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Surgeon: Customize multifocal IOL use based on patients' needs, lifestyles
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ROME — Because diffractive and refractive multifocal IOLs have different optical properties, use of such lenses — either alone or combined — should be based on patients' individual needs, according to a surgeon speaking here at the OSN Rome Symposium.
 Michael C. Knorz |
In addition, careful patient selection is crucial for achieving good results with multifocal IOLs, noted Michael C. Knorz, MD.
According to Dr. Knorz, there are basically three types of multifocal IOL patient candidates.
"The first is 'the golf player,' a patient with predominantly distance vision tasks who occasionally uses a laptop and rarely reads a book," he said. "This patient will have best results with a distance-dominant IOL, such as the ReZoom (Advanced Medical Optics) in both eyes, and may require glasses for reading."
He described the second type of patient as "the librarian," someone who rarely drives at night and rarely uses a laptop, but who spends several hours reading books each day.
"A diffractive multifocal IOL like the Tecnis (AMO) in both eyes is the best option," he said. "[Near] vision will be perfect in any lighting condition [and] distance vision is still good, while intermediate vision is somewhat reduced."
However, most patients are in between these two extremes and want the best possible vision for a variety of tasks, including reading, driving, playing golf and using a laptop. For these patients, mixing and matching IOLs is the best option, Dr. Knorz said.
"They should receive a refractive multifocal IOL like the ReZoom in the dominant eye and a diffractive multifocal like the Tecnis in the nondominant eye," he said.
Ideal candidates for multifocal IOLs include all presbyopic hyperopic patients, followed by patients with 6 D or more of myopia and patients with both presbyopia and cataract, he noted.
"When in doubt, test the patients preoperatively with multifocal contact lenses," he added.
For surgery, Dr. Knorz prefers to operate the patient's dominant eye first, implanting a ReZoom IOL and then asking the patient to evaluate his near vision after surgery.
"If they are happy with their near vision, I implant a ReZoom also in the second eye. If they are not [happy], I implant a Tecnis," he said.
Because multifocal IOLs only work if the patient achieves emmetropia, laser vision correction can be performed to treat residual refractive errors, he said, noting that multifocal IOL implantation and customized laser refractive surgery can be offered as a package to selected patients.
The OSN Rome Symposium is a meeting held jointly by Ocular Surgery News, the Italian Association of Cataract and Refractive Surgery and the Italian Society of Ophthalmology.