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Multifocal Intraocular Lenses: Neuroadaptation Failure Corrected by Exchanging with a Different Multifocal Intraocular Lens

  • Olena Al-Shymali
  • Jorge L. Alió
Chapter
Part of the Essentials in Ophthalmology book series (ESSENTIALS)

Abstract

Although intraocular lenses (IOLs) have been explanted for decades, the explantation of multifocal (MF) IOLs has been an increasing recent phenomenon. MF IOLs are explanted because patients complain of dysphotopsias and blurred vision associated in some cases to posterior capsule opacification (PCO) and refractive error that can be easily managed with YAG-capsulotomy, spectacles, and keratorefractive surgery. However, we lack effective treatments for subjective complaints especially the feeling of inadequate or poor vision as well as photic phenomena experienced with both refractive and diffractive MF IOL models. New reports proved that cortical neural areas are responsible for the long-term adaptation to such visual symptoms, suggesting that their persistence is a neuroadaptation failure. Eventually, the only solution in such cases would be the explantation of the MF IOL. The studies available in the literature report the outcomes of MF IOLs exchange to monofocal IOLs, though no relevant investigation was carried out on the exchange of MF IOLs to another MF IOL technologies. Our group is conducting such a study where MF IOLs were explanted due to neuroadaptation failure followed by the re-implantation of a different MF optical technology based on the hypothesis that there may be different neuroadaptation processes for refractive and diffractive IOLs in different patients. Into neuroadaptation failure we included all the subjective visual symptoms that did not have any clear anatomical cause such as photic phenomena, blurred vision, insufficient vision, and monocular diplopia. We had excellent results with an increase in both far and near visual acuities and improvement of patients’ quality of life and vision assessed by validated questionnaires. This procedure showed to be feasible and able to correct the patient’s dissatisfaction and keep the advantages of MF IOLs such as spectacle independence in the benefit of the patient.

Keywords

Multifocal intraocular lens exchange Multifocal intraocular lens explantation Multifocal intraocular lens Neuroadaptation failure Patients’ satisfaction Cataract surgery Refractive IOL exchange Diffractive IOL exchange 

Notes

Compliance with Ethical Requirements

Conflict of Interest

Olena Al-Shymali and Jorge Alió declare that they have no conflict of interest.

Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Animal Studies

No animal studies were carried out by the authors for this article.

