Does age make a difference in IOL surgical planning?

We have some amazing surgical technology now with IOLs that give a wide range of vision and can even help us treat corneal astigmatism. But does the patient age make a difference with the decision to perform surgery?

If we have a patient with a refraction of +5.00 -2.00 x 175 who desires less dependence on spectacles / glasses, can we offer IOL surgery to help?

LASIK surgery can be done for this prescription but it is less than ideal. The spherical equivalent of this prescription is +4.00 and that is a lot for the excimer laser to steepen on the cornea.

Age 30: If the patient is young, such as 30 years old, even if we treat a prescription of +4.00 -2.00 x 175, the residual Rx will be +1.00 and the strong accommodative power of the eye will allow this patient to see very well for at least 10 years. Doing the IOL surgery can result in an Rx of zero after surgery, but the vision provided by the multifocal or trifocal IOL is not as good as the accommodation in a patient of this young age. In the absence of a cataract, I would not perform IOL surgery for a 30 year old patient with this Rx. No.

Age 50: This is about the age where the accommodation has decreased substantially and the IOL option may make more sense than the LASIK or excimer laser treatment. Even still, the vision from the MFIOL or trifocal IOL may be seen as insufficient by this patient. Careful pre-op counseling is needed to ensure that the patient’s expectations are in line with the likely results from the surgery. This patient falls into the category of: Maybe.

Age 70: At this age, there is always some degree of cataract present and there is effectively zero accommodation left. This patient will do best with IOL surgery and would be quite pleased with the results from the toric MFIOL. The key to happiness is producing results which exceed the patient’s expectations. And this is a case where that will certainly happen. Yes.

Click below to understand the effect of age with the decision to perform IOL surgery:

1 Comment

  1. Hi Dr. Devgan. What IOL would you suggest for a young person with 6,5 mm pupil? If the IOL has a 6 mm optic it can cause PD. Are there any iols with large optic or any other ways to avoid PD?

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