Table Of ContentEssentials in Ophthalmology
Series Editor: Arun D. Singh
Jorge L. Alió
Joseph Pikkel E ditors
Multifocal
Intraocular
Lenses
The Art and the Practice
Second Edition
Essentials in Ophthalmology
Series Editor
Arun D. Singh
More information about this series at http://www.springer.com/series/5332
Jorge L. Alió • Joseph Pikkel
Editors
Multifocal Intraocular
Lenses
The Art and the Practice
Second Edition
Editors
Jorge L. Alió Joseph Pikkel
Research & Development Department Department of Ophthalmology
and Department of Cornea Assuta Samson Hospital
Cataract, and Refractive Surgery Ashdod
VISSUM Corporation and Miguel Israel
Hernández University
Alicante Ben Gurion University
Spain School of Medicine
Beer-Sheva
Israel
ISSN 1612-3212 ISSN 2196-890X (electronic)
Essentials in Ophthalmology
ISBN 978-3-030-21281-0 ISBN 978-3-030-21282-7 (eBook)
https://doi.org/10.1007/978-3-030-21282-7
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To our dear wives and children who follow us along the routes
of medicine, encourage, and support us – the reason for all that
we do and the joy of our lives, and to our patients from whom
we have received the inspiration and expertise to build up the
second edition of this book.
Jorge L. Alió and Joseph Pikkel
Alicante (Spain)/Safed (Israel)
Fall 2019
Preface
In our modern world, now on the first quarter of the twenty-first century,
medicine faces, more than ever before, the challenge of not only fighting
diseases and saving lives but also improving quality of life. While life expec-
tancy rises, patients’ activities remain at the same level that they were used to
being young and hence their visual demands keep being high. While in previ-
ous decades older people tended to lessen their activity, nowadays older peo-
ple do not reduce daily activities as driving, sport activities, and various
hobbies that require good visual acuity to different distances and are more
convenient if multifocality exists.
This evolution derived – among other things – new techniques and new
approaches of cataract surgery. The evolution of cataract surgery and IOL
implantation during the last decade has been, not surprisingly, focused on
improving the quality of vision and the quality of life of our patients.
Near vision and intermediate vision have been identified as one of the
reasons by which quality of life is really acknowledged by our patients.
Another trend in recent years is the tendency to operate younger patients than
before with better visual acuities, even with mild cataracts, which means that
patients are less tolerant to visual disabilities, and moreover the advances in
refractive surgery have educated them in their request for spectacle indepen-
dence. While usually we succeed in achieving good far vision without spec-
tacles or contact lenses, optimal multifocality for far, intermediate, and near
vision is still a challenge to be met.
Since multifocal lenses, by definition, divide light into different foci, using
multifocal intraocular lenses causes a dispersion of the energy of light enter-
ing into the eye and, consequently, distributing the light in different foci. This
causes a change in distribution of light and images at the level of the visual
function at the level of the retina. This is the reason why neuroadaptation,
which means the capability of the brain to adapt to changes, is necessary to
adjust neurophysiology to the changes that are induced in the quality of the
retinal image by dispersion of light. Moreover, the overlapping of different
foci is neither physiological nor normal in the human or animal evolution. To
the best of our knowledge, no visual system is multifocal in nature and it has
not existed in the human being throughout evolution. For this reason, neuro-
processing is the main challenge of multifocal intraocular lenses. The new
technologies emerging in recent years have aimed at smoothing the changes
in visual perception and to make a much more physiological division of light,
vii
viii Preface
but even in these conditions, their effectivity has to be demonstrated and con-
firmed by an improvement in the subjective quality of vision of the patient.
About four years ago we published the first edition of this book which was
welcomed by many ophthalmologists around the world. In recent years, a
tremendous advance in the field of multifocal intraocular has been made. In
this second edition, we bring the updated information on multifocal intraocu-
lar lenses techniques and about lenses available in the market today as well as
our personal experience on the subject. The main aims of this book are how
the practical ophthalmologist and ophthalmic surgeon can select an adequate
multifocal intraocular lens, how to differentiate them among the different
technologies, how to identify the best on the market, and how to use evidence
in favor of the selection of the best for the benefit of the patients.
