IOL selection important in patients with retinal disease

Reviewed by Timothy W. Olsen, MD

Take-home: When dealing with patients with retinal disease, macular disease, or a meaningful risk of retinal detachment, certain types of IOLs should be avoided due to potential complications.

For routine cases, cataract surgeons should choose whatever type of intraocular lens (IOL) they prefer for their patients. However, in patients with retinal disease, or a risk of retinal detachment, certain IOLs should be avoided due to their potential complications.

Timothy W. Olsen, MD, discussed the selection of the type of IOLs that surgeons should use for such cases–from a retina surgeon’s perspective. Dr. Olsen is professor of ophthalmology, chairman emeritus, Emory University, Atlanta.

In routine cases with no retinal disease, or in low-risk eyes, cataract surgeons should choose the lens they feel best meets the patient’s need. However, when there are risks of retinal disease, retinal detachment, such as in high myopes with extensive lattice degeneration, macular disease, or a strong family history of macular disease, certain types of IOLs should be avoided due to association with problems in certain conditions.

IOLs that should be avoided include silicone, multifocal, or hydrophilic acrylic lenses. In general, retina surgeons are aware that plate-style lenses are more likely to dislocate into the posterior segment.

Silicone lenses

Dr. Olsen explained that silicone lenses are not a good choice if the patient may need retina surgery in the future. These lenses can make vitreous surgery difficult by limiting visibility, and the lens may need to be explanted. Further, silicone oil adheres to these lenses and diminishes the patient’s quality of vision.

In patients with maculopathy, or potential for macular disease, multifocal IOLs are a concern. These patients carry a higher risk of being unhappy with the quality of their vision. The reason for this is not yet known.

“It may be due to a reduced level of contrast sensitivity in some cases and exaggerated metamorphopsia in cases of epiretinal membranes or with macular edema,” Dr. Olsen suggested.

Hydrophilic acrylic lenses have a risk of opacities from calcification that may necessitate lens replacement. If a patient receives an anterior segment or posterior segment gas bubble in a future procedure, that can induce a calcification process and opacification in these lenses.

Blue-blocking IOLs

Blue-blocking IOLs

Another consideration is whether or not to use a blue-blocking IOL. These lenses reduce the amount of blue and violet (shorter wavelength) light in the eye. However, there is no consensus on the value of using these lenses.

Mainster and Turner have provided a comprehensive discussion about this topic.¹ They concluded that the use of blue-blocking IOLs offers no evidence-based medicine. They pointed out that most age-related macular degeneration (AMD) occurs in phakic adults, 60 years and older, despite crystalline lens photoprotection that is greater than that of blue-blocking IOLs. If light is involved in AMD pathogenesis, senescent crystalline lenses cannot prevent it and neither can blue-blocking IOLs.

Obviously, it is important to make the best IOL selection for each patient. Considering the patient’s current and future eye health will provide the best information for the proper decision.

There are clear reasons why certain lenses should not be used in some patients. This should be discussed with the patient and an informed decision made. For an optional choice, such as the blue-blocking lenses, educating the patient on what is known can be helpful to allow them to be involved in the decision.

Reference

1.    Mainster MA, Turner PL. Blue-blocking IOLs decrease photoreception without providing significant photoprotection. Surv Ophthalmol. 2010 May-Jun;55(3):272-89. doi: 10.1016/j.survophthal.2009.07.006. Epub 2009 Nov

Timothy W. Olsen, MD

P: 404-778-4996

E: tolsen@emory.edu

This article was adapted from a presentation that Dr. Olsen delivered at 2017 American Society of Cataract and Refractive Surgery annual meeting. Dr. Olsen has no financial disclosures relevant to this topic.