Patients recently shared their postoperative experiences and the changes that refractive lens surgery brought to their lives with an audience at Augenklinik Mainfranken, a centre in Schweinfurt, Germany, specializing in cataract and refractive surgery. The purpose of the session, which was conducted by Dr Harry Domack, the centre's leading surgeon, was to evaluate the influence the implantation of a modern MIOL can have on the quality of daily life. The two things all these patients had in common: they did not suffer from an 'average' refractive error but rather from high myopia, hyperopia and/or severe astigmatism. They received an AT.LISA 366D, a modern one-piece, 4-haptic multifocal lens. Those with corneal astigmatism received an AT.LISA toric 466TD, which has the same design as the AT.LISA but comes with an aspheric toric anterior surface and an aspheric diffractive structure on its posterior surface.

"Now I see things like everybody else!"

Klaus H., 47 years old, had a different refractive problem: high hyperopia and considerable astigmatism (Right eye: +9,25; cyl. -2,25 @ 7°, left eye: +8,75; cyl. -3,00 @ 170°). The computer specialist was severely restricted with his contact lenses which could not provide him with a better visual acuity than 0.6/0.7. Klaus's visual acuity now is 1.2 (decimal) for far and 1.25 (decimal) for near vision; without additional glasses.

"I wanted to undergo surgery", Klaus says, "to be finally able to see like a normal human being. Now, I work 8 hours a day without major problems after putting the computer in a position that is most suitable for me." Klaus also sees some halos at night when driving, but says they have diminished since his operations in November: "They have no influence on my night driving. On the contrary, the reflections and halos I have seen around light sources when I was wearing my contact lenses were worse." He has not noticed any change in his colour perception. He does not see any glare at night. Asked about his satisfaction, he answers immediately: "One hundred percent!" adding: "It is a completely new life. The increase in quality of life is remarkable! Now I see things like everybody else – something that most people do not fully appreciate."

Oculus ultimus

A cold chill runs down the spine of even the most intrepid ocular surgeon when faced with the prospect of operating on a patient with only one functional eye. Until recently, most surgeons would be planning such a cataract operation with great caution, generally setting the date for intervention at a stage of the disease when visual comfort had already markedly deteriorated.

Peter W., a 49-year old bank accountant from Germany, lost his eye in a childhood accident. He considers himself lucky that a reluctant approach to lens surgery as a means of getting rid of a refractive error has given way to an optimistic attitude. This has been bolstered by recent advances in small-incision surgery and by state-of-the-art multifocal intraocular lenses. Peter felt more and more uncomfortable with the constant switching from his glasses for distant vision (he was myopic, -3.5 dioptres) to near vision and equally irritated by not being able to wear regular sunglasses. He consulted his ophthalmologist and learnt about the potential of the latest MIOL and the operation itself. So, in October 2008, he underwent a clear lens extraction. His lens was removed after the surgeon performed a minimal incision; then an AT.LISA 366D IOL (Carl Zeiss Meditec) with a refractive power of +14 dioptres was implanted in an operation that was completely devoid of any complications.

Peter laughs when recalling his experience: "It took me about eight to twelve weeks to get used to the iintraocular lens. Every morning after waking up I reached for my glasses – until I realized that I did not need them anymore!" He now works a couple of hours a day on his computer without any major problems. The same applies to driving – Peter drives about 30,000 kilometres a year: "Over the first few weeks I was a bit irritated by the red lights at night which looked quite different to me. It took a bit longer, approximately half a year, to get used to oncoming headlights at night. There certainly was an initial sense of being blinded by them. But now, it's alright. I have no trouble recognizing colours; I have what I would call a perfect night vision. It is not that I'm avoiding driving in the dark – I really prefer to start my vacation trips at night when the highway is not jammed." Does he see halos at night – one of the most widely reported optical phenomenon after MIOL implantation? "Not really. They're there – but I just do not notice them." His hobby is his motorbike so now he has reason to enjoy it more than ever: "I just put on sunglasses; no stopping at the roadside and take a look at the map. It's just a new freedom."