“Which Lens for which patient”
In the January 2023 Review of Ophthalmology cataract surgeons describe what goes into their decision-making process for IOL selection.
There are a couple of points in this article that I take issue with.
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First is this statement about monofocal lenses - “Monofocal IOL… are designed to provide the highest quality vision at a single distance.” While they do provide the highest quality vision all lenses peak in visual acuity at some point. And all lenses including monofocal lenses have a range of vision distance around that peak visual acuity point. When statements like this are made I think it gives patients the impression that they have to pick the exact distance that they want the lens to be effective at. The reality is that these lenses provide quite a wide range of vision especially further away. A standard monofocal set for distance will typically give a range of vision from 2-3 feet to the moon. That is quite a wide range and not a single distance. And, loss of vision as you get to the limit of the effective range drops off gradually. It does not drop off a cliff. It is true that if targeted to closer distances the range is less. My nearer eye which is at about -1.625 D gives me a range of good vision from about 8" to 8-9 feet. In short this single distance categorizing of monofocal lenses is misleading, and can often be used as a lead in for the, “we do have these premium (priced) lenses that offer a wider range of focus…”
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And second I take issue with this statement - “One of the major factors to consider in IOL selection, besides personality, is the patient’s preoperative refractive error,”. I think that is an unfortunate slotting process that is somewhat condescending to actual patient needs and desires. Basically they make the assumption that if you were myopic before surgery, you will want to be myopic after surgery, and that if you are far sighted you will be more tolerant to full distance correction. I think this sell patients short. A cataract surgery is a once in a lifetime opportunity to correct prior lifetime issues with your vision. It is more important in my opinion that surgeons be open and honest about outcomes and let the patient decide what they want.
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But, what the article does show is that there is an extensive list of issues to consider when selecting “the best” lens for each patient. It is not that simple and explains why many find the process of selecting the lens very daunting.
You summed that up pretty well. And yes the selection of a lens for patients is a daunting task. And as more IOLs enter the market in the coming years, it will become more daunting for patients and for cataract surgeons.
i think the drop of the cliff happens only when iol is set for near. (-2 and lower).
i had my daughter move printed paper and photo from 8 inch to farther away and to notice the dip for intermediate but we couldn’t spot it.
is your -1.65 clareon?
Hopefully they will become better, and the risk of making a bad choice will be lower.
That may be something unique to a multifocal lens. With my monofocal set at -1.625 I can see somewhat OK at 8" on a computer monitor, but as I move further and further away it gets better and better. Vision peaks at about 25", and then starts to fade again until it is only Ok at 8 feet or so - large screen TV viewing. But since my distance eye is perfect at about 3’ plus I don’t notice that fade out.