This 58 year old patient is highly hyperopic, wearing +8.5 D glasses for distance vision and then +11.0 D glasses for reading. She has been intolerant of her rigid gas permeable contact lenses for a few years now and is in full-time glasses, which are so heavy that they distort her nose. She desires refractive surgery to finally achieve freedom from glasses. We are electing to perform a refractive lens exchange and replace her crystalline lens with a trifocal IOL (Alcon PanOptix) in order to correct the distance, intermediate, and near vision.
There are some challenges with the surgery, beginning with setting patient expectations. This trifocal IOL will be able to give a wide range of vision without glasses, but it is not the fountain of youth. There is simply no way to give this patient the perfectly healthy eyes of a normal 25 year old human. The diffractive IOL will reduce contrast and cause night glare / halos. In addition, the image size will return to normal, which means that the added magnification from her +8.5 D glasses will be lost. The patient is understanding and has reasonable expectations.
The IOL calculations are also challenging and the choice of IOL can be limited. Fortunately, we calculate that a +34.0 D PanOptix IOL will be the perfect choice and that is the highest power that Alcon makes.
During surgery, the crowded anterior segment and shallow anterior chamber means that creating the capsulorhexis is more challenging. We need to use a sufficient amount of viscoelastic to flatten the anterior lens capsule.
click below to see the video of this case, showing the pearls for success: