She was referred by the ophthalmology department of a general hospital for consultation about multifocal intraocular lenses. There was little difference in axial length between the eyes, but the right eye alone had high myopia exceeding −6.0 D, having become myopic through progression of a nuclear cataract of about grade 3. In addition, corrected vision had fallen below 0.1 because of a posterior subcapsular cataract, probably diabetic, but her blood sugar was well controlled and there was no retinopathy, so we judged her a candidate for multifocal lenses.
She had originally been mildly myopic in both eyes, did not drive or play sports, and wished to see at about 30 cm for reading and sewing-machine work, about 50 cm for cooking and so on, and the TV; so we set the extended depth of focus TECNIS Symfony, which gives smooth continuous vision from near-intermediate to distance, with near-dominant powers.
As a result, binocular near vision was 1.2, so she can thread a needle for sewing without glasses, and distance vision was 1.0, enough to renew her driver's license without glasses, and she was very satisfied.
Even among multifocal lenses, there is at present no intraocular lens that sees everything well from 30 cm to distance. At our clinic, after making sure patients understand this in the preoperative explanation, we confirm which they could accept glasses for, distance or near, if they need them after surgery, and use that as a reference for setting the power. Of course, by setting micro-monovision and the like, we aim for patients to manage without glasses, but to avoid dissatisfaction after surgery, I think it is important to understand clearly each patient's priorities and what they want from surgery. Evidence-Based Medicine (EBM), "medicine based on scientific evidence," is of course the basic premise, but in today's world of diverse individual wishes, we strive at the same time to provide Patient-Based Medicine, "medicine suited to each individual patient."
Cataract Surgery Cases / Case
Multifocal IOL
Case #27: Woman in her 70s from Nerima (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
- 0.05(0.07)→0.9(1.5)
- Near
- —→1.2p(1.2)
Left eye: pre-op → post-op
- Far
- 0.3(0.5p)→1.0(1.5)
- Near
- —→1.0(1.2p)
2019.05.26
Patient questionnaire
Answers translated from Japanese.
- What was your condition before surgery?
The cataract in my right eye was more advanced.
- What led you to have surgery?
At my age-60 check-up I was told I was a cataract candidate and used cataract eye drops, but from about a year ago it started getting worse.
- Which did you choose, a multifocal lens or a monofocal lens?
Multifocal lenses.
It's nice not to have the inconvenience of putting glasses on and taking them off. Apparently you feel it
even more when a natural disaster strikes.