Multifocal IOL exchange

Fixing neuroadaptation

Multifocal IOL exchange with different optics can remedy neuroadaptation failure. Roibeard Ó hÉineacháin reports

Patients with failed neuroadaptation to multifocal IOLs might achieve high satisfaction through exchange with a multifocal IOL with optical characteristics different in the optical profile to the one implanted more suited to their needs, said Prof Jorge Alió MD, PhD, Miguel Hernández University and Vissum Miranza, Alicante Spain.

A series of 43 eyes of 25 patients who failed in their neuroadaptation to previously implanted multifocal IOLs had high levels of satisfaction and significant improvements in uncorrected and best-corrected vision, after exchange of a diffractive multifocal IOL with a refractive multifocal or vice versa, Prof Alió told the 24th ESCRS Winter Meeting in Marrakech, Morocco.

Residual refractive error was excluded as the reason for dissatisfaction in all cases prior to the diagnosis of neuroadaptation failure. Among the explanted IOLs, 42% were refractive multifocals, 21% were diffractive multifocal, 21% were Precizon presbyopic lenses and 16% were EDOF lenses. Of the implanted IOLs, 42% were refractive and 58% were diffractive. The reasons for exchange included photic phenomena in 23%, blurred vision in 61%, insufficient near vision in 8% and monocular diplopia in 8%. The mean time from the initial implantation to multifocal IOL exchange was nine months.

The multifocal IOL exchange procedures were successful in all cases with no significant complications, Prof Alió said.

After a mean follow-up of 2.9 months, the mean uncorrected distance visual acuity (UDVA) improved significantly from 20/35 to 20/26 after the exchange(p=0.001). The corrected distance visual acuity (CDVA) improved from 20/27 to 20/21 (p=0.002) and corrected binocular distance visual acuity improved from 20/23 to 20/19 (p=0.005). There was no significant change in spherical equivalent.

In their responses to a subjective quality of vision questionnaire, the patients’ frequency of visual symptoms subscale values were significantly lower after the IOL exchange (p=0.41). The severity subscale was also lower postoperatively, although the difference did not reach statistical significance (p=0.073).

In addition, the percentage of patients saying they had good and very good satisfaction increased from 33% to 83.3%. Furthermore, 90% of patients reported they would repeat the procedure, compared to 20% before the exchange procedure.

Prof Alió noted that although the surgery can be difficult, previous studies have shown that exchanging a multifocal for a monofocal IOL can produce good results in patients with neuroadaptation failure. However, patients who are highly motivated to be spectacle-free may be disappointed with a monofocal outcome.

“Treatment of neuroadaptation failure following multifocal IOL surgery by multifocal IOL exchange with a different multifocal IOL with a different optical profile improves quality of vision, visual function and significantly increases patient’s satisfaction,” he concluded.