Update knowledge about Muntifocal IOL made by Asaduzzaman Working as Associate Optometrist in Ispahani Islamia Eye Institute &Hospita, Dhaka 1215 Email:asad.optom92@yaho. com

1. Optometry Care For
Multifocal IOL Implant
Presenter:
Md. Asaduzzaman
Jr.Optometrist
Moderator :
Mr. Riton Deb
Chief Optometrist

2. Multifocal and Accommodating
intraocular lenses are artificial
intraocular lenses (IOLs) that are
designed to provide focus of both
distance and near objects, in
contrast to monofocal intraocular
lenses which only have one focal
point and correct distance vision.
Multifocal IOLs

3. History of Multifocal IOLs
• Hoffer in 1982 was the first to hit upon the
idea of a multifocal IOL after observing a
patient who had 6/6 vision in spite of an IOL
that was decentred by more than 50% of the
pupillary area
• The credit goes to Dr. John Pierce in 1986 who
was to implant the bull’s eye style of the
multifocal IOL.

4. Types of MF IOLs
 Refractive
 Diffractive
 Combination of both

5. REFRACTIVE MFIOLS
Concentric rings of different powers
• 1) Two zone lenses
• 2) Annulus type lens / Bulls eye lens

6. Two Zone Lenses
• Central near vision segment
surrounded by distance vision
segment
• Central section 2mm in
diameter since pupil constricts
during near vision
• When pupil dilates during distance viewing peripheral
distance segment is exposed
• Disadvantage- in bright sunlight
• Poorly tolerated by pts enjoying outdoor sports

7. Annulus Type Or Bulls Eye Lens
• Central most portion –distance
vision
• Surrounded by near vision ring
• Surrounded by another distance
vision ring
• Marked pupillary constriction allows distance
vision,mild constriction allows distance and near
,all 3 segments exposed when pupil is dilated
• Excessive constriction during reading in bright light
blocks near ring –prevents clear near vision

11. DIFFRACTIVE MFIOLS
• This IOL utilizes the principle of diffraction in
conjunction with refraction to create two foci.
• The basic refractive power is provided by the
anterior aspheric surface and the diffractive
power comes from the multiple grooves on its
posterior surface

12. DIFFRACTIVE MFIOLS

14. Refractive & Diffractive MFIOLs

15. AcrySof IQ ReSTOR Multifocal Toric
• Single solution for presbyopic patients who
also present with some astigmatism.
• In addition to its diffractive multifocality and
its toric correction, the lens is aspheric, uses a
single-piece design and has UV and blue-light
filters built in
• 0.5-3D of astigmatism

16. Pre-operative Considerations
• The Patient should have a strong desire to be spectacle
independent. This is the single most important
indication for multifocal lens surgery.
• Age- By and large, it would be better to operate
within the age group 35 to 75.
• Functional & Occupational Requirements -
patient have any hobbies like painting, playing
the piano, playing cards or billiards or is he just
the unusual avid reader?
• Patients often complain of the difficulty in
MULTI TASKING post IOL surgery with
monofocal lens implant.

17. Hypercritical & Demanding Patients
• This class of patients should be strictly avoided.
• One should prefer to operate on those patients
who trust their surgeon’s skills and capability
• It is better to avoid proving ourselves to a cynical
and suspecting patient who remains unhappy no
matter how best we perform.

18. Optometry Care for Multifocal
IOL Implantation
• Patient Selection- The right patient is to be
selected
• Accurate Biometry- IOL master strongly
recommended as optical biometry is
approximetely 10 times more exact. Use of
immersion biometry , would be better choice
than applanation biometry. Cross-checking by 2
technicians, clinical correlation with present or
past refractive error and comparison with fellow
eye is suggested

19. • Power Calculation- Maximize visual outcomes
by calculating for a post-operative refractive
spherical equivalent from Plano to <+0.25. Use
of newer formulae like SRK-T and Holladay are
helpful.

20. Disadvantages Of MFIOLs
• In bulls eye lenses amount of light transmitted for each of focal
length varies with pupil size
• In diffractive lenses image intensity is equal for distance and near
vision but even in ideal situation only one half of light entering
eye is in focus
• Even more light may be lost due to scattering
• Thus pts with MFIOL require brighter light to read well and
generally function less well in dim light

21. Home
Message
• Increase patient comfort
• Check refraction carefully
• Examine the patient with slitlamp

22. Reference
• Theory and practice of optics and
refraction, AK Khurana 3rd edition
• ATLAS ophthalmology pdf web portal
• Current and future IOL choices Where we
stand with MFIOLs, by Stefanie Petrou
Binder, MD
• Source: https://www.eyeworld.org/
• Picture Google and me

23. If any
Question Please ?

24. THANKS ALL