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Question:
I am considering lens replacement surgery — not for cataracts but to be free of glasses. Is it correct that I should avoid multifocal lenses if I’m at risk of age-related macular degeneration (AMD)? I had "flecks" in my eyes indicating that I may be at risk in the future.

Answer:
This is an excellent question and you will likely get a very different answer depending on whom you ask. There are ophthalmologists who are concerned about multifocal technology and rarely use it, if at all, and there are others who recommend it for the majority of their patients. Neither are wrong. Many ophthalmologists will agree that for the appropriate candidate multifocals are a great option and we have many patients thrilled to be done with glasses.

Unfortunately there are other patients who see very well after multifocals but complain about experiencing reduced night vision and seeing halos and glare. Many of those patients with complaints are still satisfied because they are willing to trade the complaints for not wearing glasses. Rarely, a patient is very dissatisfied to the point of having to have the multifocal exchanged for a monofocal. The problem is, sometimes we cannot know which patient will fall into which category. Many believe that, despite studies showing excellent optics with a multifocal, a multifocal by its very nature will compromise aspects of visual quality. More prudent surgeons then will avoid recommending multifocals in patients with any additional eye condition that can also compromise optics of the eye and vision. Disorders such as dry eye and other ocular surface diseases or corneal diseases would be in this category. Also any disease which affect the macula such as diabetic retinopathy or age-related macular degeneration would also fall into this category. So the decision to use a multifocal must take into account the existence of these conditions and whether they should be treated first or perhaps a multifocal should not be used.

I am assuming your description of "flecks" means you have drusen in the macula. In my experience a few small drusen don't necessarily lead to clinical age-related macular degeneration. So the question becomes, "Maybe I am a candidate now but what will happen if I get significant dry eye or macular changes in the future? Will having a multifocal lens cause me to have worse symptoms in the future than if I had a monofocal?" These questions have not been answered. The calculation becomes what are your present and future risks. You may be the type of person who discounts future risks or overemphasizes them—you have to know who you are.

At the risk of getting many disagreements from my colleagues I will say this: Refractive lens exchange with multifocal lenses is generally most effective in those over age 50 and with NO coexisting ocular problems. Furthermore, if you find yourself in a practice that seems to be very strongly in favor of proceeding with this surgery but that fails to engage in the type of discussion that I have attempted here then perhaps additional opinions will be warranted.

Answered by: Gary Hirshfield, MDDr. Gary Hirshfield

Categories: Eye Surgery, Eye Conditions, Vision Correction

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Answered: Jul 21, 2014

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