Tuesday, April 26, 2011

Multifocal Lens Implant for AMD

Question: My mother is 67 years old and has age related macular degeneration (AMD) and she went through the laser treatment for that twice. The treatment was performed 5 year ago. She has been fine since then but her vision has never been the same.


She developed a cataract in the same eye almost 2 year ago. Initially the eye doctors asked her to wait till the cataract grows. It’s been 2 years and the eye doctor has suggested that she should get the cataract surgery done. I have 2 questions.

1. She does not feel any discomfort- Should we still get the surgery done?
2. The eye doctor has said you can have a multifocal lens implant rather than a monofocal lens implant. But online I found that if you have AMD - bifocal cataract lens are not the best choice. Please advise.

Answer: You do not state the level of vision that your mother had after the laser treatment for Macular Degeneration. You also do not state what her level of vision is today with the Cataract and the Macular Degeneration. These would be important for you to understand so that you could get some approximation of what her best vision was as a result of the Macular Degeneration and then how much it has deteriorated from the formation of the Cataract.

It would not be expected that your mother would experience any “discomfort” from the development of a Cataract but it might be expected that she is disturbed by the loss of clarity, distortion of colors, glare and shadows that are common symptoms of Cataracts. It may also be that she had adapted to using the better eye without Macular Degeneration and without a Cataract as it is a much “better seeing” eye. This would explain her lack of Cataract symptoms.

In general the decision to have Cataract Surgery is made by the patient when the vision and symptoms are disturbing enough that they would like to see better. Sometimes however there are medical reasons that a Cataract Surgeon might suggest that a patient proceed with Cataract Surgery even if it doesn’t seem that bad. For example, some patients have a very “narrow iris angle” that can predispose the patient to narrow angle glaucoma if a Cataract becomes too large. Sometimes, the Cataract is just dense enough so as to blur the eye doctor’s view of the Retina and Macula, making it too difficult to effectively follow the health and stability of the eye and thus they recommend the Cataract be removed.

The use of multifocal lens implants (IOL) to correct near vision really requires a healthy Macula in most cases. Each multifocal lens design does have some optical compromise which is not typically compatible with Macular Degeneration. However there are exceptions and you should probably seek a second opinion from a top Cataract Surgeon in your area who will evaluate both the need and benefit of the surgery as well as the potential benefit of the multifocal lens in your mother’s case.

Important Note: The information presented on the See With LASIK Blog or provided in response to a request for information in the Ask LASIK Surgeons section on http://www.seewithlasik.com/ is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to LASIK. In particular a response to an inquiry made on the Ask LASIK Surgeons section of http://www.seewithlasik.com/ is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and LASIK surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

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