References

  1. 1.
    Mojzis P, Peña-García P, Liehneova I, Ziak P, Alió J. Outcomes of a new diffractive trifocal intraocular lens. J Cataract Refract Surg. 2014;40(1):60–9.CrossRefGoogle Scholar
  2. 2.
    Alió J, Kaymak H, Breyer D, Cochener B, Plaza-Puche A. Quality of life related variables measured for three multifocal diffractive intraocular lenses: a prospective randomised clinical trial. Clin Exp Ophthalmol. 2018;46(4):380–8.CrossRefGoogle Scholar
  3. 3.
    Alio J, Plaza-Puche A, Férnandez-Buenaga R, Pikkel J, Maldonado M. Multifocal intraocular lenses: an overview. Surv Ophthalmol. 2017;62(5):611–34.CrossRefGoogle Scholar
  4. 4.
    Rosen E, Alió J, Dick H, Dell S, Slade S. Efficacy and safety of multifocal intraocular lenses following cataract and refractive lens exchange: metaanalysis of peer-reviewed publications. J Cataract Refract Surg. 2017;42(2):310–28.CrossRefGoogle Scholar
  5. 5.
    Alió J, Grabner G, Plaza-Puche A, Rasp M, Piñero D, Seyeddain O, et al. Postoperative bilateral reading performance with 4 intraocular lens models: six-month results. J Cataract Refract Surg. 2011;37(5):842–52.CrossRefGoogle Scholar
  6. 6.
    Xu Z, Li W, Wu L, Xue S, Chen X, Wu Q. Comparison of the clinical performance of refractive rotationally asymmetric multifocal IOLs with other types of IOLs: a meta-analysis. J Ophthalmol. 2018;2018:47282.Google Scholar
  7. 7.
    Llovet-Rausell A, Llovet-Osuna F, Bilbao-Calabuig R, Martínez Del Pozo M, Ortega-Usobiaga J, Baviera-Sabater J. Visual outcomes, spectacle independence and satisfaction after diffractive trifocal intraocular lens implantation. Arch Soc Esp Oftalmol. 2018;93(10):481–90.CrossRefGoogle Scholar
  8. 8.
    Alió J, Plaza-Puche A, Alió Del Barrio J, Amat-Peral P, Ortuño V, Yébana P, et al. Clinical outcomes with a diffractive trifocal intraocular lens. Eur J Ophthalmol. 2018;28(4):419–24.CrossRefGoogle Scholar
  9. 9.
    Mencucci R, Favuzza E, Caporossi O, Savastano A, Rizzo S. Comparative analysis of visual outcomes, reading skills, contrast sensitivity, and patient satisfaction with two models of trifocal diffractive intraocular lenses and an extended range of vision intraocular lens. Graefes Arch Clin Exp Ophthalmol. 2018;256(10):1913–22.CrossRefGoogle Scholar
  10. 10.
    Cochener B, Boutillier G, Lamard M, Auberger-Zagnoli C. A comparative evaluation of a new generation of diffractive trifocal and extended depth of focus intraocular lenses. J Refract Surg. 2018;34(8):507–14.CrossRefGoogle Scholar
  11. 11.
    Calvo-Sanz J, Sánchez-Tena M. Characterization of optical performance with defocusing curve: analysis of two refractive intraocular lens models with high and medium addition. J Optom. 2018;. pii: S1888–4296(18)30086-4. [Epub ahead of print]Google Scholar
  12. 12.
    Plaza-Puche A, Alio J. Analysis of defocus curves of different modern multifocal intraocular lenses. Eur J Ophthalmol. 2016;26(5):412–7.CrossRefGoogle Scholar
  13. 13.
    Ortiz D, Alió J, Bernabéu G, Pongo V. Optical performance of monofocal and multifocal intraocular lenses in the human eye. J Cataract Refract Surg. 2008;34(5):755–62.CrossRefGoogle Scholar
  14. 14.
    Hayashi K, Hirata A, Hayashi H. Possible predisposing factors for in-the-bag and out-of-the-bag intraocular lens dislocation and outcomes of intraocular lens exchange surgery. Ophthalmology. 2007;114(5):969–75.CrossRefGoogle Scholar
  15. 15.
    Pieh S, Lackner B, Hanselmayer G, Zöhrer R, Sticker M, Weghaupt H, et al. Halo size under distance and near conditions in refractive multifocal intraocular lenses. Br J Ophthalmol. 2001;85(7):816–21.CrossRefGoogle Scholar
  16. 16.
    de Vries N, Webers C, Touwslaqer W, Bauer N, de Brabander J, Berendschot T, et al. Dissatisfaction after implantation of multifocal intraocular lenses. J Cataract Refract Surg. 2011;37(5):859–65.CrossRefGoogle Scholar
