Thursday, June 7, 2012

Toric Multifocal Lens Implant Problem

Question: I had the Mplus Multifocal Toric lens Implant 2 months ago after cataract surgery. I had an episode of flashing lights and seem to have lost the near reading vision, but not my distance vision, in my left eye. My cataract surgeon seems unable to explain why. He checked my eye, and sent me away saying all seems OK with the lens position. There is no detachment of the retina. I did have excellent near vision two weeks after the operation. Also my right eye has shocking ghosting, and star-burst effects and has also developed a rather large annoying floater. Any ideas what I could ask on my next follow up appointment would be helpful.

Answer: First, it is highly probable that your Cataract Surgeon has investigated most if not all of the possible causes. The LENTIS Mplus Toric IOL is a very sophisticated Lens Implant and does require exact positioning as it is a "sector" style multifocal lens implants rather than the more common "ring" multifocal lens implants. A small degree of rotation could in fact eliminate the near vision correction. Typically this would also be associated with some compromise in the distance vision as well as the astigmatic correction would be off axis. Your cataract Surgeon should be able to observe this as with this Lens Implant the orientation marks are quite visible. It is possible that there is some posterior capsular opacification beginning in a position so as also to decrease the near vision considerably. As this progresses if will become obvious and could be remediated with a YAG Laser Capsulotomy if indeed it were the cause. As part of your retinal evaluation to rule out the possibility of detachment it is likely but is worth revisiting the health and integrity of the Macula and have an Ocular Coherence Tomogram(OCT) to be certain that the Macula and underlying spaces are healthy.

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