Exchanging multifocal IOL optic design proves successful in study
MARRAKECH, Morocco — When neuroadaptation fails, exchanging a multifocal IOL with another multifocal IOL is possible, provided that a different type of optic design is used, according to one speaker.
“The classic solution is IOL exchange with a monofocal lens, but this is inevitably perceived as a failure. Surgery was primarily intended to achieve good vision at all distances and possibly spectacle independence, and this is not achieved,” Jorge L. Alió, MD, PhD, said at the European Society of Cataract and Refractive Surgeons Winter Meeting.
He believes that multifocality should be given a second chance, using a diffractive optic when a refractive optic was previously implanted and vice versa. In a study, he showed that this approach leads to successful outcomes and that neuroadaptation occurs naturally with the new lens.
“Neuroadaptation is a difficult process, and when it fails it becomes a major cause of dissatisfaction. Patients complain of unsatisfactory VA, discomfort, dysphotopsia, blurred vision at specific working distances or even for far, decreased [contrast sensitivity], bad quality of vision, photic phenomena and other unexplained visual phenomena such as distortions. In these cases, there is not much else to do but exchange the lens,” Alió said.
In a study, he analyzed the outcomes of 43 eyes of 25 patents who underwent IOL exchange with another multifocal IOL. Reasons for dissatisfaction were blurred vision in the majority of cases, followed by photic phenomena, insufficient near vision or monocular diplopia in a small number of cases. An approximately equal number of diffractive and refractive IOLs were explanted. Refractive IOLs were exchanged with diffractive IOLs and vice versa. Extended depth of focus lenses were regarded as diffractive.
Although no significant change was seen in spherical equivalent, binocular uncorrected and corrected distance visual acuity improved significantly and so did the frequency and severity of photic phenomena. The number of satisfied or very satisfied patients increased from 33% to 83%, and the number of patients who said they would have surgery again increased from 20% with the first lens to 90% with the newly implanted lens.
“Our successful outcomes in IOL exchange using a different multifocal technology indicates that different multifocal IOL profiles activate different neuroadaptation pathways. These findings encourage us to do further research into the mechanism of neuroadaptation with multifocal IOL surgery,” Alió said. – by Michela Cimberle
Alrabiah H, et al. Treatment of neuroadaptation failure following multifocal IOL implantation by multifocal IOL optical exchange: an update in clinical outcomes and patient satisfaction. Presented at: European Society of Cataract and Refractive Surgeons Winter Meeting; Feb. 21-23, 2020; Marrakech, Morocco.
Disclosure: Alió reports he is a clinical investigator for Oculentis and Zeiss.