Vision outcomes

The relationship between multifocal IOL vision outcomes and pupil size is another issue to consider for glaucoma patients who may have a small or poorly dilating pupil as a result of their medical treatment or pseudoexfoliation syndrome.

"Pupil issues in glaucoma patients relate particularly to the use of refractive design multifocal IOLs since the near vision performance of these implants is decreased with a very small pupil size," Dr. Ahmed said.

IOL centration and stability also are critical for achieving good visual outcomes with multifocal IOLs but may be compromised in glaucoma patients in the presence of pseudoexfoliation syndrome. Furthermore, those eyes may be at increased risk for capsule contraction and anterior capsule opacification, resulting in covering of the peripheral lens and reduction in vision.

"Another question that remains to be determined is whether relative to healthy eyes, glaucomatous eyes with visual field loss are at increased or decreased risk for being affected by multifocal IOL-related dysphotopsias, including halos, blur, and glare," Dr. Ahmed said.