Myopic Multifocal Duet Implantation For The Correction Of Presbyopia And Myopia

Due to an increasingly active lifestyle in advanced age, the desire of many patients to be spectacle independent is growing. The myopic multifocal duet procedure offers a simple and low-risk option for reversible multifocality, especially for patients with high visual demands at close distance ranges. Should it become necessary to remove the multifocal lens in the course of time, patients can retain their natural near visual acuity. This case report describes the outcome of a 60-year-old myopic and presbyopic male with an intolerance of multifocal contact lenses and the desire to be spectacle independent after cataract surgery.

Augenklinik des Klinikums der Universität München

Department of Ophthalmology, University Hospital, LMU Munich

The 60-year-old male complained about his presbyopia and his intolerance of wearing multifocal contact lenses. The refractive error of the patient before surgery was -3.75 D / -1.25 D @ 94° in the right eye with a CDVA of 0.8 decimal, and OS -2.5 D / -0.5 D @ 148° with a Corrected Distance Visual Acuity (CDVA) of 1.0 decimal. In addition, he presented a slight nuclear cataract in both eyes.

After discussion of all aspects, decision was made for the myopic multifocal duet procedure: the implantation of a monocular intraocular lens (IOL) within the capsular bag, target postoperative refraction of -2.5 D and simultaneous implantation of a sulcus fixated trifocal additive IOL to achieve emmetropia in combination with reading ability.

Six months postoperatively, the patient had a Uncorrected Distance Visual Acuity (UDVA) of 1.0 decimal in the right eye, 1.0 decimal in the left eye and a binocular UDVA of 1.25 decimal. Uncorrected Near Visual Acuity (UNVA) was 1.25 decimal in the right eye, 1.25 decimal in the left eye and binocularly 1.25 decimal. Uncorrected Intermediate Visual Acuity (UIVA) was OD 0.8 decimal, OS 0.63 decimal and binocularly 1.0 decimal, respectively.

Residual refractive error after myopic multifocal duet procedure at this timepoint was OD -0.25 D / -0.5 D @ 95° and OS -0.25 D / 0.0 D.

Our patient was very satisfied, without using any spectacles for his daily life activities.

In summary, we believe that the myopic multifocal duet procedure provides good near, intermediate, and far vision with a high degree of patient satisfaction. Sulcus fixated trifocal additive IOLs can be a good option for subjects who do not want to wear spectacles after cataract surgery. Furthermore, this technique is a potentially reversible procedure, without the loss of spectacle free near visual acuity.