Trifocal guidelines for best results

Stable tear film and accurate biometry and toric alignment improve outcomes

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Matteo Piovella MD
Trifocal intraocular lenses (IOLs) are a good choice for many cataract patients because they provide good vision at far, intermediate and near distances.However, a good tear film and ocular surface, careful biometry and accurate toric alignment are critical for preserving vision quality, said Matteo Piovella MD, of Monza, Milan, Italy, at the ASCRS Virtual Meeting 2020. Dr Piovella stressed that getting toric lenses properly aligned is essential to preserve the integrity of the image transmitted to the retina. To ensure proper axis alignment, he uses the microscope mounted Callisto marker-less digital system and the IOLMaster 700 TK (Carl Zeiss Meditec), which measures both the anterior and posterior corneal surfaces. This combination is the best for avoiding alignment errors due to cyclotorsion, he said, noting that it is not possible to do this manually. Accurately measuring the corneal surface and other biometric parameters requires a stable corneal tear film, Dr Piovella emphasised. To ensure functional Meibomian glands and tear film quality, he provides BlephEx (BlephEx) to remove debris on the lid margin and LipiFlow (Johnson & Johnson Vision) thermal treatment to liquify and remove impacted lipid build-up in the Meibomian glands to all patients receiving multifocal IOLs. The Right Lens Dr Piovella has used the AT Lisa Trifocal since it became available in 2012. He noted that early bifocal IOLs lacked intermediate vision needed for computers, mobile phones and tablet devices. For this reason, trifocal lenses have largely replaced bifocals in countries where they are available. Dr Piovella’s experience bears out the promise of trifocal technology. He reported on 491 eyes in 269 patients implanted with the AT Lisa Trifocal followed for a mean of five years. Of these, 222 had bilateral implants, with 77 both trifocal IOLs, 108 both trifocal toric IOLs and 37 with one of each. In the entire bilateral implant group, 95% reached a spherical equivalent within 0.5D of target, with 80% reaching it in both eyes. In the bilateral trifocal group, 94% had one eye within 0.5D and 84% had both eyes, while the bilateral toric group had 96% and 83% respectively. Sphere equivalent and uncorrected distance visual acuity remained excellent and stable for five years. Overall, just 2% of patients reported using spectacles sometimes for near vision. Dr Piovella had them implanted in his own eyes in 2014. Matteo Piovella: piovella@piovella.com
Tags: trifocal intraocular lenses