Would you recommend a multifocal IOL for another eye doctor?

If I were a hyperope who had never worn glasses before my 40s and now needed bifocals, I would definitely have a MF IOL. I personally had RK in one eye and -6.5 D. of myopic LASIK in the other, so by the same standards I use on selecting patients, I would not be a very good candidate for a MF IOL. The thing is: There is no ONE best IOL. The different pros and cons of each IOL must be matched to a particular patient's needs.

From my Psych background: A sensorium is the sum of an organism's perception, the "seat of sensation" where it experiences and interprets the environments within which it lives.

In my experience, people whose sensorium has been shaped over decades by their refractive error feel that not only is it "normal" for them, but that it is the normal sensory state for everyone else. It is a rare presbyopic myope who knows he IS presbyopic, just like his friends who wear reading glasses. A very intelligent -3 myope can be told he will lose his uncorrected near vision and understand it intellectually, but still not "get it." I find I must show them with a handheld -3 lens, directing their attention to the distance eye chart, then the reading card. A verbal transfer of information from doctor to patient is often not sufficient because we are dealing with sensory data, not symbol manipulation (language).

A low-to-moderate hyperope has had >20/20 visual acuity all through his life (that is where the "hyper-" comes from) so losing that distance visual performance on top of having lost near vision is usually as devastating as it is unexpected. [I like Marc's "hyperopia as a disease" aphorism.] This patient is going to be far more forgiving of halos at night or whatever undesirable optical side-effects he may experience. And yet he may have the exact same refractive outcome post-IOL as his myopic friend who is now unhappy.

This is one reason I have lost much faith I once had in the Real World applicability of our "numbers" oriented analysis of outcomes: those numbers do not reflect the change in sensorium that can be significantly different from patient to patient . Satisfaction with results is always going to be a trade-off between what is gained and what is lost visually as compared to what a person has come to assume is "normal."


Written by J. Trevor Woodhams, M.D. - Chief of Surgery, Woodhams Eye Clinic

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