A diverse patient population with high preoperative expectations about multifocal intraocular lenses (IOLs) report excellent visual outcomes and high rates of postoperative satisfaction, according to findings published in Clinical Ophthalmology. In addition, researchers conclude that glare and other visual phenomena may not be as troublesome with new multifocal lenses as previously reported.

An increasing number of patients expect a high degree of improvement in their vision, and a reduced dependence on their glasses after multifocal IOL implantation. Investigators prospectively collected data from 67 patients (134 eyes) who underwent bilateral AcrySof IQ PanOptix® (Alcon) implantation to determine if anticipated results match actual outcomes. Patients completed a questionnaire regarding vision satisfaction, visual phenomena, and expectations before surgery. 

After surgery, patients’ unaided distance vision was 20/20 (0.01±0.10) and binocular near vision 20/25-2 (N5; 0.14±0.06). The portion of patients who said they were satisfied with their vision increased from 6% (n=4) unaided and 48% (n=32) aided preoperatively to 94% (n=63) unaided post-operatively (P <.001). There was no difference in satisfaction or residual astigmatism in those implanted with toric lenses (66% of all lenses). 


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The study shows a significant increase in the frequency of halo, from 14% (n=9) to 69% (n=46; P <.001); however, it, finds no corresponding increase in how bothersome patients found this symptom (P =.193) or the frequency of other visual phenomena. Most patients (96%; n=64) were spectacle-free at 3 months and said they would recommend this procedure to others. Not surprisingly, worse postoperative vision and fluctuating vision were associated with lower postoperative satisfaction. 

“The established thinking regarding the extent to which multifocal IOLs are associated with troubling visual phenomena should be revisited with new lens designs,” the study says. “As expectations and the range of patients considered for multifocal IOLs continue to expand, the clinical judgment of the surgeon in patient and lens selection remains as important as ever in delivering a satisfactory outcome.”

While a preoperative questionnaire may help identify patients who may be dissatisfied after multifocal IOL implantation, investigators say they had trouble identifying the preoperative characteristics that can best predict postoperative satisfaction. 

Limitations of this study include a patient cohort that had already been screened for multifocal IOL suitability, not measuring clinical parameters using tools specifically designed for research, the relatively short follow-up time, and administering the 3-month questionnaire to patients by phone instead of allowing them to complete it on their own.

Reference

Ison M, Scott J, Apel J, et al. Patient Expectation, Satisfaction and Clinical Outcomes with a New Multifocal Intraocular Lens. Clin Ophthalmol. Published online October 13, 2021. doi:10.2147/OPTH.S327424.