Limits for the indication of multifocal lenses based on the contrast sensitivity function

Abstract

SummaryMultifocal IOLs are more often responsible for lower contrast sensitivity (CS) than monofocal IOLs, especially in mesopic light conditions. Thus, multifocal IOLs are contraindicated in many ocular diseases, which are characterized by decreased contrast sensitivity function. They included irregular astigmatism, Fuchs dystrophy, and many retinal diseases affecting macular function like retinitis pigmentosa, Stargardt disease, diabetic retinopathy, age‐related macular degeneration, epiretinal membrane, and many optic nerve disorders. IOL decentration and tilt lead to decreased contrast sensitivity, aberrations, and ultimately decreased visual acuity, thus zonular weakness, esp. when severe, should be regarded as absolute or relative contraindication to choosing a multifocal IOL. Since contrast sensitivity is found to be most affected in eyes with aberrations and implanted multifocal IOLs, increased aberrations are relative contraindications for multifocal IOL implantation. It was proved that patients with the aspheric multifocal IOL had significantly better contrast visual acuity than patients with the spherical multifocal IOL.