Selection of Intraocular Lenses for Patients with Maculopathies

Abstract

Multifocal intraocular lenses (MIOLs) may bring independence from glasses. In practice the question often arises as to which patient would be suitable for the implantation of MIOLs. Surgeons are hesitant to implant MIOLs in patients with macular or retinal pathologies, mostly due to a fear that the multifocality of the implanted IOL might increase patients' existing visual handicap. In this study we use virtual implantation to determine how various multifocal intraocular lens designs impact visual performance in the presence of macular pathologies. 17 pseudophakic normal eyes (group 1) and 13 pseudophakic eyes with retinal maculopathologies (group 2) and lower visual acuity were included in this study. We analysed best-corrected distance visual acuity (BCDVA), near- and distance-corrected near visual acuity (DCNVA) and contrast sensitivity (CS) while the patients were looking through the VirtIOL optical simulator to virtually experience vision through implanted intraocular lenses (IOL). Three different IOL types: aspheric monofocal, EDOF (extended depth of focus) and diffractive trifocal were tested. Comparisons were made between the different IOL types and between groups 1 and 2. Group 2 had lower visual acuity and also lower CS than group 1. The benefit from the multifocal IOLs was seen as a significantly increased DCNVA over the monofocal IOL. This was demonstrated in both groups: increases of 0.29 logMAR and 0.39 logMAR in DCNVA with EDOF- and trifocal IOL in group 1, respectively, and increases of 0.17 logMAR and 0.25 logMAR in DCNVA in group 2, respectively. However, at lower spatial frequencies of 3 cpd, CS was reduced in both groups compared to monofocal IOL. For the visual functions tested here, MIOLs are a viable option for patients with maculoretinal pathologies or previous retinal surgery to support their wish for independence from glasses. Although their visual performance is limited, they can still benefit from MIOLs with improved reading performance without near addition.