Right lens for right patient
The key to implanting multifocal lenses is matching the right lens to the right patient, he said. Too many ophthalmologists are not familiar enough with the optical differences between the two lens types to explain them. Others use technical language that may be correct but makes no sense to patients who are unfamiliar with optics.
“We show our patients possible photopic phenomena and show the defocus curves of the different IOLs and let them make the choice,” Dr. Breyer said. “I ask about their jobs, their hobbies, their family life, how they like to read, and in what kind of setting. We use simulation software to show them just what halo and glare look like in four categories–none, mild, moderate, and severe (see Image 2). They know they will have to make a compromise and they know what the different compromises will look like after surgery.”
It is impossible to predict post implant photopsia precisely, Dr. Breyer added, but vision around age 30 can be a good guide. Patients who report no halos and glare while they were driving at night at age 30 will have mild halos and glare. Patients who had mild or moderate problems at age 30 are more likely to have severe halos and glare with a refractive IOL.
“Many of the problems with multifocal IOLs occur because too many doctors implant whatever IOL they just heard about,” Dr. Breyer said. “They do not realize they are free to implant the right multifocal IOL for the right patient. When we individualize the lens choice to the patient, we have much better results.”