A senior ophthalmologist of mine with a unilateral anterior subcapsular cataract came to consult about it, including candidacy for multifocal lenses. With anterior subcapsular opacity in a relatively young person, one suspects trauma or atopy, but she said neither applied.
She herself performs microsurgery, including cataract surgery, so we chose the lens with that in mind. In terms of quality of vision, the order at present is thought to be monofocal (no halos or glare) ≧ MiniWELL > Symfony > trifocal lenses; but the eye to be operated on was her non-dominant eye, she was originally myopic at about −2.5 D in both eyes and a soft contact lens (SCL) user, and her dominant fellow eye had good vision of 1.2 with an SCL (occasionally using reading glasses), so we judged her a candidate for multifocal lenses. She accepted that the operated non-dominant eye's uncorrected distance vision would be somewhat inferior to the fellow eye's SCL-corrected 1.2, and we set the target refraction giving priority to covering the fellow eye's uncorrected near focal distance. She also had advanced medical care insurance, so after explaining the pros and cons and discussing them, we chose the extended depth of focus TECNIS Symfony.
Since this was surgery on a senior ophthalmologist who knows cataract surgery inside out, it was a tense operation in which I narrated each step in technical terms, like a cooking show, but as usual it was completed without problems. She said she felt no pain at all during surgery (*sensitivity varies between individuals), and she was delighted, saying, "At home, even when I take out my right contact lens, I no longer need glasses!"
At a recent meeting it was reported that ophthalmologists using multifocal lenses can practice as before, and my senior colleague, too, has had no problems at all after surgery and is operating more vigorously than ever. Her fellow eye will probably need cataract surgery someday; I hope that by then a multifocal intraocular lens will have been developed that, without halos or glare, sees both far and near continuously and well, like autofocus.
Cataract Surgery Cases / Case
Multifocal IOL
Case #15: Woman in her 40s from Bunkyo (ophthalmologist, extended depth of focus multifocal lens: TECNIS Symfony)
This is an English translation of the original Japanese case report. If the two differ, the Japanese version takes precedence. Visual acuity is shown in decimal notation (1.0 ≈ 20/20).
Change in visual acuity (decimal; corrected values in parentheses)
Right eye: pre-op → post-op
- Far
- 0.1(1.5)→—
Left eye: pre-op → post-op
- Far
- 0.3(0.5)→0.9(1.5)
- Near
- —→1.0(n.c)
2018.07.25
Patient questionnaire
Answers translated from Japanese.
- What was your condition before surgery?
Things were hazy and I couldn't see clearly, which was stressful.
- What led you to have surgery?
It was gradually becoming more bothersome; there was no particular trigger, but I wanted to prioritize my work (as an ophthalmologist), so I felt I just had to do it.
- Which did you choose, a multifocal lens or a monofocal lens?
Dr. Morohoshi kindly explained the properties of the intraocular lenses. There were choices even among multifocal lenses, but I was able to decide with full understanding.