Multifocal intraocular lenses

It has been 10 years since I implanted the first multifocal intraocular lens (IOL). Unfortunately, there has been a gradual lessening of commitment to this modality by the ophthalmic community. The most important single factor for this lack of interest despite the more than adequate available clinical data is the repeated moving of "goal posts" by the American FDA when a multifocal lens style nears premarket approval. The refractive multifocal lens styles of iolab (Claremont, CA), Stortz Ophthalmics (St. Louis, MO), Domilens (Lyon, France), and Amo with the diffractive multifocals of 3M (St. Louis, MO), and Pharmacia (Kalamazoo, MI) and their recent modifications are reviewed. Reports show that they generally give excellent visual results depending on whether a near or distance dominant lens is indicated. The foldable Amo Array SA40N provides a good distance dominant foldable lens for the surgeon performing small incisions and has a small but dedicated surgical following. Loss of contrast sensitivity at low-light levels remains a source of concern in certain professions and with certain lifestyles, and a report suggesting that many monofocal and multifocal patients do not achieve the standards set for night driving by the German Ophthalmic Society warrants further consideration. Development of a new accommodative IOL for small incision surgery is the only really new concept, and it will be interesting to see the results of independent reports. Spectacle dependence is considerably reduced with all the current multifocals when compared to monofocals, and for patients there are ample multifocal lens styles from which to choose. It is the author's opinion that more than 60% of the cataract population is currently suitable for multifocals if small incision surgery is performed. More multifocals would be used if price disparity with monofocals was reduced.