Identifying Candidates for Multifocal Lenses

Many factors must be taken into account when you assess a patient’s candidacy for multifocal IOLs. From ocular pathology and biometric candidacy to lifestyle needs, vision goals and personality, knowing what to look for is the key to success.

Explore the tabs below to learn more about how to identify ideal candidates for multifocal IOL implantation.

Multifocal IOL Patient Selection Based on Pre-op Measurements

Accurate preoperative biometry assessment is essential to properly determining whether a patient is a candidate for multifocal IOLs. Keep reading to learn about how refraction, keratometry, corneal assessment and lens power calculation can influence AcrySof® IQ ReSTOR® IOL patient selection.

Refractive assessment

An axial length measurement that is erroneous by 1 mm will cause a postoperative refractive error of about 3.0 D,1 so A-scan procedures are extremely important. Remember to:

  • Consider A-Scan method carefully:
    • -   Optical coherence is highly accurate but may not measure through dense cataract.
    • -   Immersion can be variable based on administrator but is more accurate than contact/applanation.
    • -   Contact/applanation can cause corneal compression causing artificially shortened axial length
          measurement that may result in a myopic surprise.
  • Recheck if the difference in axial length between the two eyes is > 0.2 mm.

Performing keratometry and assessing the corneal status

When performing keratometry and corneal assessment, remember to:

  • Discontinue contact lens wear prior to keratometry (2–4 weeks for soft lenses, longer for hard contacts).
    • - Contacts should not be worn again until readings are obtained and confirmed.
  • Use one dedicated keratometer, such as the LENSTAR LS 900,*,† IOLMaster or a manual keratometer of your choice, for all pre- and post-op measurements.
  • Check keratometry measurements using topography to confirm irregular readings.
    • - If readings are consistently irregular, do not proceed with multifocal IOL implantation.
  • Recheck keratometry if readings are < 40.0 D or > 47.0 D (< 40.0 D may indicate previous refractive surgery), or if astigmatism measured correlates poorly with refraction.
  • Ensure corneal examination is normal with no significant guttata or epithelial dystrophy.

IOL calculation tips

The AcrySof® IQ IOL with the UltraSert™ Pre-loaded IOL Delivery SystemTarget emmetropia for optimal visual performance and refractive outcomes.

The AcrySof® IQ IOL with the UltraSert™ Pre-loaded IOL Delivery SystemUse a new-generation IOL calculation formula, such as the Holladay 2 or SRK/T, and recheck if there is > 2.0 D difference in lens implant powers between eyes.

The AcrySof® IQ IOL with the UltraSert™ Pre-loaded IOL Delivery SystemPersonalize your lens constants to compensate for the differences in instrumentation, measurement technique, surgical techniques and calculation methods.


*LENSTAR® is a registered trademark of Haag-Streit.

Trademarks are the property of their respective owners.

View Important Product Information for
AcrySof® IQ ReSTOR® Family of IOLs +

ACRYSOF® IQ RESTOR® FAMILY OF INTRAOCULAR LENSES IMPORTANT PRODUCT INFORMATION

CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician.

INDICATIONS: The AcrySof® IQ ReSTOR® Posterior Chamber Intraocular Lens (IOL) is intended for primary implantation for the visual correction of aphakia secondary to removal of a cataractous lens in adult patients with and without presbyopia, who desire near, intermediate and distance vision with increased spectacle independence. The lens is intended to be placed in the capsular bag.

WARNINGS/PRECAUTIONS: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling. Physicians should target emmetropia, and ensure that IOL centration is achieved. Care should be taken to remove viscoelastic from the eye at the close of surgery.

Some patients may experience visual disturbances and/or discomfort due to multifocality, especially under dim light conditions. As with other multifocal IOLs, visual symptoms may be significant enough that the patient will request explant of the multifocal IOL. Spectacle independence rates vary with all multifocal IOLs; as such, some patients may need glasses when reading small print or looking at small objects.

Clinical studies with the AcrySof® ReSTOR® lens indicated that posterior capsule opacification (PCO), when present, developed earlier into clinically significant PCO. Prior to surgery, physicians should provide prospective patients with a copy of the Patient Information Brochure available from Alcon for this product informing them of possible risks and benefits associated with the AcrySof® IQ ReSTOR® IOLs.

Studies have shown that color vision discrimination is not adversely affected in individuals with the AcrySof® Natural IOL and normal color vision. The effect on vision of the AcrySof® Natural IOL in subjects with hereditary color vision defects and acquired color vision defects secondary to ocular disease (e.g., glaucoma, diabetic retinopathy, chronic uveitis, and other retinal or optic nerve diseases) has not been studied. Do not resterilize; do not store over 45° C; use only sterile irrigating solutions such as BSS® or BSS PLUS® Sterile Intraocular Irrigating Solutions.

ATTENTION: Reference the Directions for Use labeling for a complete listing of indications, warnings and precautions.

Click here to view the AcrySof® IQ ReSTOR® +2.5 D IOL Directions for Use (DFU).

Click here to view the AcrySof® IQ ReSTOR® +3.0 D IOL Directions for Use (DFU).

ACRYSOF® IQ RESTOR® FAMILY OF INTRAOCULAR LENSES IMPORTANT PRODUCT INFORMATION

CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician.

INDICATIONS: The AcrySof® IQ ReSTOR® Posterior Chamber Intraocular Lens (IOL) is intended for primary implantation for the visual correction of aphakia secondary to removal of a cataractous lens in adult patients with and without presbyopia, who desire near, intermediate and distance vision with increased spectacle independence. The lens is intended to be placed in the capsular bag.

WARNINGS/PRECAUTIONS: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling. Physicians should target emmetropia, and ensure that IOL centration is achieved. Care should be taken to remove viscoelastic from the eye at the close of surgery.

Some patients may experience visual disturbances and/or discomfort due to multifocality, especially under dim light conditions. As with other multifocal IOLs, visual symptoms may be significant enough that the patient will request explant of the multifocal IOL. Spectacle independence rates vary with all multifocal IOLs; as such, some patients may need glasses when reading small print or looking at small objects.

Clinical studies with the AcrySof® ReSTOR® lens indicated that posterior capsule opacification (PCO), when present, developed earlier into clinically significant PCO. Prior to surgery, physicians should provide prospective patients with a copy of the Patient Information Brochure available from Alcon for this product informing them of possible risks and benefits associated with the AcrySof® IQ ReSTOR® IOLs.

Studies have shown that color vision discrimination is not adversely affected in individuals with the AcrySof® Natural IOL and normal color vision. The effect on vision of the AcrySof® Natural IOL in subjects with hereditary color vision defects and acquired color vision defects secondary to ocular disease (e.g., glaucoma, diabetic retinopathy, chronic uveitis, and other retinal or optic nerve diseases) has not been studied. Do not resterilize; do not store over 45° C; use only sterile irrigating solutions such as BSS® or BSS PLUS® Sterile Intraocular Irrigating Solutions.

ATTENTION: Reference the Directions for Use labeling for a complete listing of indications, warnings and precautions.

Click here to view the AcrySof® IQ ReSTOR® +2.5 D IOL Directions for Use (DFU).

Click here to view the AcrySof® IQ ReSTOR® +3.0 D IOL Directions for Use (DFU).