Multifocals to mix and match that is the question?

Today at the Florida Society of Ophthalmology (FSO) meeting, I attended a presentation by Dr. R. Bucci. He shared his multifocal IOL implantation results for the Restor and Rezoom IOLs. The interesting points presented:

1) The Restor has a significant rate of patients unhappy with intermediate vision.
2) The Rezoom gives much better intermediate vision.
3) Using the Rezoom for the dominant eye and Restor for the non dominant eye appeared to have a higher rate of patient satisfaction and bifocal independence.
4) Using the Lindstrom mini RK nomogram and the Donnenfeld arcuate keratotomy nomogram rapidly, safely and effectively enhanced low levels of myopia/astigmatism in these post op patients.

It is ironic that Dr. Lindstrom was one of the first to propose mixing and matching multifocal IOLs AND developed the original mini RK nomogram. A convergence of these two techniques provides a very potent synergy for general ophthalmologist who do not want to couple the learning curve of multifocal IOLs with a moderatly steep excimer learning curve. Interestingly Dr Bucci suggested that subtle levels of prk haze might contribute to poorer quality vision in post multifocal IOL patients. Dr. Bucci also noted that it was much more difficutl to perform custom ablations on these patients as well. For speed of recovery, avoiding lasering and/or cutting the cornea (flap creation) the mini RK/AK approach to enhancing residual refractive error was his preferred method of achieving high levels of spectacle independence.

Furthermore Dr. Bucci discussed a new clinical diagnosis that he said was the key note address at the Rome OSN meeting. Apparently 4.3% of his first 300 Restor implanted patients were complaining of a waxy, shadowy, film, veil like vision effect. Noted early in the postop period, constant, independent of point light source and inability to neuroadapt are all factors in the diagnosis of vaseline vision dysphotopsia VVD.


Dr. Bucci further noted he explanted 9 of 300 of his restor group by using the McKool IOL cutter to cut the lens in half. One of the issues not being considered is the effect of intracameral cutting of acrylic intraocular lenses. At ARVO 2006 there was one abstract looking at the expression of phtalates in cut acrylic IOLs. Effects on the eye are currently unknown.

M.K. Green, S. Porbandarwalla, N. Kumar, V.L. Dougherty, C.P. Mullens, R.D. Glickman, S.B. H. Bach, and W.E. Sponsel
Can Phthlates Be Released From Intraocular Lenses?
Invest. Ophthalmol. Vis. Sci. 2006 47: E-Abstract 608.

You can read the full abstract here by searching for the above authors or key words:

http://www.iovs.org/search.dtl

The search for the perfect multifocal intraocular lens continues.

Sam Omar