lens exchange, physician advises

THOROFARE, N.J. — Refractive lens exchange with a multifocal IOL can offer substantial benefits to patients with high hyperopia, presbyopia or developing cataracts. But patient selection is important, according to I. Howard Fine, MD.

Patients with high myopia are not suited for refractive lens exchange because they have a higher incidence of retinal detachment, Dr. Fine told Ocular Surgery News. Those who are unsure about the procedure are also not good candidates, he said.

Patient education is also important before performing lens exchange, he added.

“The major concern we have are halos around point sources of light. It requires notifying the patient that it is a possibility,” Dr. Fine said. Most of the time, he said, both glare and halos resolve within a few months and are no longer a problem.

Another education issue is the possibility the patient will need postop spectacle correction. In Dr. Fine's practice in Eugene, Ore., 44% of his patients never need to wear glasses, 44% wear them upon occasion and 12% need to wear them most of the time.

Although monofocal lenses can have small amounts of posterior capsular opacification and still function well, Dr. Fine said multifocal IOLs are less tolerant of PCO.

“Very small amounts of PCO will degrade the quality of the image, and patients will drop in their visual acuity. If you think it can't be the capsule because you've seen monofocal lenses with that amount of opacification and no impact on vision — it is the capsule,” he said.

More details of Dr. Fine's technique will be published in the May 15 Ocular Surgery News U.S. print edition.