Unhappy Patient with Two Different Diffractive IOLs

Gerd U. AuffarthGermany Speaker Unhappy Patient with Two Different Diffractive IOLs.Title: Unhappy Patient with Two Different Diffractive IOLs Author: Gerd U. Auffarth This is a case report about a 76-year-old patient who attended my clinic in 2008. He underwent cataract surgery on his right eye and an IQ Restor SN6AD1 was implanted. The second eye was not operated on for almost nine years, and then, in 2017, the patient underwent cataract surgery on the left eye. Interestingly, a different surgeon performed the surgery and said that the original intraocular lens (IOL) was no longer available, so a Tecnis Symfony ZXR00 was implanted instead. The patient was not satisfied with the outcome. He complained of blurred vision, could not read road signs while driving, and had different colour perception in both eyes. He noticed that the image in his right eye with the blue filter lens appeared more brown than the image in his left eye, and he could not get used to this over the years. In daily life, this was very bothersome for him. The patient complained that the doctors tried several corrective lenses and PCO laser was performed on the right eye. All without any positive effect on this vision. The results of the visual acuity examination were: uncorrected 20/30 in both eyes and 20/25 binocularly for distance. For near vision, it was 20/40 in both eyes and 20/30 binocularly. His refraction was +0.5, -0.25 @ 130° in the right eye and +0.25, -0.5 @ 77° in the left eye. The patient was not satisfied with the visual outcome and the different optics, as the AcrySof IQ Restor is a multifocal IOL with a 3.0 near addition and a blue light filter, whereas the Tecnis Symfony has an extended depth of focus design and no blue light filter. The surgical options were IOL explantation of one or both lenses and reimplantation of either a monofocal or another multifocal intraocular lens. However, the previous laser capsulotomy on the right eye could be problematic for this. In addition, the patient did not want any extensive surgery. The aim was to help him by achieving good binocular visual performance, with particular focus on visual quality and balanced performance. Visual acuity was not really something that could be addressed. In the end, the patient received a special pinhole add-on lens (Morcher Extrafocus). This is a pinhole optic with a central opening of 1.3 mm, which was placed in the right eye. This reduced the amount of light entering the eye and consequently diminished colour perception, which made the visual impression more similar to that of the left eye. One week after the surgery, the patient was extremely satisfied, especially because he could see and read in balance. Visual acuity remained at 20/30, similar to before. However, after two months, his visual acuity had improved on both sides between 20/25 and 20/20, and it was 20/20 for distance and near vision as well. He is now a very satisfied patient as he wouldn't say there is a big difference between his right and left eyes, he doesn't need glasses anymore, and his quality of life has improved.