WARSAW, Poland — Steady advances in multifocal IOL technology could make monofocality obsolete in the near future, according to a speaker.
"Recent improvements and new designs have solved or minimized the problems of multifocal IOLs, and new options like the toric component, the low near power and the trifocal technology have increased the opportunities for spectacle independence," Roberto Bellucci, MD, said at the winter meeting of the European Society of Cataract and Refractive Surgeons.
A 2012 Cochrane review included 16 studies comparing multifocal vs. monofocal IOLs, for a total of 1,608 participants. Mean near acuity was shown to be significantly higher with multifocal IOLs, while distance vision was not affected and spectacle dependence was reduced by half, Bellucci said.
"Monofocal IOLs are still winners when it comes to visual quality, but multifocals are catching up with the recent improvements. Glare is worse but rarely disturbing. Part might come from [posterior capsular opacification], which should be carefully evaluated and treated earlier in multifocal-implanted eyes," he said.
Patient satisfaction still varies and should be evaluated in relation to expectations.
"These patients expect not to wear glasses at all, not to have disturbances, and to go back to the vision they had in their 20s," Bellucci said.
However, in his experience with hundreds of multifocal implants, Bellucci said the exchange rate is very low. Only five of his patients had the lens explanted, two of them due to macular degeneration.
"The opposite also occurs: I had three patients who had a multifocal IOL in one eye and a monofocal in the fellow eye and asked me to have lens exchange to have a multifocal IOL in both," he said.
Disclosure: Bellucci is a consultant to Bausch + Lomb and receives travel/research grants form Hanita Lenses and SIFI.