Lens and Glaucoma
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Patients who have glaucoma already have a reduction in contrast sensitivity. I discourage my glaucoma patients who have any kind of visual field loss from getting a multifocal lens. Trubnik, Dr. Okeke, and Dr. I think these lenses are great for glaucoma patients who have mild to moderate severity. Sarkisian said. If the patient has 0.
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Sarkisian said he will offer arcuate incisions with the femtosecond laser or a toric IOL for those with 1 D or more. Okeke agreed, expressing that toric IOLs can play a role for patients with even advanced glaucoma. He had toric lenses in both eyes, and he was happy as can be because he had the ability to see at long distances and be free of glasses doing an activity that he enjoyed.
For Dr. If a patient understands that, I definitely go along with the procedure, and I have not had any issues. Trubnik said she has not implanted toric IOLs in patients with tube shunts because their visual potential is generally not great to begin with. Sarkisian said any of the MIGS procedures that unroof the trabecular meshwork carry the risk of hyphema, thus he would avoid premium lenses in these patients as well. Sarkisian, Dr.
Trubnik, and Dr. Okeke mentioned discussion in the glaucoma community about CyPass resulting in transient myopic shift. Sarkisian said he was involved in the CyPass trials and has been implanting them since FDA approval with only three such cases; two of the cases resolved on their own, and in one case he had to plug the CyPass with a Prolene suture. Okeke expressed a similar sentiment. Sarkisian said though a rare event, he tends to shy away from using the CyPass in patients getting bilateral Symfony lenses.
From a refractive standpoint, Dr. Sarkisian said some ophthalmologists involved in tertiary care of glaucoma patients might not be used to having conversations about premium lenses, but they should start. I think that you would not benefit from those, and they may actually make your vision not the highest quality that I can offer you. Trubnik provides a similar explanation and tells the patient that she is trying to do what is in their best interest.
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References 1. Ichhpujani P, et al.
Premium IOLs in glaucoma. They direct the light at the same time toward the two near and distance foci.
Apodized optics, such as the AcrySof ReSTOR Alcon , integrate the two technologies and reduce photic phenomena because of a more gradual transition to the two points of focus. Apart from photic phenomena, a major drawback of multifocality is that the distribution of light to several refractive points results in loss of contrast.
The amount of filtration, the presence of a drainage implant, a noncentered pupil, the anatomical changes of the anterior chamber and, potentially, the astigmatism induced by cataract surgery could alter the performance of the multifocal IOL in an unpredictable way. Biometric calculation, which is so important in the outcomes of multifocals, is likely to be imprecise and misleading, Dr.crysguzztertioscuflunch.ml
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No negative impact seems to be produced by these lenses on the performance of routine follow-up examinations, such as ocular fundus, optical coherence tomography and GDx Carl Zeiss Meditec , which are crucial for monitoring the progression of the disease. Multifocal lenses should be avoided in patients younger than 60 years, particularly when contrast sensitivity is already reduced by the disease and when visual field is already altered.
They should not be used in patients who have already undergone filtration surgery, and also in view of a possible filtration surgery, to avoid refractive surprises.
They should not be implanted when combined filtration and cataract surgery are performed because of the potential mistakes with biometric calculation and the induced astigmatism that would jeopardize their performance, Dr. They can be considered only in a few cases of early, nonprogressive, well-stabilized glaucoma in elderly patients with no signs of macular degeneration.
Multifocal implants should be used in glaucoma patients with caution. My view is that they are not entirely contraindicated, as the majority of patients with glaucoma have a mild form of the disease that is well-controlled, and denying them the potential benefit of multifocality is not appropriate. However, in patients with advanced or unstable disease, caution needs to be exercised. Glaucoma with co-existing cataract is a common scenario. The range of available options has tremendously increased with premium IOLs, and patients need to be offered the best feasible opportunities.
There is a lack of high-level evidence in this field, and we need further research. For the time being, decisions have to be individualized to each patient.
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