Take-home: When dealing with patients with retinal disease, macular disease, or a meaningful risk of retinal detachment, certain types of IOLs should be avoided due to potential complications.
For routine cases, cataract surgeons should choose whatever type of intraocular lens (IOL) they prefer for their patients. However, in patients with retinal disease, or a risk of retinal detachment, certain IOLs should be avoided due to their potential complications.
Timothy W. Olsen, MD, discussed the selection of the type of IOLs that surgeons should use for such cases–from a retina surgeon’s perspective. Dr. Olsen is professor of ophthalmology, chairman emeritus, Emory University, Atlanta.
In routine cases with no retinal disease, or in low-risk eyes, cataract surgeons should choose the lens they feel best meets the patient’s need. However, when there are risks of retinal disease, retinal detachment, such as in high myopes with extensive lattice degeneration, macular disease, or a strong family history of macular disease, certain types of IOLs should be avoided due to association with problems in certain conditions.
IOLs that should be avoided include silicone, multifocal, or hydrophilic acrylic lenses. In general, retina surgeons are aware that plate-style lenses are more likely to dislocate into the posterior segment.
Dr. Olsen explained that silicone lenses are not a good choice if the patient may need retina surgery in the future. These lenses can make vitreous surgery difficult by limiting visibility, and the lens may need to be explanted. Further, silicone oil adheres to these lenses and diminishes the patient’s quality of vision.
In patients with maculopathy, or potential for macular disease, multifocal IOLs are a concern. These patients carry a higher risk of being unhappy with the quality of their vision. The reason for this is not yet known.
“It may be due to a reduced level of contrast sensitivity in some cases and exaggerated metamorphopsia in cases of epiretinal membranes or with macular edema,” Dr. Olsen suggested.
Hydrophilic acrylic lenses have a risk of opacities from calcification that may necessitate lens replacement. If a patient receives an anterior segment or posterior segment gas bubble in a future procedure, that can induce a calcification process and opacification in these lenses.