She had a cataract after LASIK in one eye, and because intraocular lens power calculation was said to be difficult, she was referred onward to us from a nearby core hospital. The left eye had a nuclear cataract of about grade 3 plus a cortical cataract covering the pupillary area, and vision had fallen to 0.2 (0.5). At first we proceeded on the basis of a monofocal lens, but she uses a computer heavily at work, and despite her LASIK, corneal higher-order aberrations were low, so we told her about the option of multifocal lenses. She had advanced medical care insurance and did not drive, so after discussion she wished for PanOptix, the latest trifocal lens covered by advanced medical care.
Since it was a LASIK eye, we explained the risk of postoperative refractive error in intraocular lens power; she wished for near-dominant vision, so we decided the intraocular lens power using the corneal power from the OPD-Scan and her pre-LASIK refraction data.
As a surgeon, besides the surgery itself, I am especially nervous at the examination the day after cataract surgery in a LASIK eye, wondering whether there is refractive error. People who have had LASIK are often highly conscious of quality of vision to begin with, so I was worried, but the feared postoperative refractive error did not occur, and she was very satisfied with uncorrected vision of about 1.0 at both near and distance. After surgery she said the poor near vision of 0.4 in her fellow right eye bothered her, and she promptly booked surgery on that eye too.
A recent journal of an ophthalmic society carried a warning that, as coverage of multifocal intraocular lenses under advanced medical care is expected to end around spring 2020, a last-minute rush of surgeries should not be allowed to throw clinics into confusion. If you are considering surgery with multifocal lenses using advanced medical care insurance, please take note and consult us early, allowing plenty of time.
Cataract Surgery Cases / Case
Multifocal IOL
Case #38: Woman in her 50s from Nishitokyo (after LASIK, left eye: trifocal multifocal lens PanOptix)
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
- 1.2p(1.5)→—
- Near
- 0.4(1.0)→—
Left eye: pre-op → post-op
- Far
- 0.2p(0.5p)→1.2(n.c.)
- Near
- 0.4(0.5)→1.0p(1.0)
2019.10.19
Patient questionnaire
Answers translated from Japanese.
- What was your condition before surgery?
Work documents were hard to read, and it felt as if I couldn't focus.
- What led you to have surgery?
Because I was diagnosed with cataract.
- Which did you choose, a multifocal lens or a monofocal lens?
It's expensive, but I judged that in daily life multifocal would give vision closer to natural.