Causes and Correction of Dissatisfaction With Presbyopia-Correcting IOLs
Gibbons et al. assessed the causes and potential solutions for patients who were dissatisfied after implantation with presbyopia-correcting intraocular lenses (PC-IOLs). They found that the major causes of dissatisfaction were refractive error and dry eye.
The study was a retrospective review of clinical records of patients seen at Bascom Palmer Eye Institute between January 2009 and December 2013, whose primary complaint was dissatisfaction with visual performance after PC-IOL implantation (74 eyes of 49 patients). A single treating physician determined the probable cause of dissatisfaction and the intervention to address it.
The most common cause of dissatisfaction was blurred or foggy vision for both distance and near (68%). The authors attributed most of these complaints to residual refractive error (57%) or dry eye (35%). The most common interventions were management of residual refractive error with glasses or contact lenses (46%) and treatment for dry eye (24%). Corneal laser vision correction was performed in 8% of eyes, and 7% of eyes required an IOL exchange. After the interventions, 45% of patients had complete resolution of symptoms; 23% were partially satisfied with the results; and 32% remained completely dissatisfied.
The authors noted that most patients who undergo PC-IOL implantation are satisfied with the results. They concluded that the best ways to avoid patient dissatisfaction are 1) education on the risks and benefits so that patients will have reasonable expectations about outcomes, 2) aggressive identification and treatment of ocular surface disease, 3) selection of an appropriate refractive target, and 4) avoidance of patients with significant preexisting pathology.
The original article can be found here.