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What Is Glaucoma?
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EyeWorld | Considering premium IOLs for glaucoma patients
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Is glaucoma associated with cataract
Subspecialties Glaucoma. Sign up now. Most Popular 1. It is debatable whether these IOLs should be used in the setting of exfoliation disease because of the potential for a decentered lens.
Although this may not be an absolute contraindication, thorough informed consent is required. Other newer IOL technologies and common refractive options may not be advisable in patients with moderate to advanced glaucoma. Although these options are not absolutely contraindicated, I tend to discourage patients with advanced glaucoma from two refractive alternatives in particular.
Monovision can be very effective in motivated patients if both of their eyes function normally and they can achieve sensory adaptation. In patients with advanced glaucoma, a permanent visual defect sometimes does not allow one or both eyes to function independently at an adequate level to support monovision.
This can be true even if the patient successfully used monovision contact lenses years earlier Figure. I therefore usually do not recommend monovision for patients with advanced glaucoma.
Easing the Pressure
If one of these individuals is extremely motivated to pursue this option, I generally insist on a contact lens trial first. Multifocal IOLs can provide spectacle-free postoperative vision to many patients, but the technology is not without its limitations. The ideal candidate for a multifocal IOL is motivated and has a cataract but otherwise normal eyes. Unfortunately, there is little published data to guide the use of multifocal IOLs in this patient population 5,6 so surgeons are left mostly with anecdotal experience.
Current multifocal IOLs can reduce contrast sensitivity compared with monofocal lenses. Newer aspheric multifocal IOLs might perform better in terms of contrast sensitivity. Someone with advanced glaucoma, decreased contrast sensitivity, and visual field compromise—often very near fixation—likely will not benefit from the potential advantages of a multifocal IOL.
Considering the out-of-pocket expense for this technology, the cost-benefit ratio for these patients is unfavorable. Another consideration in this population is the effect of multifocal IOLs on visual field testing. Little has been published on the subject, but at least one study reported a reduction in visual sensitivity of up to a 2 dB, as measured by standard automated perimetry, in patients with a multifocal IOL compared with phakic controls.
After controlling for other variables, the investigators felt that the decrease in sensitivity related to the multifocal IOL design and not to pseudophakia alone.