Posters

Algorithmic considerations for screening candidates for cataract surgery with multifocal intraocular lens implantation in patients at risk for retinopathy

Poster Details

First Author: S.Sayegh USA

Co Author(s):                        

Abstract Details

Purpose:

We sketch the elements of a quantitative model to allow refractive cataract surgeons to estimate the probability that a patient would develop retinopathy, potentially interfering with benefits provided by a multifocal intraocular lens (IOL), or rendering such IOL suboptimal. The first component of our model evaluates the loss of contrast sensitivity introduced by multifocal intraocular lenses in combination with that caused by retinal disease. The second component of the model analyses epidemiological studies to estimate the degree of retinopathy that a patient presenting for cataract surgery would potentially develop.

Setting:

Private Practice, Champaign, IL, USA.

Methods:

We identify and review the characterization of contrast sensitivity, its central role for high quality vision, and how it affects vision even in the presence of excellent Snellen acuity. We review and present the effects of ocular disease, particularly retinal pathologies, on contrast sensitivity, and use epidemiological data to predict the evolution of retinopathy. We develop a model of the combined effect of multifocal lenses and retinopathy on contrast sensitivity. We then trace a time evolution of the decrease in contrast sensitivity for patients at risk of developing retinopathy throughout their remaining life following cataract surgery.

Results:

Studies utilizing the Pelli-Robson contrast sensitivity chart are demonstrated to cause a reduction in contrast sensitivity for multifocal IOL recipients (as compared to monofocal) as well as amongst patients with retinopathies. With a number of studies predicting millions of new cases of diabetes in the next decade, our model anticipates a significant fraction of these patients developing diabetic retinopathy. Similarly our population based model predicts a sharp increase in macular degeneration in the next ten to twelve years with the result that the rate of developing any type of retinopathy increases exponentially from age 65 to 85 years old.

Conclusions:

For patients with current retinopathies and actual or presumed decreased contrast sensitivity, many surgeons refrain from multifocal lens selection. However, most physicians restrict attention to current or imminent retinopathy. Considering that patients undergoing cataract surgery are often above the age of 65, the probability of developing retinal pathology increases significantly with time. This analysis also becomes of importance when considering younger age of intervention coupled with increased longevity, which could contribute to the combined consequences of multifocal IOL and retinopathies for many years. These considerations need be discussed with the patient as part of the informed consent.

Financial Disclosure:

None