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Centration of multifocal IOLs
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With the recent introduction of two multifocal IOLs to the U.S. market, the range of presbyopic IOLs has increased significantly.
 The multifocal rings of the Alcon ReSTOR IOL are seen well-centered with the pupil at a postop exam. |
We now have U.S. Food and Drug Administration approval of six presbyopic IOLs: the Advanced Medical Optics Tecnis multifocal (newly released), the AMO ReZoom multifocal, the Alcon ReSTOR aspheric +3 D add (newly released), the Alcon ReSTOR aspheric +4 D add, the Bausch & Lomb Crystalens accommodating IOL and the B&L Crystalens HD accommodating IOL. I think that there is a place for each of them, and I look forward to incorporating the newly released IOLs into my spectrum of surgical options.
With the multifocal IOLs, centration is important to maximize visual performance and image quality. This can be a challenge because the center of the pupil is not necessarily the center of the capsular bag.
In most eyes, the pupil is slightly more nasal. Intraoperatively, the IOL haptics can be positioned at the 12 and 6 o'clock meridian to facilitate nudging the IOL nasally. Under topical anesthesia, the patient can be instructed to foveate on the microscope light to help determine the visual axis. Postoperatively, the pupil can be slightly shifted by argon laser pupilloplasty as described by Eric Donnenfeld, MD. It involves using a few 500-µm spots for 500 milliseconds at a power of 500 mW placed in the iris mid-stroma to shift the pupil.
Centration of multifocal IOLs takes a bit more effort, but it can result in better visual results, which make patients happy.
Plus it looks prettier at the slit lamp, and that makes me happy.