gms | German Medical Science

Correction of presbyopia is still a major challenge in refractive and cataract surgery. Nevertheless, refractive lens exchange with multifocal IOL has become the leading procedure for this issue over the last decade.

Implants are available with diffractive, refractive or rotationally asymmetric design and concur with other procedures like corneal inlays, excimer laser ablation and accommodating or extended depth of focus IOLs.

The advantages of multifocal IOL are: satisfying addition of ~1.7D and ~3.5D with excellent binocular visual acuity for near, intermediate and distance.

Toric IOL design is available and so the correction of astigmatism predictable.

Excimer touch up even with more sophisticated laser algorithms is possible. At least, a final solution is created: stable, lifelong refractive conditions – lenssurgery is already done.

The disadvantages are physically optical sensations (halos, glare) and reduced contrast sensitivity. Major pitfall might be the patient selection in case of unrealistic expectations or insufficient informed consent. Finally the risk of retinal detachment is still discussed controversally. Longterm complaints are the six C: cylinder, cornea, centration, capsule, cystoid macular edema, “crazy patient” -neuroadaptation is extremely individual and could end up in MIOL explantation, if there is waxy vision due to simultaneous foci.

One more thing: surgical technique (FLACS), IOL technology, as well as biometry methods and calculation formulas will get better and more accurate.