These are the patients where I tend to avoid using multi-focal and trifocal IOLs. While these diffractive design MFIOLs can provide a wide range of good vision for most patients, they are not perfect and they are not a substitute for having youthful eyes with great accommodation. While there are no absolutes, these guidelines can help you avoid situations like shown in this video. Here we have a patient who was a low myope (-2.00 refraction without astigmatism) for his whole life, who then had cataract surgery and implantation of a trifocal IOL. The light-splitting technology of this IOL produced an image quality for near vision that was not acceptable to him, so we elected to perform an IOL exchange and implant a monofocal IOL with the same refractive goal of -2.00 and this made him very happy.
Being a low myope who enjoys taking off his glasses to read is my number 1 reason to avoid a multifocal IOL. The others include those who value the highest visual quality over freedom from glasses, those with unrealistic expectations of youthful vision, and those who have professions like pilots and truck drivers who need great quality distance vision at night. The last set are the patients who are emmetropic presbyopes who wish to regain their accommodation. Listen to the video for the full explanation.
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