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Multifocal IOL useful in patients with anisometropic amblyopia, other ocular problems
The asymmetric lens design, with two sharp foci on the same optical axis, avoids image displacement, glare and halos.
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Patients with anisometropic amblyopia or ocular pathologies who were considered a contraindication for multifocal IOLs may benefit from implantation of the Lentis Mplus from Oculentis, according to one surgeon.
“The asymmetric design of this lens, with two sharp foci on the same optical axis, avoids image displacement. When the light hits the transition zone, it is refracted outside the optical axis, minimizing glare and halos,” Magda Rau, MD, OSN Europe Edition Board Member, said in an interview with Ocular Surgery News.
New design of multifocal IOL
Unlike other multifocal IOLs, which are based on the rotational symmetry concept with concentric circles, the Lentis Mplus combines an aspheric asymmetric distance-vision zone with a 3-D sector-shaped near-vision zone with seamless transition. A toric model is also available.
Several specialists who have experience with this IOL have found that the new design broadens the indications for multifocality to several problem cases with comorbidities, such as macular degeneration, diabetes and glaucoma.
“Of course there are factors that need to be evaluated, such as age, stage of the disease and prognosis,” Rau said.
In AMD patients, the Lentis Mplus can safely be implanted when the disease is at the initial stage of maculopathy with macular drusen, when no progression has been reported for at least 1 year and the presence of edema has been excluded by optical coherence tomography.
“The patient can enjoy better intermediate vision, can deal better and faster with daily tasks, and have a more active life. It’s a huge increase in life quality, which I don’t want to deny in view of what might happen in 10 or 20 years,” Rau said.
This also applies to patients with diabetes, if they have not developed diabetic retinopathy. The Lentis Mplus, contrary to other multifocal lenses, is not an issue in retinal surgery cases because there are no concentric circles to disturb visualization.
Rau does not consider primary open-angle glaucoma, well-compensated by one or two medications and without changes in the visual field or retinal nerve fiber layer, a contraindication for implantation of multifocal IOLs in general.
“This lens is even safer as far as results are concerned, because of the absence of glare and halos,” Rau said.
An option for amblyopia
Anysometropic amblyopia is an interesting indication for the toric Lentis Mplus, according to Rau.
Many patients with anisometropia do not wear any optical correction. Spectacles are not accepted, because the brain cannot connect images that are so different in size. Contact lenses are not well tolerated, due to the high astigmatism that is often the cause of amblyopia. Excimer laser treatment is not successful considering the limitation of hyperopia to 4 D to 5 D. As a result, the worse eye is never used, and vision is very low.
Rau implanted the toric Lentis Mplus in six eyes of five patients. Preoperative best corrected visual acuity ranged between 20/200 and 20/32, refraction was between +2.5 D and +4.75 D, and astigmatism was between 1.74 D and 4.5 D.
Phacoemulsification was performed through a 2.2-mm incision. The 0° and 180° axis were marked with argon laser perilimbally, in the clear cornea. The lens was implanted using the Oculentis Viscojet injector, enlarging the incision to 2.4 mm.
“The lens can be implanted in one step, rotating the lens with a Sinskey hook and supporting it with a spatula. The implantation of the lower haptic can sometimes cause problems, and it is necessary to gently push it into the capsular bag,” Rau said.
Full correction of the astigmatism and hyperopia was obtained. A mean gain of one line of corrected visual acuity was achieved, with two patients gaining up to two lines.
“Patients were very happy. They thought they’d no longer use that eye, and now they are able to use it and even read with it,” Rau said.
“This lens works well in patients with amblyopia because the lens is customized in 0.1 D steps for sphere and astigmatism of high range, even up to the spherical equivalent of 41 D,” she said.
Rau also implanted the Lentis Mplus in two patients with keratoconus, one of whom was implanted bilaterally. The patients were older than 48 years and had stable keratoconus. Both patients are satisfied and now have 20/20 vision. – by Michela Cimberle
- For more information:
- Magda Rau, MD, can be reached at Augenklinik Cham, Cham, Bavaria, Germany, 93413; +49-99-7186-1078; email: info@augenklinik-cham.de.
Disclosure: Rau has no relevant sfinancial disclosures.