Multifocal intraocular lenses and retinal diseases

Abstract

Purpose Multifocal intraocular lenses (MIOLs) are often discouraged in patients with or at risk of retinal disorders (including diabetic retinopathy, age-related macular degeneration, and epiretinal membranes), as MIOLs are believed to reduce contrast sensitivity (CS). Concerns with MIOLs have also been raised in individuals with visual field defects, fixation instability or eccentric preferred retinal locations. The aim of this study is to review the influence of MIOL on quality of vision in patients with retinal diseases. Methods We reviewed the PubMed and Web of Science databases to identify relevant studies using the following keywords: multifocal intraocular lens, cataract surgery, cataract extraction, lens exchange, diabetic retinopathy, age-related macular degeneration, and contrast sensitivity. Results Studies evaluating CS in MIOLs present conflicting results: MIOLs either did not influence CS or resulted in worse performance under low-illuminance conditions and higher spatial frequencies when compared to monofocal IOLs. Nevertheless, MIOLs preserved CS levels within the age-matched normal range. Two studies reported that patients with concurrent retinal diseases receiving a MIOL, both unilaterally and bilaterally, reported a significant improvement in visual-related outcomes. Individuals with a monofocal IOL in one eye and a MIOL in the fellow eye reported greater subjective satisfaction with the MIOL. Conclusion We were unable to find evidence suggesting that patients with retinal diseases should be advised against MIOLs. Nevertheless, more research is needed to address the aforementioned concerns and to optimize the use of MIOLs in eyes with retinal disease.

Visual outcomes after vitrectomy for epiretinal membrane in pseudophakic eyes with a diffractive trifocal intraocular lens.

“…The results of this retrospective study are similar in terms of mean gain in CDVA to those recorded in patients with monofocal IOL implants [18][19][20][21], thus mitigating one of the main concerns with respect to implantation of multifocal IOLs which is the rationale of this study and is consistent with the outcomes observed for multifocal IOL implants in eyes with other macular diseases, such as aged-related macular degeneration and diabetic retinopathy [12]. Our observation seems to be more associated with macular SD-OCT ndings in the ellipsoid zone ( IS/OS junction) recovery, as observed and discussed by Inoue and Morita [6,22].The mean UNVA results also improved signi cantly after the decrease recorded at diagnosis of ERM, which is also associated in our study with complete recovery of the ellipsoid zone.…”

“…A reduction in contrast sensitivity has been reported with diffractive trifocal IOLs [10] and many authors therefore recommend avoiding implantation of a multifocal IOL in patients with macular impairments such as ERM [11,12]. However others have reported good visual outcomes with implantation of multifocal IOL in patients with age-related macular degeneration and diabetic retinopathy [12]. One population-based prevalence study on 4439 subjects with an age ≥ 40 years has shown a 10-year incidence of ERM of 8.4% [13].…”

Selektion von Intraokularlinsen bei Patienten mit Makulopathien

“…Erkrankungen der Makula bzw. der Netzhaut stellen zwar keine absoluten Kontraindikationen für die Implantation multifokaler Intraokularlinsen (MIOL) dar [1,2]. Dennoch werden diese in solchen Fällen selten implantiert, meist weil befürchtet wird, dass Patienten, die bereits eine verminderte Sehleistung haben, durch die Multifokalität der implantierten IOL zusätzlich eingeschränkt werden [3].…”

“…Dennoch werden diese in solchen Fällen selten implantiert, meist weil befürchtet wird, dass Patienten, die bereits eine verminderte Sehleistung haben, durch die Multifokalität der implantierten IOL zusätzlich eingeschränkt werden [3]. Die durch MIOLs vermeintlich hervorgerufene Herabsetzung der Kontrastempfindlichkeit wird oft angeführt, obwohl es in der Literatur selbst bei gesunden Augen widersprüchliche Ergebnisse zur Reduktion der Kontrastempfindlichkeit durch MIOLs gibt, wie Grzybowski et al [2] berichten.…”

One-year Results of Health-related and Vision-related Quality of Life After Clear Lens Extraction and Multifocal Intraocular Lens Implantation

“…Modern surgical implantation of multifocal intraocular lenses (MIOLs) is an option for optical correction of presbyopia that exists before cataracts are present. [3][4][5] The procedure is referred to as "clear lens extraction (CLE)", and advances in this technology have enabled it to become a popular refractive procedure. [6][7][8][9][10] MIOLs can induce aberrant light perception disturbances; 11 thus, motivation to achieve spectacle freedom must outweigh the potential adverse effects.…”