Multifocal IOLs can provide good vision for adult anisometropia

This prospective study found that implantation of the Lentis Mplus multifocal IOL can provide excellent binocular visual and refractive outcomes in adult patients with mild to moderate anisometropia and no strabismus. This keeps us aware that anisometropic amblyopes often have surprisingly good vision after cataract surgery that resolves asymmetry.

Subjects were 14 consecutive adult patients with anisometropic amblyopia and no strabismus who underwent bilateral MPlus multifocal IOL implantation with a +3.0 D reading addition.

At 12 months postop, all IOLs were well-centered in the capsular bag with good near and distance visual results and a mean spherical equivalent of -0.02 D. On average, amblyopic eyes achieved 1.5 lines less vision than nonamblyopic eyes. Two patients required a neodymium:YAG laser capsulotomy for posterior capsule opacification. Two patients had surface laser retreatment for residual refractive error. No glare or halos were reported; one patient had mild starburst symptoms at one year.

Bilateral reading speeds surpassed unilateral nonamblyopic eye speeds. Mean Quality of Vision scores improved from 7.78 to 1.92.

The authors note that depth of stereopsis was not directly related to visual acuity. One patient with 120 degrees of stereopsis achieved only 0.3 logMAR CDVA in the amblyopic eye compared with three patients with less than 480 degrees stereopsis who achieved 0.2 logMAR CDVA. This information may assist in preoperative case selection and counseling and implies that poorer visual acuity does not exclude binocular functional improvement in reading speed.

They conclude that with the small numbers involved, it is difficult to draw strong conclusions from this finding other than to emphasize the high early acceptance and high percentage of amblyopic patients with good near vision in this group.