Ocular surface disease should be treated aggressively prior to surgery to ensure a normal tear film and accurate biometry measurements.Corneal astigmatism must be treated at the time of surgery or afterwards, because more than 0.5 D of cylinder can reduce acuity.Fortunately, I have not encountered a patient who was unable to tolerate the dysphotopsias and desired a lens exchange.In addition, it is very important preoperatively to identify any eye pathology that could interfere with the final vision, especially when considering a multifocal lens design.
Although some patients initially notice glare/halo from bright lights, I have found that they usually adapt to this quickly.
Success with PCIOLs also requires the ability to properly manage postoperative issues.
I extend the use of a topical steroid and nonsteroidal anti-inflammatory agent so patients instill these drops for a total of 2 months after surgery in order to reduce the risk of cystoid macular edema, posterior capsular opacification, ocular surface disease, and rebound iritis.
Both patients were very happy with multifocal IOLs in their fellow healthy eyes, liked the vision with a multifocal contact lens in the eye with macular distortion and therefore wanted a multifocal IOL in that eye.
In both instances, we had lengthy discussions about the possibility of poor vision and need for IOL exchange, and the patients were fully informed about the risks, benefits, and complications.
The accommodating IOLs have less risk of dysphotopsias and do not alter contrast sensitivity, but the near vision can be quite variable.