More patients may be candidates for multifocal IOLs than anticipated

Cataract surgery patients with a healthy eye suitable for a multifocal IOL should be offered that option in preoperative counseling, said Kenneth J. Rosenthal, MD, a private practitioner in Great Neck, NY.

Dr. Rosenthal said that when it comes to deciding who are good candidates for a multifocal implant, he differs from conventional "wisdom," which primarily considers lifestyle factors and patient motivation for spectacle independence.

"Most patients cannot intuit how fantastic it is to be spectacle-independent after cataract surgery, and our experience has been that every patient who receives a multifocal IOL is ecstatic beyond what they anticipated, even if they were indifferent before surgery," Dr. Rosenthal said.

Thorough counseling about all pseudophakic IOL options and extensive evaluation to identify any subtle problems that may affect outcomes involves a significant time commitment. Ultimately, it is the patient's decision on which implant to receive.

For those who select the multifocal implant, a successful outcome also involves comprehensive preoperative diagnostic testing, meticulous surgical technique, and postoperative counseling that focuses on enhancing adaptation.

"There is tremendous variation in how quickly multifocal IOL patients adapt, but we tell them it can take several months and up to 1 year," Dr. Rosenthal said. "However, nonadapters are rare if we follow the strategies outlined for achieving success after multifocal IOL implantation."