SAN FRANCISCO — Patients who have received a multifocal lens may be in need of further refractive error correction, and with many multifocal lenses entering the market, this is something refractive surgeons should be aware of and prepared for, as well as discuss with patients, according to a speaker here.
“With all these lenses, it’s absolutely critical to correct residual refractive error,” Scott M. MacRae, MD, said at refractive Subspecialty Day at the American Academy of Ophthalmology annual meeting. “When I look at these patients, I look at whether these patients are 20/happy or 20/unhappy. If they’re 20/happy, they see well at distance, intermediate and near. If they’re 20/unhappy, then I go ahead and look at the residual refractive error and we try to correct that.”
Secondary procedures are needed in a disproportionate 10.8% to 25% of eyes implanted with multifocal lenses, he said.
Most commonly, LASIK or PRK are the best options for correcting residual error, and MacRae recommends surgeons who implant a lot of multifocal or premium IOLs to anticipate the need to perform enhancements.
“Understanding the optics is absolutely critical in this,” he said.
This includes using corneal topography, looking at the ocular surface and evaluating manifest refraction, he said.
Most importantly, MacRae believes this is a conversation to be had with patients before their IOL implantation.
“You want to have that discussion about going back and doing post-IOL refinement before the procedure,” he said. “If you don’t, it’s perceived as a treatment failure, but if you talk about the retreatment before the procedure, it’s an anticipated refinement.” – by Rebecca L. Forand
MacRae SM. Modulating the cornea in patients who are off target with refractive IOLs. Presented at: American Academy of Ophthalmology annual meeting; Oct. 11-15, 2019; San Francisco.
Disclosure: MacRae reports no relevant financial disclosures.