Systematic Review of the Use of Supplemental Multifocal Intraocular Lenses in the Ciliary Sulcus for Presbyopia Correction

Abstract

PURPOSE: To conduct a critical review of the peer-reviewed literature on the use of supplemental multifocal intraocular lenses in the ciliary sulcus. METHODS: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. According to the inclusion and exclusion criteria defined, 15 articles were selected for the current systematic review. Each of them was analyzed carefully and their risk of bias was assessed with the Quality Assessment Tool for Case Series Studies from the National Heart, Lung, and Blood Institute. RESULTS: Data of 384 eyes from 227 patients were analyzed. Most of the studies reviewed had a short follow-up and poor or limited design, including case reports, case series, and clinical trials with several gaps in their methodology. Post-operative uncorrected distance and near visual acuity ranged from 20/40 to 20/20 and from 0.4 to 0.02 logMAR, respectively. Pigment dispersion (12 eyes) and deposits (13 eyes) were the most described complication. Dysphotopsia, glare, and halos were the more frequently reported visual disturbances. However, most of the patients reported a high level of satisfaction with their surgery. Most articles reviewed (13 of 15) achieved a risk of bias score between 6 and 8, representing a high level of evidence despite the study design limitations. CONCLUSIONS: Supplemental multifocal intraocular lenses seem to offer good distance and near visual results, leading to high levels of spectacle independence and patients' satisfaction, with limited complications associated. However, more studies with a more robust design are needed to confirm these trends. [ J Refract Surg . 2021;37(12):830–835.]

Influence of prismatic effect due to decentration of optical center in ophthalmic lens

“…We do not know whether prismatic effect occurred either due to improper fitting/edging of lenses or the primary eye care practitioner has not taken all the parameters like interpupillary distance along with accurate subjective acceptance, but we found that majority of the individuals are not looking through the optic center of an ophthalmic lens. Here we have measured only for individuals using single‐vision glasses and we observed that the prismatic effect is the major cause of intolerance leading to visual discomfort in individuals with single‐vision lenses and previous studies shown that the prolong use of decentered spectacle lens can lead to strabismus 19–21 …”

“…Here we have measured only for individuals using single‐vision glasses and we observed that the prismatic effect is the major cause of intolerance leading to visual discomfort in individuals with single‐vision lenses and previous studies shown that the prolong use of decentered spectacle lens can lead to strabismus. 19 , 20 , 21 …”

“…Here we have measured only for individuals using single-vision glasses and we observed that the prismatic effect is the major cause of intolerance leading to visual discomfort in individuals with single-vision lenses and previous studies shown that the prolong use of decentered spectacle lens can lead to strabismus. [19][20][21] Optometrists must raise awareness in patients since they are the ones who prescribe glasses and ensure that a set of criteria is appropriately monitored during the dispensing. Also, dispensing optician must take all the necessary steps while edging and fitting of lens to avoid unnecessary prismatic effect.…”

Refractive and Visual Outcomes After Implantation of a Secondary Sulcus Intraocular Lens with an Extended Depth of Focus

“…Results here appear as good or better than reported for an aggregate data set of several different sulcus lenses. 22 …”