Is a Multifocal Intraocular Lens Right for My High Myopia?

Am I suitable for multifocal intraocular lenses?

Hello Dr.
Chang,
I am 31 years old and have high myopia.
I recently underwent an evaluation for myopia surgery at the hospital.
Here are the examination details I remember: my myopia is approximately 1100-1200 degrees in both eyes, with astigmatism around 125-200 degrees.
My corrected visual acuity is 1.0 in both eyes, corneal thickness is 480 micrometers, endothelial cell count is 2300, pupil size is 7 mm, intraocular pressure is normal, and the anterior chamber depth is normal.
The fundoscopic examination was normal, and the doctor noted that my retina and macula appeared healthy, which is atypical for someone with high myopia.
Therefore, despite my high myopia, I can still achieve a corrected vision of 1.0.

In conclusion, the doctor mentioned that my cornea is not thick enough for laser surgery, leaving me with two options: implantable contact lenses or an implantable multifocal intraocular lens (Tecnis multifocal IOL).
The doctor indicated that the implantable contact lens is only 6 mm, while my pupil is 7 mm, which would likely cause glare issues.
He also mentioned that I currently have mild cataract formation, and it is estimated that I may develop cataracts in about ten years.
Thus, he does not recommend the implantable contact lens and suggests considering the multifocal intraocular lens to address both my current myopia and potential future cataract issues.
I would like to ask you the following questions:
1.
If we disregard the risks and costs associated with surgery, what are the potential side effects of the multifocal intraocular lens? Will I be able to achieve my current visual acuity of 1.0 after the lens is implanted?

2.
What does mild cataract entail? I do not currently experience any visual blurriness.
Will it inevitably worsen? Are there any medications or dietary supplements that can help manage mild cataracts?

3.
I have heard about a type of foldable soft implantable contact lens.
Is it approved in Taiwan?

4.
If I choose laser surgery to reduce my prescription to 500 degrees, will there be any visual issues if I then wear glasses afterward?

5.
I have intermittent allergic rhinitis, and sometimes I unconsciously rub my nose or eyes at night.
Occasionally, I wake up with red, itchy, and gritty eyes.
I am unsure how hard I rub, but I know it is self-inflicted.
Given this situation, would it still be appropriate for me to consider laser corneal surgery, implantable contact lenses, or an implantable intraocular lens? Could rubbing my eyes affect the laser correction or displace the artificial lens?

6.
If I choose not to undergo any surgery and want to wear glasses, what type of lenses can minimize the appearance of thickness in high prescriptions?
Thank you in advance for your answers.
Best regards,
Ah Wei

Awei, 30~39 year old female. Ask Date: 2006/08/19

Dr. Zhang Yanrui reply Ophthalmology

Given your condition, with a visual acuity of 1.0, it is unlikely that any physician would strongly recommend cataract surgery; especially since you are only in your thirties and have good accommodation ability of your natural lens.
Artificial lenses do not have the ability to accommodate.
Multifocal intraocular lenses can allow you to see both distant and near objects clearly, but they may cause halos and reduced contrast sensitivity, making them functionally inferior to your natural lens.
Unless you are over 42 years old and have presbyopia, you may find that your visual function would not be as good as with your current lens.
Additionally, your cornea is too thin for refractive surgery; attempting it could leave residual refractive error and would not achieve the goal of eliminating your glasses.
If it is not absolutely necessary, wearing glasses remains the safest option.
Typically, glass lenses, being smaller in area, are less likely to cause halos.
For more detailed information about glasses, you may consult a qualified optometrist.

Reply Date: 2006/08/19

More Info

When considering whether a multifocal intraocular lens (IOL) is appropriate for someone with high myopia, several factors must be taken into account, including the specific visual needs, the degree of myopia, and any potential future complications such as cataracts. Given your situation, let's address your questions one by one.

1. Multifocal IOL Side Effects and Visual Acuity: Multifocal IOLs are designed to provide clear vision at multiple distances, which can be particularly beneficial for individuals who wish to reduce their dependence on glasses for both near and distance vision. However, some common side effects include glare, halos around lights, and reduced contrast sensitivity, especially in low-light conditions. While many patients achieve satisfactory vision post-surgery, it is essential to understand that achieving the same level of visual acuity (1.0 in your case) may not be guaranteed. The outcome can vary based on individual healing responses and the specific characteristics of the lens used.