  17. 17.
    Woodward M, Randleman J, Stulting R. Dissatisfaction after multifocal intraocular lens implantation. J Cataract Refract Surg. 2009;35(6):992–7.CrossRefGoogle Scholar
  18. 18.
    Gibbons A, Ali T, Waren D, Donaldson K. Causes and correction of dissatisfaction after implantation of presbyopia-correcting intraocular lenses. Clin Ophthalmol. 2016;10:1965–70.CrossRefGoogle Scholar
  19. 19.
    Rosa A, Miranda Â, Patrício M, McAlinden C, Silva F, Murta J, et al. Functional magnetic resonance imaging to assess the neurobehavioral impact of Dysphotopsia with multifocal intraocular lenses. Ophthalmology. 2017;124(9):1280–9.CrossRefGoogle Scholar
  20. 20.
    Rosa A, Miranda Â, Patrício M, McAlinden C, Silva F, Castelo-Branco M, et al. Functional magnetic resonance imaging to assess neuroadaptation to multifocal intraocular lenses. J Cataract Refract Surg. 2017;43(10):1287–96.CrossRefGoogle Scholar
  21. 21.
    Kim E, Sajjad A, Montes de Oca I, Koch D, Wang L, Weikert M, et al. Refractive outcomes after multifocal intraocular lens exchange. J Cataract Refract Surg. 2017;43(6):761–6.CrossRefGoogle Scholar
  22. 22.
    Fernández-Buenaga R, Alio J, Muñoz-Negrete F, Barraquer Compte R, Alio-Del Barrio J. Causes of IOL explantation in Spain. Eur J Ophthalmol. 2012;22(5):762–8.CrossRefGoogle Scholar
  23. 23.
    Kamiya K, Hayashi K, Shimizu K, Negishi K, Sato M, Bissen-Miyajima H, et al. Multifocal intraocular lens explantation: a case series of 50 eyes. Am J Ophthalmol. 2014;158(2):215–20.CrossRefGoogle Scholar
  24. 24.
    Tassignon M, Bartholomeeusen E, Rozema J, Jongenelen S, Mathysen D. Feasibility of multifocal intra-ocular lens exchange and conversion to the bag-in-the-lens implantation. Acta Ophthalmol. 2014;92(3):265–9.CrossRefGoogle Scholar
  25. 25.
    Galor A, Gonzalez M, Goldman D, O’Brien T. Intraocular lens exchange surgery in dissatisfied patients with refractive intraocular lenses. J Cataract Refract Surg. 2009;35(10):1706–10.CrossRefGoogle Scholar
  26. 26.
    Jones J, Jones Y, Jin G. Indications and outcomes of intraocular lens exchange during a recent 5-year period. Am J Ophthalmol. 2014;157(1):154–62.CrossRefGoogle Scholar
  27. 27.
    Davies E, Pineda R 2nd. Intraocular lens exchange surgery at a tertiary referral center: indications, complications, and visual outcomes. J Cataract Refract Surg. 2016;42(9):1262–7.CrossRefGoogle Scholar
  28. 28.
    Mamalis N, Brubaker J, Davis D, Espandar L, Werner L. Complications of foldable intraocular lenses requiring explantation or secondary intervention-2007 survey update. J Cataract Refract Surg. 2008;34(9):1584–91.CrossRefGoogle Scholar
  29. 29.
    Al-Shymali O, McAlinden C, Alió J. Outcomes of multifocal intraocular lens exchange by a different multifocal technology in patients with neuroadaptation failure. Manuscript submitted for publication; 2018;Google Scholar
  30. 30.
    Van der Mooren M, Steinert R, Tyson F, Langeslag M, Piers P. Explanted multifocal intraocular lenses. J Cataract Refract Surg. 2015;41(4):873–7.CrossRefGoogle Scholar
  31. 31.
    Wilkins M, Allan B, Rubin G, Findl O, Hollick E, Bunce C, et al. Randomized trial of multifocal intraocular lenses versus monovision after bilateral cataract surgery. Ophthalmology. 2013;120(12):2449–55.CrossRefGoogle Scholar
  32. 32.
    McAlinden C, Skiadaresi E, Khadka J, Pesudovs K. Pupil size and LASIK. Ophthalmology. 2012;119(8):1715–6.CrossRefGoogle Scholar
  33. 33.

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Olena Al-Shymali
    • 1
  • Jorge L. Alió
    • 1
  1. 1.Research & Development Department and Department of Cornea, Cataract, and Refractive SurgeryVISSUM Corporation and Miguel Hernández UniversityAlicanteSpain

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