Visual field deficits with a multifocal intraocular lens

Abstract

An 84-year-old woman with Sj € ogren syndrome was evaluated for hydroxychloroquine toxicity. Surgical history was significant for cataract surgery with implantation of a multifocal intraocular lens (IOL) in the right eye and a monofocal IOL in the left eye. Examination revealed no retinal pigment epithelial or optic disc changes. However, on testing with the Humphrey Field Analyzer II 10-2 red III program, the visual field in the right eye showed generalized depression with central sparing and the visual field in the left eye exhibited nonspecific rim defects. Since further tests suggested factors other than the IOL type were apparently equal in both eyes, the multifocal IOL in the right eye may have contributed to the abnormal visual field testing. Further studies are needed to clarify whether multifocal IOLs are appropriate in patients with autoimmune disorders possibly affecting vision, such as Sj € ogren syndrome, and those requiring hydroxychloroquine use.Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned. JCRS Online Case Reports 2013; 1:e60-e62 Q 2013 ASCRS and ESCRSFew studies have investigated the effects of multifocal intraocular lenses (IOLs) on the results of visual field testing. We report a case demonstrating generalized depression on 10-2 automated perimetry testing in an apparently healthy pseudophakic eye with a multifocal IOL. CASE REPORTAn 84-year-old woman with a history of Sj€ ogren syndrome was evaluated for hydroxychloroquine toxicity. She had used 200 mg of hydroxychloroquine twice daily for 20 years. Her only complaint was ocular dryness, which was consistent with a long-standing history of keratoconjunctivitis sicca, for which she had punctal cautery 25 years earlier.Other medications included topical cyclosporine twice daily and cevimeline for dry mouth. The surgical history was significant for cataract extraction in both eyes with implantation of a multifocal IOL (Tecnis ZMA00, Abbott Medical Optics, Inc.) in the right eye and a monofocal IOL (Tecnis ZCB00, Abbott Medical Optics, Inc.) in the left eye 1 year and 4 months prior to the current examination, respectively. Both procedures were uncomplicated.The uncorrected distance visual acuity was 20/30 in the right eye and 20/25 in the left eye. The manifest refraction was plano C0.25 Â 120 and À0.75 C0.25 Â 35, respectively. The corrected distance visual acuity (CDVA) was 20/25 in the right eye and 20/20 in the left eye. The preoperative manifest refraction was À2.75 C1.50 Â 180 and À3.25 C0.25 Â 83, respectively.At the time of the current examination, the intraocular pressure was 10 mm Hg in both eyes. The pupils were round and reactive without evidence of relative afferent pupillary defects. Tear break-up time was slightly decreased, but fluorescein staining revealed clear corneas bilaterally. The IOLs were well-centered with no evidence of misalignment or tilt. No significant posterior capsule opacification was evident in either eye. Fundoscopic examination showed no signs...