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    Formula for achieving successful multifocal IOL outcomes



    Anatomical considerations

    Anatomical considerations include conditions affecting the back of the eye and the ocular surface. Dr. Rocha recommended against patients with category 3 or 4 dry age-related macular degeneration, anyone with an epiretinal membrane and thick retina, and glaucoma patients.

    “In addition, it may be a good idea to have a plan B in case some anatomical feature that would preclude a good outcome with a multifocal IOL is found intraoperatively,” she added.

    Figure 1 and 2: Dynamic measurement of the point-spread-function over a 20-second interval in normal eyes (control group) and mild dry eye syndrome.

    Ocular surface optimization is also critical prior to planning surgery because an irregular ocular surface will affect biometry measurements used for surgical planning, as well as higher-order aberrations and visual acuity. In addition to performing standard evaluations for dry eye disease, Dr. Rocha said she conducts a thorough tear film analysis and measures the Ocular Scatter Index (OSI), using double-pass wavefront technology (OQAS, Visiometrics) that provides insight on retinal image quality and tear film stability.

    “Double-pass wavefront technology provides a dynamic analysis of the point-spread-function, which is represented as the OSI, while the patient blinks normally over a 20-second interval,” Dr. Rochas explained. “We found that OSI in an eye with a healthy ocular surface will be low and stable, but that it can fluctuate and worsen during the testing period, even in patients with just mild dry eye and no ocular surface staining.”

    Intraoperative aberrometry

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