Multifocal add-on IOLs appear of little benefit

This prospective, randomized study found only slight differences in one-year results between patients who received a standard in-the-bag multifocal IOL and those who received an in-the-bag monofocal IOL with an additional multifocal IOL in the sulcus.

The rationale for add-on multifocal IOLs is that if the patient is unhappy later, the multifocal lens can be more easily removed from the sulcus than from the bag. However, I think that the relatively low rate of patients who later require lens exchange after multifocal lens implantation will limit this method from becoming the standard of practice. 

Subjects in the study included 38 patients who received an in-the-bag multifocal IOL or an in-the-bag monofocal IOL with an additional three-piece multifocal IOL in the sulcus.

At one-year follow-up, there were only slight differences in visual acuity at all distances. All patients achieved a UDVA of 0.1 logMAR or better and an uncorrected intermediate/near visual acuity of 0.3 logMAR or better. The add-on multifocal IOL group showed slightly better results in contrast sensitivity at high spatial frequencies under almost all lighting conditions.

A slightly higher proportion of patients who received the single multifocal IOL expressed high satisfaction. A smaller proportion of patients who received an additional IOL reported disturbing light phenomena compared with those who received the single multifocal IOL. No patients decided to undergo a lens exchange during the one-year study period.

The authors write that using additional multifocal IOLs offers certain advantages, such as minimal surgical invasiveness, the time-independent reversibility of the intervention and the possibility of implanting the multifocal part of the optic independent of the primary lens exchange. More extended long-term studies with this type of lens system are in progress.