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PUBLICATION EXCLUSIVE: Multifocal IOLs: Patient selection and optical performance

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Multifocal IOLs have slightly less than 5% of the market in the U.S., which has been constant for the past 5 years. Yet, there are practices that implant in excess of 90% of their cataract surgery patients with multifocal IOLs. How is this disparity possible?

In this article we will discuss objective and subjective patient selection criteria as well as the optical performance of multifocal IOLs.

In successful practices with high conversions to multifocal IOLs, the staff assesses the patient’s suitability for a multifocal IOL, from the front desk and ophthalmic assistant to the insurance interview and surgeon. The staff spends more time with the patient and is usually very good at giving a rating that is useful to the surgeon during his discussion of IOL options. A questionnaire developed by Steven Dell, MD, is also helpful in assessing a patient’s needs and how the patient rates himself on a scale from “easygoing” to “perfectionist.”

Multifocal IOLs have approximately a 30% loss of contrast sensitivity (0.2 log units or 2 dB) and a decrease of slightly less than one line of best corrected visual acuity (0.1 logMAR), which is usually from 20/16 to 20/20. This slight decrease in optical performance is minimal and rarely clinically significant; it is the presence of halos and glare at night or low light levels that can cause a problem. If these “observations” (not “symptoms”) are tolerable, then the patient will be a success. The only treatment for an unhappy patient is lens exchange, and most surgeons consider this catastrophic, hence the low market share. Identifying the successful patient correctly is by far the most important factor with these IOLs.

There are occupations that make multifocals inadvisable — airline pilots, truck drivers, taxi drivers, astronomers and anyone whose job requires activity at night or low-light conditions. These people are not good candidates for multifocal IOLs because they are continually reminded of the halos and glare and have difficulty performing their jobs.

• Click here to read the full publication exclusive, Clinical Optics 101, published in Ocular Surgery News U.S. Edition, February 10, 2017.