2. Understanding Mild Cataracts: Mild cataracts refer to the early stages of cataract formation, where the lens of the eye becomes slightly cloudy but does not significantly impair vision. Many individuals with mild cataracts may not notice any changes in their vision. However, cataracts typically progress over time, and while there are no medications or dietary supplements proven to reverse cataract development, maintaining a healthy lifestyle and regular eye check-ups can help monitor their progression.

3. Soft Foldable Intraocular Lenses: Soft foldable IOLs are indeed available and have been approved in various regions, including Taiwan. These lenses can be implanted through smaller incisions, which may lead to quicker recovery times and less postoperative discomfort. However, the choice of lens should be discussed with your ophthalmologist to ensure it aligns with your specific needs and eye anatomy.

4. Laser Surgery for Myopia Reduction: If you opt for laser surgery to reduce your myopia to around 500 degrees, you can still wear glasses afterward. However, it is crucial to consider the potential for visual imbalance if there is a significant difference in prescription between your two eyes. Ideally, the difference should be kept within 200-400 degrees to minimize issues with depth perception and visual comfort.

5. Impact of Allergies on Eye Procedures: Your intermittent allergic rhinitis and the habit of rubbing your eyes can pose risks to any eye surgery. Rubbing can lead to complications such as corneal abrasions or dislocation of an IOL. It is essential to manage your allergies effectively and discuss your symptoms with your ophthalmologist before proceeding with any surgical options. They may recommend treatments to alleviate your symptoms and ensure your eyes are in optimal condition for surgery.

6. Choosing Glasses for High Myopia: If you decide against surgery and wish to wear glasses, consider high-index lenses. These lenses are thinner and lighter than standard lenses, which can help reduce the "coke bottle" appearance often associated with high prescriptions. Additionally, aspheric lenses can provide a flatter profile and improved aesthetics while maintaining optical quality.

In conclusion, the decision to proceed with multifocal IOLs or any surgical intervention should be made after thorough discussions with your ophthalmologist, considering your lifestyle, visual needs, and any potential risks. Regular monitoring of your eye health, especially given your high myopia and mild cataracts, is crucial to ensure the best possible outcomes for your vision.

Similar Q&A

Choosing the Right Intraocular Lens for Cataract Surgery: Monofocal vs. Multifocal

Hello, Director! I would like to ask a question. My right eye has a myopia of -17.50 diopters and has cataracts, and I will be undergoing surgery soon. My left eye has a myopia of -10.00 diopters and a slight cataract, with both eyes having astigmatism of about -2.50 diopters. In...

Dr. Ke Meilan reply Ophthalmology
If I were a patient, I would choose monofocal lenses to achieve better vision and wear reading glasses for close-up tasks. Wishing you health and safety, Ophthalmologist Dr. Ke Mei-Lan.

Understanding Artificial Lenses for High Myopia: Risks and Recommendations

Due to my high myopia (around -1400 diopters with -300 astigmatism), I recently visited an ophthalmologist who suggested that if I were to undergo surgery, I should consider using an artificial intraocular lens. I would like to ask the director: 1. With high myopia, even if the...

Dr. Cai Wenyuan reply Ophthalmology
1. Yes. 2. 3. No comment.

Can You Use Different Intraocular Lenses for Each Eye?

Hello, I usually spend a lot of time on the computer, read newspapers, and use my phone less frequently, with less emphasis on long-distance vision. However, I have high myopia and over 100 degrees of astigmatism. If I wish to reduce my dependence on glasses after surgery, can I ...

Dr. He Jianxian reply Ophthalmology
Using different artificial lenses for each eye primarily depends on the individual’s specific condition, which can vary. As long as the patient can adapt, it is not an issue; however, if adaptation is not possible, it can become problematic. This cannot be assessed in advance. Dr...

Understanding Intraocular Lenses: Cataracts, Glaucoma, and Vision Clarity

1. Why are multifocal intraocular lenses not suitable for patients with glaucoma? 2. Are aspheric intraocular lenses suitable for glaucoma patients? Do they have side effects? After surgery with aspheric intraocular lenses, will patients still experience blurriness when looking...

Dr. Ke Meilan reply Ophthalmology
Hello: 1. If the pupil is too small, it may not be suitable; if the vision is too poor, then the multifocal lens may not provide adequate results. 2. Generally, it can be used without side effects. Yes, because it is aspheric, it does not have multifocal capabilities. 3. National...