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Several factors influence IOL choice in patients with glaucoma
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DANA POINT, Calif. — There is little evidence-based data available regarding use of multifocal and accommodating lenses in glaucoma patients, but sometimes a patient insists on getting a particular type of lens, a surgeon said here.
"We have to think carefully about what to consider," Barbara Smit, MD, PhD, said at the American Glaucoma Society meeting. Physicians have two concerns, she said: "One, the patient should be able to see very well, now and in the future. And two, the physician must still be able to follow the patient's glaucoma and treat it adequately."
When considering the impact of using multifocal lenses in patients with glaucoma, the physician needs to consider the limitations of the lenses under normal circumstances and then translate those factors into the context of glaucoma. For example, Dr. Smit said that there are possible additive effects of decreased contrast sensitivity when using a multifocal lens in a patient with glaucoma.
Putting the unknown factors into context, Dr. Smit said, "There is an unknown effect of that visual field loss on the IOL performance. Concurrent zonular disease, which we oftentimes see in our pseudoexfoliative patients or other patients with glaucoma, may affect IOL centration, both initially and long-term, and by shifting where the lens is sitting, they give us a different outcome or a poor outcome."
Patients with glaucoma also may have poor pupil function, either due to pseudoexfoliative disease or the effect of medication on pupil size, as well as an increased prevalence of dry eye. They also may need filtering surgery in the future.
"With future filtering surgery, we may induce new astigmatism, we may cause a change in the axial length, and therefore the refraction of the patient, and change our outcome, or we can end up with hypotony maculopathy and so have a new macular factor," Dr. Smit said.
"In making a decision about multifocal IOLs in our glaucoma patients, we need to keep in mind the severity of the glaucoma, the likelihood of progression, the possible need for surgery in the future and the patient motivation. The patient needs to be informed of any added risk," she said.
- Disclosure: Dr. Smit reports no financial disclosures relevant to this presentation.