Adverse Effects, Complications, and Patient Dissatisfaction With Multifocal Intraocular Lenses
Patient concerns after MFIOL implantation can generally be divided into 2 categories: blurred vision and photic phenomena (glare, halos). Patients may experience both groups of symptoms. These symptoms can occur even after uneventful surgery with a well-centered MFIOL.
Patients with MFIOLs are more likely to have significant glare, halos, and ghosting than are patients with monofocal, toric, or accommodating IOLs. These issues stem from a variety of different etiologies, including residual refractive error, ocular surface disease, or intrinsic IOL problems. The reports of halos intrinsically related to the IOL tend to subside over several months, perhaps from the patient’s neural adaptation, but they may be persistent. Because of a reduction in contrast sensitivity, the subjective quality of vision after MFIOL insertion may not be as good as after monofocal IOL implantation. The trade-off of decreased quality of vision in return for reduced dependence on glasses must be discussed fully with the patient preoperatively. With MFIOLs, intermediate vision may be less clear than distance or near acuity.
Some patients never adapt to MFIOLs and require IOL exchange to recover vision. All patients should be counseled as to this possibility before surgery. Patients with MFIOLs appear to be more sensitive to posterior capsule opacification (PCO) than are individuals with monofocal IOLs. These patients benefit from Nd:YAG capsulotomy; however, tolerance of the MFIOL must be determined before undergoing the Nd:YAG capsulotomy, as an open posterior capsule significantly complicates IOL exchange. Intrinsic IOL symptoms usually appear very early if not immediately in the postoperative course and do not generally worsen over time. In contrast, symptoms from PCO are not present initially but gradually worsen over the first few weeks to months after the surgical procedure.
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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.