Multifocal intraocular lens implantation in children

May 01, 2014

In children, implantation of a multifocal IOL remains a topic of debate. With lacking evidence on post surgery outcomes and no head-to-head comparison of multifocal IOLs in children, this issue remains to be clarified. Therefore, the authors of this article were prompted to perform research in this area to address a number of concerns among paediatric ophthalmologists.

Why try multifocal at all?

Studies such as the one conducted by Dr Phillip C. Jacobi et al., 2 have shown promising results with the use of multifocal IOLs in children. Children with unilateral cataracts had a satisfactory outcome with multifocal IOLs as per a study by Dr José Cristóbal.3 Multifocal IOLs come with an advantage of promoting binocularity and improved stereopsis. In adult patients, multifocal IOLs considerably reduce the dependability on glasses. There is no evidence whether multifocal IOLs offer similar benefits in children.

Children with bilateral cataracts propose a unique clinical situation because they do not have normal eyes with youthful accommodation. In our study, we selected children older than 5 years of age so that by this time, the growth of the eye has been largely completed.1 Children with bilateral congenital/ developmental cataracts were included in the study.

We compared the performance of two types of multifocal IOLs, AcrySof IQ ReSTOR SN6AD1 IOL (Alcon Laboratories, Fort Worth, Texas, USA) with +3 D add for near and Preziol with +4 D add (Care group, Baroda, India). AcrySof IQ ReSTOR has apodized diffractive optics and Preziol is an aspheric refractive IOL.

Monofocal IOLs used in the study included Sensar OptiEdge (AMO, Santa Ana, California, USA) and Alcon MA60AC or SA60AT IOLs. The children were tested for near and distance visual acuity, fusional status, contrast sensitivity and stereopsis.

Results in brief

However, there was spectacle independence in more than 70% cases with multifocal IOLs over one year follow-up period. It was encouraging to note that multifocal IOLs did not decrease the contrast sensitivity and stereopsis versus the monofocal IOLs.

Apodized diffractive IOLs performed better than refractive IOLs. This means that with development of newer designs of multifocal IOLs, it is certainly possible to achieve good vision without compromising on its quality.