Successful integration of modern multifocal IOLs into a clinical practice

Presbyopia rehabilitation becomes more important in cataract operation nowadays. For this, new generation of multifocal lens shows very successful clinical outcome so far. For successful integration of modern multifocal IOLs into a clinical practice, the importance of patient selection and accurate biometry including astigmatism control cannot be overemphasized. Additionally, posterior capsule opacification is absolutely critical obstacles in multifocal IOLs especially for near vision. In our study for 3 years follow up of 500 cases of Array (former zonal refractive type silicone IOLs) lenses, average uncorrected visual acuity were measured 0.81at far and 0.64at near immediate postoperatively. However, average uncorrected visual acuity decreased 0.60at far and 0.34at near at 3 years after operation. In our another study for the clinical effect of the planned posterior capsulorhexis with Array IOLs implantation, average uncorrected visual acuity were measured 0.73at far and 0.54at near at 3 years after operation. These results show the importance of posterior capsular opacification for the full function of multifocal IOLs, especially for near vision. In contrast, our recent study for clinical outcome of Restor lenses (Apodized diffractive acrylate IOLs) for 1 year follow up shows very much desirable result compare to former Array IOLs. We performed patient selection very cautiously and more accurate biometry was performed using standard A scan and IOL master simultaneously. And we need perfect capsulorhexis to reduce the developing of posterior capsular opacification, especially fibrotic type. For this, anterior capsule must overlap 360 degrees of IOL optic margin and there must be no optic capturing by capsulorhexis. This perfect capsulorhexis can give us not only less developing of posterior capsular opacification but also less tilting and decentration of multifocal IOL.