Multifocality comes with trade-offs

January 17, 2022

1 minute read


Holladay JT. Optics and clinical performance: mono IOL, EDOF, pinhole, diff/ref, bifocal and trifocal. Featured at: Hawaiian Eye; January 15-21, 2022; Waikoloa, Hawaii.

Disclosures: Holladay does not report any relevant financial information.

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WAIKOLOA, Hawaii – There is “no free lunch” when matching the right patient to the right IOL, Jack T. Holladay, MD, MSEE, FACS, told Hawaiian Eye 2022.

Jack T. Holladay

“Everything we do has a trade-off if we produce more multifocality,” Holladay said in a presentation discussing the range of intraocular lenses available, from aspherical monofocal lenses to extended depth-of-field, pinhole, bifocal and trifocal lenses.

When examining a monofocal lens, he said doctors should imagine 100 rays passing through an aperture to a “perfect point” and then spreading out.

“What we do with multifocality, whether refractive or diffractive, is we take those rays and move them to a second or third focal point,” Holladay said.

Rays at the far focus have a second image above which creates a halo from the near focus which is out of focus, and there is still a decrease in contrast sensitivity, he said.

“That’s the bottom line. When we go from the aspherical monofocal lens to a trifocal lens, we see an increase in multifocality and we see an increase in depth of field, an increase in the independence of the glasses and a increased glare and halo,” Holladay said.

However, when one of these high-end lenses is properly fitted to the right patient, patients are satisfied, he said.

“Realize that with every increase in multifocality, there’s a trade-off and a trade-off, but if you choose the right patient for their degree, they’ll end up being happy,” Holladay said.

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