We hope that the reader will find this book useful for the purpose for which
it was created, independent opinion, information, and credibility, and also
unbiased information on the subject of multifocal intraocular lenses, which is
constantly progressing and takes more and more part in our daily clinical
practice. If we achieve this goal, the time and work dedicated to this book will
be worthy.
Alicante, Spain Jorge L. Alió
Ashdod, Israel Joseph Pikkel
Contents
1 Multifocal Intraocular Lenses: What Do They Offer Today? . . . 1
Jorge L. Alió and Joseph Pikkel
Part I H istorical Background and Clinical Indications
2 Multifocal Intraocular Lenses: Historical Perspective . . . . . . . . 9
Kenneth J. Hoffer and Giacomo Savini
3 Multifocal Intraocular Lenses: Basic Principles . . . . . . . . . . . . . 31
Vicente J. Camps, Juan J. Miret, María T. Caballero,
David P. Piñero, and Celia García
4 Multifocal Intraocular Lenses: Preoperative
Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Jorge L. Alió and Joseph Pikkel
5 Multifocal Intraocular Lenses: Neuroadaptation . . . . . . . . . . . . 53
Jorge L. Alió and Joseph Pikkel
6 Multifocal Intraocular Lenses: Considerations
in Special Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Jorge L. Alió and Joseph Pikkel
7 Multifocal Intraocular Lenses and Corneal Refractive
Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Jorge L. Alió and Joseph Pikkel
8 Multifocal Intraocular Lenses: Complications. . . . . . . . . . . . . . . 73
Roberto Fernández Buenaga and Jorge L. Alió
9 Multifocal Intraocular Lenses: Postimplantation Residual
Refractive Error . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Maja Bohac, Ante Barisic, Sudi Patel, and Nikica Gabric
10 Multifocal Intraocular Lenses: Solutions
for the Unhappy Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Richard B. S. Packard
11 Multifocal Intraocular Lenses: Neuroadaptation Failure
Corrected by Exchanging with a Different Multifocal
Intraocular Lens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Olena Al-Shymali and Jorge L. Alió
ix
x Contents
Part II M ultifocal Intraocular Lenses: Types and Models
12 Multifocal Intraocular Lenses: Types and Models . . . . . . . . . . . 123
Michael Mimouni and Jorge L. Alió
Part III The Zeiss Family Multifocal IOLs
13 Multifocal Intraocular Lenses: AT LISA tri 839 MP . . . . . . . . . 177
Peter Mojzis, David Pablo Piñero, and Jorge L. Alió
14 Multifocal Intraocular Lenses: AT LISA Tri
Toric 939 M/MP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Peter Mojzis
15 Multifocal Intraocular Lenses: AT LISA 809 Diffractive
Bifocal Intraocular Lens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Ana B. Plaza-Puche and Jorge L. Alió
16 Multifocal Intraocular Lenses: The Hanita Family
of Lenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Jorge L. Alió, Alfredo Vega-Estrada, and Ana B. Plaza-Puche
17 Multifocal Intraocular Lenses: The Acriva Family
of Lenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Minoru Tomita
Part IV The Alcon Family Multifocal IOLs
18 Multifocal Intraocular Lenses: AcrySof ReSTOR®
SN6AD2 + 2.5 D Lens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Rodolfo Mastropasqua, Francesco Aiello, Emilio Pedrotti,
and Giorgio Marchini
19 Multifocal Intraocular Lenses: AcrySof ReSTOR
SN6AD1 Lens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Ana B. Plaza-Puche and Jorge L. Alió
20 Multifocal Intraocular Lenses: AcrySof IQ PanOptix
Trifocal Lens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
Ana B. Plaza-Puche and Jorge L. Alió
21 Multifocal Intraocular Lenses: The Johnson and Johnson
Family of Lenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Béatrice Cochener-Lamard
22 Multifocal Intraocular Lenses: FineVision (PhysIOL)
Lens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Verónica Vargas and Jorge L. Alió
23 Multifocal Intraocular Lenses: Fyodorov Gradiol . . . . . . . . . . . . 279
Boris Malyugin, Tatiana Morozova, and Valentin Cherednik
