Premium and Specialized Intraocular Lenses

Multifocal IOLs – Clinical Indication and Pearls for Successful Application and Clinical Results

Author(s): Gerd U. Auffarth, Adi Abulafia and Guy Kleinmann

Pp: 81-101 (21)

DOI: 10.2174/9781608058327114010008

* (Excluding Mailing and Handling)

Abstract

Cataract surgery has undergone dramatic improvements, rehabilitation is quick, the complication rate is decreasing, IOL material and calculations have improved, and excellent uncorrected distance visual acuity can be expected in most cases where the eye is healthy. Currently, one of the major challenges of cataract surgery is presbyopia correction. Patients expect excellent distance vision, as well as spectacle freedom for near vision. Multifocal IOLs, better termed bifocal IOLs, and recently trifocal IOLs, create 2 or 3 foci. These IOLs have improved in recent years and can provide a good solution for those who seek to reduce spectacle dependency. However, the downside to these IOLs includes halo, glare and reduced distance vision contrast sensitivity. In this chapter, we will review the basic principles of multifocal IOLs and their clinical results. It is worthy to note that currently only the Alcon AcrySof ReSTOR (Fort Worth, TX, USA) MIOL and the Tecnis ZMB00 (Abbott Laboratories, Inc., Abbott Park, IL, USA) MIOL have FDA approval and a large database of detailed clinical results.


Keywords: Presbyopia, near vision, intermediate vision, multifocal IOL, bifocal IOL, trifocal IOL, range of vision, complication, halo, glare.

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      • 14. app/Models/UserAccess/UserAccess.php:784
      • 15. middleware::check_user_access:114
      • 16. vendor/laravel/framework/src/Illuminate/Pipeline/Pipeline.php:183
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Middleware/SubstituteBindings.php:50
      • 18. vendor/laravel/framework/src/Illuminate/Pipeline/Pipeline.php:183
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      • 20. vendor/laravel/framework/src/Illuminate/Routing/Route.php:206
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      • 17. app/Http/Controllers/ChapterController.php:1434
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      • 14. app/Models/Subject.php:238
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      • 16. app/Models/Subject.php:255
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    • select count(*) as total_count, content_type_access_id as access_type from ebook_access where content_type_id = '6332' and content_type = 'c' and ( (from_date <= CURDATE() and to_date >= CURDATE() and perpetual= 0) or (from_date is null and to_date is null and perpetual= 1) )
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      • 11. app/Models/ContentAccess.php:647
      • 12. app/Http/Controllers/ChapterController.php:1465
      • 13. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 14. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select count(*) as total_count, content_type_access_id as access_type from ebook_access where content_type_id = '1494' and content_type = 'v' and ( (from_date <= CURDATE() and to_date >= CURDATE() and perpetual= 0) or (from_date is null and to_date is null and perpetual= 1) )
      1.27msalphaeurekaselec_live_10_06_2022ContentAccess.php#647
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      • 11. app/Models/ContentAccess.php:647
      • 12. app/Http/Controllers/ChapterController.php:1478
      • 13. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 14. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
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      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1518
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 314549955 and j.to_ip >=314549955 )) and ((j.from_date <= 1740496826 and j.to_date >= 1740496826 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 6332) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 314549955 and j.to_ip >=314549955 )) and ((j.from_date <= 1740496826 and j.to_date >= 1740496826 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 6332) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 314549955 and j.to_ip >=314549955 )) and ((j.from_date <= 1740496826 and j.to_date >= 1740496826 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 6332)
      1.01msalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 1494 and `b`.`banner_from_date` <= 1740496826 and `b`.`banner_to_date` >= 1740496826 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.53msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 1494
      • 3: 1740496826
      • 4: 1740496826
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='e05f0a3d352c922bff7e69885f1cd4c1'
      310μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    10Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        bY4EvwYVzpiefOIYzU0LwmP5genrVyyrZPrIxDgb
        uc_cart_id
        e05f0a3d352c922bff7e69885f1cd4c1
        _previous
        array:1 [ "url" => "http://alpha.eurekaselect.com/chapter/6332" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/6332
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:8 [ "accept-encoding" => array:1 [ 0 => "gzip, deflate" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] "connection" => array:1 [ 0 => "keep-alive" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] ]
        request_cookies
        []
        
