Multifocal Intraocular Lenses
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What is a multifocal lens?
Traditional monofocal lenses, including lens implants, focus light to only one point in space.
A multifocal lens has more than one point of focus. A bifocal, which is a type of multifocal, has two points of focus,
one at distance and the other at near.
What is the benefit of a multifocal lens implant?
A multifocal lens implant focuses light from distance and near simultaneously.
This feature addresses both distant and near vision and makes the recipient less dependent on
glasses or contact lenses.
Is a multifocal lens similar to the natural
lens of the eye?
No. The natural lens of a young person changes shape to produce a change in
focus. As a person ages, the natural lens becomes more rigid and functions more like a
monofocal lens. Lens implants do not change shape. A multifocal lens compensates for the eye s
inability to change shape by allowing the eye to see at distance and near simultaneously through
the same optic.
What are the different multifocal lenses
now available?
There are two different types of multifocal lenses currently available:
the diffractive multifocal IOL (e.g. ReSTORŪ lens by Alcon Laboratories) and the refractive
multifocal IOL (e.g. ReZOOMŪ lens by Advanced Medical Optics). Each of these lenses provides
both distance and near vision but each has its own set of advantages and disadvantages.
What are the advantages and
disadvantages of the diffractive multifocal IOL?
The diffractive multifocal lens implant provides
excellent reading vision and very good distance vision. The intermediate
vision is acceptable but some patients who do lots of computer work find
they need to sit closer to the computer, make the font size larger on the
screen, or get a pair of intermediate vision spectacles to make intermediate
work more comfortable. In addition, 25% of patients note glare and haloes around
lights at night with the diffractive multifocal IOL, a feature that is inherent to
multifocal lenses. These effects may interfere with your ability to drive comfortably
at night. However, most patients find that they get used to this phenomenon with time
and the glare and haloes become less obvious. Night driving spectacles may assist
in reducing this phenomenon. You should know that approximately 7-8% of patients
implanted with monofocal lenses also notice glare and halos.
What are the advantages and
disadvantages of the refractive multifocal IOL?
The refractive multifocal lens implant provides
excellent intermediate and distance vision. The near vision is typically
adequate but may not be sufficient to see very small print, such as stock
quotes, phonebook entries or medicine labels. In addition, patients who read
for prolonged periods of time or in poor lighting may experience eye fatigue.
One can always get a pair of near vision spectacles for those near tasks that
are difficult. In addition, 25% of patients note glare and haloes around lights
at night with the refractive multifocal IOL, a feature that is inherent to multifocal
lenses. These effects may interfere with your ability to drive comfortably at night.
However, most patients find that they get used to this phenomenon with time and the
glare and haloes become less obvious. Night driving spectacles may assist in reducing
this phenomenon. You should know that approximately 7-8% of patients implanted with
standard monofocal lenses also notice glare and halos.
Are there any alternatives to multifocal lenses?
The primary alternative to multifocal lens implantation is
monofocal lens implantation. If you request a monofocal lens, you will have to decide
whether you want distance vision lens implants in both eyes or whether you want a distance
vision implant in one eye and a near vision implant in the other eye. This latter arrangement,
called monovision, provides adequate distance and near vision and is best suited for patients
who have tried monovision in contacts previously and like the effect. Another alternative to
a multifocal lens is the accommodative lens implant. Please see the accommodative IOL section
for frequently asked questions (FAQs) about these lenses.
Are there any risks or side effects to multifocal lens implant surgery?
Implantation of a multifocal lens is associated with
all the risks and side effects of cataract surgery. These will be explained
separately by your doctor.
Will I see 20/20 after surgery?
We hope so, but we can t guarantee it.
You are paying for the service and the implant, not a guaranteed result.
If the eye is otherwise healthy, the vast majority of patients can achieve
20/20 vision with glasses, contact lenses or refractive surgery (e.g. LASIK, PRK, CK).
Will I need glasses after surgery?
If you opt to receive a monofocal lens implanted in
both eyes for distance vision, you will definitely need reading glasses after
surgery. If you receive a multifocal lens there is a good chance you won t
need glasses. 80% of patients implanted with the diffractive and refractive
lenses in their respective FDA clinical trials did not need glasses after
surgery for distance or near vision. Of course, not every patient in the
trial was spectacle independent. The odds of becoming free of spectacles
are better if your corneal astigmatism is low and your eyes are healthy.
Is a multifocal lens recommended for every patient?
No. It is recommended for most patients, but not for patients
who have problems with their retina (e.g. significant macular degeneration, epiretinal
membrane macular pucker , macular holes, significant diabetic retinopathy, history of
severe retinal detachment, retinal dystrophies or degenerations, retinal vascular occlusions),
advanced glaucoma affecting central vision, irregular corneal astigmatism, corneal scarring,
keratoconus, corneal dystrophies or optic neuropathy. Patients with a history of corneal
refractive surgery (CK, RK, PRK, LASIK, etc.) may require additional refractive surgery
following implantation of a multifocal lens to optimize its performance. In addition,
your doctor will discuss the advantages and disadvantages of a multifocal lens as it pertains
to your individual lifestyle and expectations. Patients with unrealistic expectations may not
be appropriate for multifocal lenses.
What if I don t see 20/20 without glasses after surgery?
We will prescribe glasses to optimize your vision.
You may also elect to wear contact lenses. If you want to improve your unaided
vision further, we will offer you discounted refractive surgery (e.g. LASIK, PRK, CK).
Only if there is a significant error in lens power calculation will we consider a
lens implant exchange.
Why doesn t insurance (or Medicare) pay for a multifocal lens?
These entities pay for surgery and devices that restore
functional vision. They will not pay for services that reduce dependence on
glasses or contact lenses. While Medicare and insurance will cover the cost
of a standard lens implant, they will not pay for the portion of a deluxe
implant that imparts multifocality.
Can I have a multifocal lens implanted later if I decide to have a monofocal lens implanted now?
No. The decision needs to be made prior to cataract surgery.
Must I pay the Astigmatism Management charge if I receive a multifocal lens?
Yes. The Astigmatism Management fee must be paid; otherwise,
a multifocal lens cannot be implanted. It is very important that we measure and
correct your corneal astigmatism when we implant a multifocal lens. If you do not
wish to pay the Astigmatism Management fee, you still have the option of receiving a
monofocal implant. Please see the Astigmatism Management section for FAQs.
Can I be implanted with a multifocal lens in one eye only?
Yes you can, as long as your other eye has a clear natural
lens or an early cataract. If your other eye already has a monofocal implant,
you may not realize the full benefit of the multifocal lens implant.
Will I need multifocal lenses in both eyes?
It is our current feeling that a multifocal lens should be implanted in
both eyes ultimately to realize the full benefit of the technology.
There are currently no studies demonstrating the advantages or
disadvantages of combining accommodative, multifocal or monofocal
lenses when surgery is performed in both eyes.
Will it take longer for my eye to recover from surgery?
Recovery from cataract surgery is the same whether you
receive a monofocal lens or a multifocal lens. The number of appointments before
and after surgery is also the same. The brain must adjust, however, to the new
optical system created with the multifocal lens. This neural adaptation takes from
weeks to months to occur. Patients typically notice that they become less aware
of their vision as this neural adaptation takes place.
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