Candidate selection is vital
Good patient selection is the key to both surgical success and patient satisfaction.
“For some ophthalmologists, ‘premium lens’ just means one thing, a multifocal lens,” Dr. Lewis said. “The premium lens category also includes aspheric lenses, accommodating lenses, and toric lenses. The bottom line is doing what is best and safest for the patient.”
Simply moving from a spherical IOL to an aspheric lens can improve contrast sensitivity by 25%. The improvement is especially notable in nighttime situations where high contrast is the norm.
Multifocal IOLs cause a decrease in contrast sensitivity, especially for refractive—rather than diffractive—lenses.
Multifocal IOLs also degrade the visual image by consolidating multiple focal points.
Patients often ask for multifocal lenses to maximize their freedom from glasses after surgery. As long as the visual field is intact, multifocal image degradation is no more of a problem in the setting of glaucoma than in non-glaucomatous eyes.
For patients with more advanced glaucoma and who have already suffered visual field loss, multifocal lenses are probably not the ideal choice, Dr. Lewis said.
Patients with intraocular hypertension but no field loss may be candidates for a multifocal IOL, but multifocal IOLs should generally be avoided in patients with glaucoma who have cupping and/or visual field loss.
Toric and accommodative IOLs do not induce a loss of contrast sensitivity, Dr. Lewis noted, which gives them an advantage in visual acuity over multifocal lenses. For most patients with glaucoma, a toric IOL is probably the best overall choice to maximize the refractive correction.
“The toric lens manages astigmatic needs,” Dr. Lewis explained. “Glaucoma patients may have astigmatism naturally or from a previous glaucoma surgery. There are a few contraindications, but the vast majority of patients with glaucoma are good candidates for a toric lens.”