Some patients just cannot tolerate a trifocal IOL design and that is compounded if the refractive target is missed and the patient was not educated as to what to expect. There is no IOL design that can cheat the physics of optics and when you split the incoming light with a trifocal lens you get a wider range of vision without needing glasses but there is also less light at each focal range and the side effect of glare and halos, particularly at night. This patient also suffered from the negative dysphotopsia phenomenon which is more common with certain lens designs. The decision was made to perform an IOL exchange and to replace this trifocal IOL (Alcon PanOptix) with a monofocal aspheric IOL (Bausch & Lomb SofPort Li61AO). This allowed the patient to achieve excellent distance vision and much improved night vision. The key in this procedure is to carefully dissect the IOL out of the capsular bag and this video explains the technique, along with the twist-and-out method to explant the trifocal IOL.
