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The optometrist plays an important role in premium intraocular lens decision-making

Optometry Times JournalJuly digital edition 2023
Volume 15
Issue 07

Spectacle independence, nighttime glare symptoms often are key factors.

Intraocular lens (IOL) on blue background, medically 3D illustration (Adobe Stock / Axel Kock)

With background information and initial guidance provided by their optometrist, the patient is better able to formulate questions for their surgeon to aid in final IOL selection. (Adobe Stock / Axel Kock)

The growing number of intraocular lens (IOL) options and technologies has made surgical decision-making more complex, sometimes leading to patient confusion and often a need for provider guidance. One common decision point is choosing between the implantation of an extended depth of focus IOL (EDOF IOL; Figure 1) and a multifocal intraocular lens (MFIOL; Figure 2). Both types of lens platforms have offered our patients reliable methods for extending the range of vision to increase spectacle independence after cataract surgery. Both lens platforms have also resulted in high levels of patient satisfaction. A recent report of outcomes after MFIOL implantation found that 96% of patients would recommend the same procedure and lens type to others.1

EDOF IOLs contain a central transition element that elongates the range of focus to allow for a greater range of vision—typically distance and intermediate. Reading spectacles are still required in most cases. Multifocal lenses are diffractive and split incoming light to allow a fuller range of vision at distance, intermediate, and near with most patients achieving spectacle independence at all distances. Because EDOF lenses do not split light, the rate of glare and halos with these IOLs is similar to that of standard monofocal IOLs. However, due to the diffractive nature of MFIOLs, glare and halos are more common and must be considered in the decision-making process.

Figure 1.  The central transition element of an extended depth of focus intraocular lens allows for elongation of light to enhance depth of focus beyond the distance and into the intermediate ranges. Reading spectacles are often required after implantation.  Figure 2. Diffractive rings on the multifocal intraocular lens split incoming light rays to provide focus at distance, intermediate, and near ranges. The diffractive nature of this lens increases the rate of postoperative glare and halos. (Images courtesy of Ahmad A. Aref, MD, MBA)

Because of the trade-offs involved with IOL selection, the decision often comes down to a balance between patient motivation for spectacle independence at all distances and tolerance for nighttime glare symptoms. A retrospective, multicenter study of more than 5000 patients who underwent diffractive IOL implantation found that although overall rates of satisfaction were very high, common reasons for dissatisfaction included dysphotopsia and glare symptoms.2

Discussions regarding spectacle independence and risk for postoperative glare can take time and often benefit from a long-term relationship between the eye care provider and patient. Usually, it is optometrists who have this long-standing relationship with patients while providing years of refractive and contact lens care prior to the onset of cataracts. It is appropriate, then, for optometrists to begin this discussion of IOL trade-offs with patients before a consultative surgical visit. Optometrists may be better suited to initiate these discussions as they are more familiar with the patient’s personality type, which can also play a role in decision-making. In a study of 85 patients, the influence of personality trait on patient satisfaction after MFIOL implantation was investigated. Neurotic personality type was associated with lower patient satisfaction whereas conscientiousness and agreeableness were associated with higher levels of satisfaction.3

With background information and initial guidance provided by their optometrist, the patient is better able to formulate questions for their surgeon to aid in final IOL selection. This approach streamlines the surgical visit tremendously and allows for an enhanced, more informed patient experience. I have also found that patients appreciate having an eye care team dedicated to helping them make the best possible decision for what is often a life-changing surgical procedure. A working and constructive relationship—with timely communication—between the optometrist and ophthalmologist is critical to the success of this approach.

1. Ison M, Scott J, Apel J, Apel A. Patient expectation, satisfaction and clinical outcomes with a new multifocal intraocular lens. Clin Ophthalmol. 2021;15:4131-4140. doi:10.2147/OPTH.S327424
2. Llovet-Rausell A, Llovet-Osuna F, Bilbao-Calabuig R, Martinez Del Pozo M, Ortega-Usobiaga J, Baviera-Sabater J. Visual outcomes, spectacle independence and satisfaction after diffractive trifocal intraocular lens implantation. Arch Soc Esp Oftalmol (Engl Ed). 2018;93(10):481-490. doi:10.1016/j.oftal.2018.05.013
3. Rudalevicius P, Lekaviciene R, Auffarth GU, Liutkeviciene R, Jasinskas V. Relations between patient personality and patients’ dissatisfaction after multifocal intraocular lens implantation: clinical study based on the five factor inventory personality evaluation. Eye (Lond). 2020;34(4):717-724. doi:10.1038/s41433-019-0585-x
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