Case #19: Woman in her 60s from Suginami (multifocal lens: ActiveFocus)

For about a year, oncoming headlights at night had been dazzling and streetlights blurred, and she could not see or focus near, so she first visited us for consultation about cataract surgery with multifocal intraocular lenses. She works in healthcare and wished to read displays such as blood pressure monitors without glasses, and she also drives at night, so we recommended ActiveFocus, which has a stronger near add than Symfony and few halos and glare.
The cataracts themselves were mainly cortical opacity without a very hard nucleus, but she had become hyperopic and at her age had almost no accommodation left, so we judged that cataract surgery as RLE (Refractive Lens Exchange) would benefit her. RLE is cataract surgery aimed at refractive correction, that is, mainly improving uncorrected vision and treating presbyopia.
She wanted to be able to drive without glasses while also securing near vision to some extent, so we operated with a target refraction of about −0.5, and achieved very good vision in each eye, 1.5 distance / 1.0 near uncorrected. Halos and glare when driving at night did not bother her, and she was delighted with life without glasses.
ActiveFocus is at present the newest multifocal lens certified for advanced medical care. Strictly speaking it is bifocal rather than extended depth of focus, but it is designed to cause fewer halos and glare without compromising intermediate vision compared with earlier lenses. Its add is 2.5 D at the lens plane (about 2.0 D at the corneal plane), only 0.5 D more near-dominant than Symfony's 2.0 D (about 1.5 D at the corneal plane). For reference, a binocular visual acuity curve compiled from overseas reports is here.
In actual use, based on patients' impressions, my impression is that for near vision ActiveFocus is somewhat weak, as its figures suggest, while Symfony does better than its figures; for intermediate to distance vision both are equivalent, but complaints of halos and glare at night are fewer with ActiveFocus.
The accommodation of multifocal lenses still falls far short of a normal crystalline lens, but with advances in intraocular lenses the proportion of RLE seems certain to increase. At present there is no perfect multifocal lens, so if you tell us your wishes without hesitation before surgery, we will propose the lens and power that seem best, including their pros and cons, so please feel free to consult us.