independent,
but he never promises
this as a certainty. He explains that
multifocal IOLs also have tradeoffs
to consider.
"One of those tradeoffs is that
vision in low light might not be as
good," he said. "Another tradeoff is
that there's a decent chance that the
patient will have rings or halos
around
some light." If a patient is
willing to put up with these possibil-
ities to be more spectacle independ-
ent, he or she would probably be a
good candidate for this type of lens.
Dr. Talley Rostov said it's impor-
tant to determine if the glare/halo
was present immediately postopera-
tively or occurred gradually. "If it's
something that was present immedi-
ately postoperatively and hasn't got-
ten any better, that may be someone
who needs an IOL exchange," she
said. However, if the patient was see-
ing great for the first several weeks
after surgery, it could be a posterior
capsule problem.
Different IOL types and designs
Sometimes the design of the IOL
matters with this problem, Dr. Talley
Rostov said. However, she noted that
glare and halos can occur with any
of the multifocal IOLs. She said
there are complaints of waxy or
diminished vision, especially a little
more with the ReSTOR IOL (Alcon,
Fort Worth, Texas).
She stressed the importance of
paying attention to details with
multifocal IOLs. "Multifocal IOLs are
especially sensitive to any sort of
refractive error, decentration, so it's
important to make sure all of those
things are spot on."
Dr.
Katsev said he sometimes
finds that both diffractive lenses, the
Tecnis Multifocal (Abbott Medical
Optics, Santa Ana, Calif.) and the
ReSTOR, can have issues, but these
can usually be overcome. "Correct-
ing any little refractive error helps to
solve the problem," he said. You
can't be 100% sure that the dyspho-
topsias
of multifocal lenses won't be
a problem, but you can eliminate
the patients who might have more
of a problem, he said, like those
with irregular astigmatism and engi-
neer-type personalities. "When you
have an accommodating IOL like
the Crystalens [Bausch + Lomb,
Rochester, N.Y.], you only need to
worry about edge glare and uncor-
rected refractive error," Dr. Katsev
said.
EW
Editors' note: Dr. Tipperman has
financial interests with Alcon. Dr.
Talley Rostov has no financial interests
related to her comments. Dr. Berdahl
has financial interests with Alcon
and Bausch + Lomb. Dr. Katsev has
financial interests with Bausch + Lomb,
Alcon, Abbott Medical Optics,
and Allergan (Irvine, Calif.).
Contact information
Berdahl:
john.berdahl@vancethompsonvision.com
Katsev: katsev@aol.com
Talley Rostov: atalleyrostov@nweyes.com
Tipperman: rtipperman@mindspring.com
April 2014