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Tue, 25 Feb 2025 15:20:26 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IlVhWnlhVlpRdzl3WmRqclNxRTFBa2c9PSIsInZhbHVlIjoiYWRYdDh5L1pSSmQ5VEg2dnliQm5BMTJCc1J5ek5FZ3lUUW1CZ0RHc0xUYVVkMDdyREk0MENGaTVvc2NRZDdvTjBLc0I4OFdqbTZkVFBRdmNTUktJdU16cG1OSTdvcVVmc1BuQzBjQkxDam8xUXp6ZnBuRnJjVDk5bFU2M0FGMFYiLCJtYWMiOiJjMWIxMjFlZjcxMWViOGJlODIyMGExYWMwMmFlM2ZiMzZjZTI3MjZmNTE3MzQ2OGJiOTY3ODBiZGE0MDkxZGU5IiwidGFnIjoiIn0%3D; expires=Fri, 28 Feb 2025 03:20:26 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6IlVhWnlhVlpRdzl3WmRqclNxRTFBa2c9PSIsInZhbHVlIjoiYWRYdDh5L1pSSmQ5VEg2dnliQm5BMTJCc1J5ek5FZ3lUUW1CZ0RHc0xUYVVkMDdyREk0MENGaTVvc2NRZDdvTjBLc0I4O" 1 => "alphaeurekaselectnet_session=eyJpdiI6InBIUlRmazBmZUxJR0JrblcvTGNEbXc9PSIsInZhbHVlIjoiWmNoeDFKdTBjM08weDNlZnJGZXZ1UGsrL29YNWtTNlEzZGREbGxra1did2lBU2syZjdGMUZ1R1IrY2pjejlQWk5UVFozN25tOWR3Z3k5ZEQrcXlxSjRMVnYrOFlBVXpPbWs0a01vTDVhcTBxVENCcWVCY0xpN21mS1I2RmZrdy8iLCJtYWMiOiI4OGYzODg2MTdkM2U1MDcxYTI4ZDFhNWUwNDJmZDcxNTYxNWM5NjI0ODVjYmUwY2Q1M2Y0ZDM4ZGEwN2FjYmEwIiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6InBIUlRmazBmZUxJR0JrblcvTGNEbXc9PSIsInZhbHVlIjoiWmNoeDFKdTBjM08weDNlZnJGZXZ1UGsrL29YNWtTNlEzZGREbGxra1did2lBU2syZjdGMUZ1R1I" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IlVhWnlhVlpRdzl3WmRqclNxRTFBa2c9PSIsInZhbHVlIjoiYWRYdDh5L1pSSmQ5VEg2dnliQm5BMTJCc1J5ek5FZ3lUUW1CZ0RHc0xUYVVkMDdyREk0MENGaTVvc2NRZDdvTjBLc0I4OFdqbTZkVFBRdmNTUktJdU16cG1OSTdvcVVmc1BuQzBjQkxDam8xUXp6ZnBuRnJjVDk5bFU2M0FGMFYiLCJtYWMiOiJjMWIxMjFlZjcxMWViOGJlODIyMGExYWMwMmFlM2ZiMzZjZTI3MjZmNTE3MzQ2OGJiOTY3ODBiZGE0MDkxZGU5IiwidGFnIjoiIn0%3D; expires=Fri, 28-Feb-2025 03:20:26 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6IlVhWnlhVlpRdzl3WmRqclNxRTFBa2c9PSIsInZhbHVlIjoiYWRYdDh5L1pSSmQ5VEg2dnliQm5BMTJCc1J5ek5FZ3lUUW1CZ0RHc0xUYVVkMDdyREk0MENGaTVvc2NRZDdvTjBLc0I4O" 1 => "alphaeurekaselectnet_session=eyJpdiI6InBIUlRmazBmZUxJR0JrblcvTGNEbXc9PSIsInZhbHVlIjoiWmNoeDFKdTBjM08weDNlZnJGZXZ1UGsrL29YNWtTNlEzZGREbGxra1did2lBU2syZjdGMUZ1R1IrY2pjejlQWk5UVFozN25tOWR3Z3k5ZEQrcXlxSjRMVnYrOFlBVXpPbWs0a01vTDVhcTBxVENCcWVCY0xpN21mS1I2RmZrdy8iLCJtYWMiOiI4OGYzODg2MTdkM2U1MDcxYTI4ZDFhNWUwNDJmZDcxNTYxNWM5NjI0ODVjYmUwY2Q1M2Y0ZDM4ZGEwN2FjYmEwIiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6InBIUlRmazBmZUxJR0JrblcvTGNEbXc9PSIsInZhbHVlIjoiWmNoeDFKdTBjM08weDNlZnJGZXZ1UGsrL29YNWtTNlEzZGREbGxra1did2lBU2syZjdGMUZ1R1I" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "bY4EvwYVzpiefOIYzU0LwmP5genrVyyrZPrIxDgb" "uc_cart_id" => "e05f0a3d352c922bff7e69885f1cd4c1" "_previous" => array:1 [ "url" => "http://alpha.eurekaselect.com/chapter/6332" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-25 15:20:26GET/chapter/63321121912