Patients’ dissatisfaction with multifocal intraocular lenses managed by exchange with other multifocal lenses of different optical profiles

Abstract

Background The aim of the study was to evaluate the outcomes of dissatisfied patients reporting poor visual quality following implantation of multifocal intraocular lenses (MF-IOLs), managed by IOL exchange with another multifocal optical profile. Methods This is a retrospective series of cases. MF-IOL exchange was done in 15 dissatisfied patients (30 eyes) with the perception of poor visual quality for far distance affected by neuroadaptation failure. Patients underwent a bilateral exchange of a MF-IOL with another MF-IOL of a different optical profile. Visual outcomes and complications were analyzed. Questionnaires including Quality of Vision (QoV), Visual Function Index-14 (VF-14) and its Rasch-revised version (VF-8R) and a satisfaction questionnaire were also used for outcome evaluation. Results The mean elapsed time from implantation to explantation-reimplantation was 11.8 months. The QoV scores improved significantly across all the three subscales. Visual function improved with a change in VF-14 score from 60.41 ± 24.81 to 90.16 ± 10.91 (P < 0.001). The VF-8R score improved as well. The uncorrected distance visual acuity improved from 0.24 to 0.12 logMAR after exchange (P < 0.001) and corrected distance visual acuity improved from 0.15 to 0.04 logMAR (P < 0.001). Safety and efficacy indexes reached 1.46 and 1.16, respectively. Concerning patients’ satisfaction following MF-IOL exchange, 80% of the patients reported they would have the MF-IOL reimplantation procedure again. Conclusions Patient dissatisfaction with neuroadaptation failure following MF-IOL implantation can be managed in 80% of our cases by MF-IOL exchange with a different MF-IOL optical profile.

Visual and Refractive Outcomes Following Exchange of an Opacified Multifocal Intraocular Lens

“… 17 A recent study by Al-Shymali et al reported the visual and refractive outcomes for multifocal-to-multifocal IOL exchange in 30 eyes of 15 patients who reported poor visual quality following the initial multifocal IOL implant. 23 However, the cohort of patients studied by Al-Shymali et al differs from ours in that the IOL exchanges were much earlier (mean time from initial surgery to exchange of 12 months vs 85 months), and none had a prior YAG capsulotomy. 23 Despite this, our patients had comparable refractive results (postoperative spherical equivalent of 0.04 ± 0.43D vs −0.35 ± 0.62D) and visual outcomes (UDVA of 0.12 ± 0.77 logMAR vs 0.10 ± 0.15 logMAR; UNVA of 0.28 ± 0.68 logMAR vs 0.25 ± 0.13 logMAR).…”

“… 23 Despite this, our patients had comparable refractive results (postoperative spherical equivalent of 0.04 ± 0.43D vs −0.35 ± 0.62D) and visual outcomes (UDVA of 0.12 ± 0.77 logMAR vs 0.10 ± 0.15 logMAR; UNVA of 0.28 ± 0.68 logMAR vs 0.25 ± 0.13 logMAR). 23 …”

Multifocal intraocular lens exchange to monofocal for the management of neuroadaptation failure

“…In a previous study from our group [ 9 ], we showed that exchanging a MF-IOL with another MF-IOL of a different optical profile either in design or power is a feasible technique, while most studies [ 4 – 7 , 17 , 21 – 23 ] report outcomes of MF-IOLs exchange to MNF-IOLs. It has been demonstrated that complaints such as photic phenomena are more often reported by patients with MF-IOLs than with MNF-IOLs [ 24 ].…”

“…However, no statistically significant differences in halos and glare were found between refractive and diffractive MF-IOLs [ 25 ]. Our previous study [ 9 ] demonstrated that the patients treated with an exchange to another MF-IOL had better satisfaction than an exchange to a MNF-IOL.…”

“…When this occurs along with dissatisfaction, one final option is to exchange the MF-IOL with another IOL. In our previous report, we studied the exchange of MF-IOLs with other MF-IOLs of a different optical design for the management of neuroadaptation failure [ 9 ]. This study investigates visual and refractive outcomes along with patient satisfaction after MF-IOL exchange with MNF-IOLs.…”