Multifocal IOLs significantly reduce spectacle use in mild to moderate glaucoma
Key takeaways:
- Significantly more patients with multifocal IOLs were spectacle-free for near tasks than those with monofocal IOLs.
- Best corrected visual acuity and vision-related quality of life were similar.
Multifocal IOLs enabled significantly more patients with mild to moderate glaucoma to be free of spectacles but made no impact on vision-related quality of life vs. monofocal IOLs, according to a study published in Journal of Glaucoma.
“Monofocal intraocular lenses can provide an adequate fixed visual acuity (generally unaided distance vision), but additional spectacles may be required,” Naris Kitnarong, MD, MBA, of Siriraj Hospital at Mahidol University, Bangkok, and colleagues wrote. “Multifocal IOLs [have] been reported to achieve good overall vision (both near and distant) with less dependence on spectacles. However, patients with [multifocal] IOLs may experience unwanted effects that include glare, halos and reduced contrast sensitivity.”
Kitnarong and colleagues conducted a cross-sectional, nonrandomized study of 109 patients with mild to moderate glaucoma who were implanted with bilateral multifocal IOLs (n = 50) or aspheric monofocal IOLs (n = 59). Moderate glaucoma was significantly more common in those who received monofocal IOLs (39.7%) than multifocal IOLs (17.5%) (P = .002).
The primary outcome was postoperative vision-related quality of life assessed using the 25-item National Eye Institute Visual Function Questionnaire. IOL implantation occurred between January 2010 and June 2022 at Siriraj Hospital.
There was no statistically significant difference in the average vision-related quality of life score with multifocal IOLs (mean score: 95.4) vs. monofocal IOLs (mean score: 93.5).
However, significantly more patients with multifocal IOLs were spectacle-free for near tasks (78%) than with monofocal IOLs (25.4%) (P < .001). There was no significant difference for distance tasks.
There was also no significant difference in best corrected visual acuity, although uncorrected near visual acuity was better with multifocal IOLs (P < .001).
Kitnarong and colleagues concluded that multifocal IOLs are “safe and can be considered in mild to moderate glaucomatous patients with concomitant cataracts.”
Perspective
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Cataract-related vision correction with IOLs in patients with glaucoma has long been complicated by concerns over glare, halos and reduced contrast sensitivity as the disease progresses. Traditionally, the conservative and safest option has been implantation of a monofocal IOL, which reliably provides stable vision without the added risk for visual disturbances linked to multifocal designs.
In a direct comparison of monofocal and multifocal IOLs in patients with mild to moderate glaucoma, Kitnarong and colleagues found that multifocal IOLs offered greater spectacle independence. However, when assessing overall quality-of-life measures related to vision, scores between the two groups were similar. This suggests that while multifocal lenses may provide convenience, they do not necessarily translate into a better day-to-day visual experience for patients with glaucoma.
Our responsibility as eye care providers is to balance the desire for spectacle independence with the reality of a progressive optic nerve disease. Patients should be informed that while multifocal lenses may offer benefits, they also carry risks that could compromise visual function over time. For patients prioritizing freedom from glasses, I still consider a monofocal IOL to be the safest option. Fortunately, advances in monofocal IOL technology now make it possible to adjust or fine-tune vision, offering greater convenience without significantly compromising contrast sensitivity and thereby preserving safe, functional vision.
Sources/Disclosures
Source:
Kitnarong N, et al. J Glaucoma. 2025;doi:10.1097/IJG.0000000000002622.
Disclosures: The authors report no relevant financial disclosures.
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