A 64-year-old woman with cataracts wished to have a trifocal IOL implant to correct her presbyopia at the time of cataract surgery. A friend of the patient recently had this type of lens implanted and was very happy with the results.
It is very important to exclude a number of conditions before offering any patient a premium IOL, such as a trifocal lens. Patients need to have a healthy ocular surface and cornea, which enables this technology to effectively deliver the three focal points in the eye. It is also important to rule out any serious retinal pathology and glaucoma.
Patients who enjoy reading are often the best candidates for trifocal lens technology. Other suitable candidates are people who lose/forget their glasses on a regular basis and those who wish to be spectacle-free for most of their daily tasks. In the last few years, there has also been an increase in the use of mobile devices such as large screen phones and tablets. Trifocal IOLs can deliver good-quality vision to satisfy such needs.
This technology delivers great results in most cases. However, it is important to discuss the process of neuro-adaptation to the new lens, which may take several weeks in a very small subset of patients. In particular, patients must be made aware of transient halos and glare to manage their expectations. These symptoms usually manifest at night and around very bright lights, such as car headlights and street lamps.
Astigmatism can be corrected with trifocal lenses, as they are now manufactured with inbuilt toric technology. It is generally possible to reduce most, if not all, of the corneal astigmatism to improve visual outcomes for the patient.
Implant centration is paramount with these lenses, so I usually combine this technology with femtosecond laser-assisted cataract surgery (FLACS). This ensures that the lens remains well centred within the capsular bag.
Following a comprehensive examination and discussion, the patient chose to proceed with trifocal IOL placement at the time of cataract surgery. One-week and one-month post-op reviews confirmed that spectacle independence had been achieved for both near and distance vision. Consequently, the patient is delighted with the outcome.
Ultimately, my decision on whether to offer a trifocal IOL is dictated by the pre-existing ocular health of the patient, in conjunction with his/her visual needs and expectations. It is important to have a detailed discussion with the patient to help determine the most appropriate lens solution for their situation and to manage their expectations. Patients who are not suitable candidates for a trifocal IOL can still benefit from cataract surgery, and other alternatives are available to optimise visual outcomes.
Pre-operative counselling is non-negotiable when considering a trifocal IOL.
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