AMD genotype worth factoring into multifocal IOL candidate selection

Cataract surgeons would agree that careful patient selection is critical for success with multifocal IOLs. According to Steve Arshinoff, MD, Toronto, Ontario, genetic risk assessment for age-related macular degeneration (AMD) should be among the considerations used when screening patients who are interested in a multifocal IOL.

The issue with implanting a multifocal IOL relates to its effect on decreasing contrast sensitivity. Since AMD also reduces contrast sensitivity, Dr. Arshinoff said he is concerned that there may be a synergistic reduction in contrast sensitivity in an eye with a multifocal IOL that develops even mild AMD.

Therefore, it has become his practice to offer genetic assessment for AMD risk in refractive lens exchange patients and individuals undergoing cataract surgery who want a multifocal IOL. The genetic testing results are then discussed. Patients at high genetic risk for AMD are discouraged from considering multifocal IOLs, but the decision on implant choice is made with the patient.

“The scientific light is just starting to dawn on our understanding of AMD, and with progress in genetic risk assessment for AMD, prediction accuracy now approaches 90%,” said Dr. Arshinoff.

“We need to be careful when making choices for these patients. I believe we should not trade contrast sensitivity to gain depth of field in patients already at high risk for contrast sensitivity loss,” said Dr. Arshinoff.