2020–2021 BCSC Basic and Clinical Science Course™
13 Refractive Surgery
Chapter 8: Intraocular Refractive Surgery
Multifocal Intraocular Lenses
Patients are most likely to achieve independence from glasses after bilateral implantation of MFIOLs. Recent meta-analyses found bilateral MFIOL implantation associated with significant improvement in both distance and near visual acuity with each type of implant studied.
As patients age, the pupillary diameter may decrease. If the pupillary diameter decreases to less than 2.0 mm, unaided reading ability may diminish. Gentle dilation with topical mydriatic drugs or laser photomydriasis may restore near acuity. Photomydriasis may be performed with an argon or dye photocoagulator, by placing green laser burns circumferentially outside the iris sphincter, or with a Nd:YAG photodisruptor, by creating approximately 4 partial sphincterotomies.
Agresta B, Knorz MC, Kohnen T, Donatti C, Jackson D. Distance and near visual acuity improvement after implantation of multifocal intraocular lenses in cataract patients with presbyopia: a systematic review. J Refract Surg. 2012;28:426–435.
Excerpted from BCSC 2020-2021 series: Section 13 - Refractive Surgery. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.