MULTIFOCAL IOL IMPLANTS

Thorough preoperative clinical evaluation and careful patient management are crucial to postoperative success with the latest generation of multifocal IOLs, according to a study presented at the annual meeting of the French Implant and Refractive Surgery Association (SAFIR) in Paris.

“Today’s range of multifocal IOLs can deliver consistently precise refractive outcomes and high levels of spectacle independence for our patients once certain conditions have been respected,” said Laurence Lesueur MD.

“In our experience, a personalised preoperative evaluation is essential to enable us to obtain the best possible outcomes for patients and to ensure that they obtain the IOL which best meets their own individual needs.”

Dr Lesueur, an ophthalmologist at Centre d’Ophtalmologie Jeanne d’Arc, Toulouse and CHU Toulouse Purpan, France, presented a four-year retrospective study of a range of IOLs – multifocal and multifocal toric lenses – implanted in 97 eyes of 49 adult patients (mean age: 64 years) between 2010 and 2014 with a minimum follow-up of three months.

Looking at the published scientific literature of over 700 publications on multifocal IOLs since 1987, Dr Lesueur said that the principal causes of failure in multifocal lenses include visual and refractive factors; ocular issues such as dry eye and posterior capsule opacification (PCO); retinal problems and glaucoma; optical factors and strabismus. The patient profile is also critically important, she said.

Excellent outcomes

Looking at the results, Dr Lesueur said that the implants delivered excellent visual outcomes for her patients, with a mean postoperative uncorrected visual acuity of 0.78 compared to 0.60 corrected visual acuity preoperatively and with a mean postoperative refraction of + 0.02 D compared to + 0.60 D preoperatively. Patient satisfaction was also very good, with a mean score of 8.1 on a scale of zero to 10.

Total spectacle independence was achieved in over 73 per cent of patients, said Dr Lesueur. YAG laser treatment was necessary in 9.7 per cent with a mean delay of 28 months for intervention. Ten patients experienced some visual symptoms (22.4 per cent); four (eight per cent) had issues with residual ametropia, two patients (four per cent) had ocular surface problems, while psychological issues occurred in two patients.

Dr Lesueur said that the overall results showed a strong correlation between patient satisfaction and spectacle independence and also uncorrected distance visual acuity. There was only a weak correlation between patient satisfaction scores and issues such as photic problems, YAG incidence, postoperative refraction and near vision.

Summing up, Dr Lesueur said that the low failure rate of just four per cent for multifocal IOLs, with no explantations required, underscored the fact that excellent outcomes can be achieved with these lenses once certain rules were adhered to.

Laurence Lesueur: lesueur.lc@gmail.com