How do you approach offering multifocal IOLs to patients with prior retinal pathology and surgery (i.e., mac-off RD) who have had relatively good recovery of vision?  

As a retina specialist, I have seen a significant increase, over recent years, in patients doing badly because someone inserted a multifocal IOL in the context of prior or impending retinal disease. In most of these cases, the patients seemed naive to the implications, reporting that they were told ...

Had a patient in their 60's - had RD repair in their 20s. Had 20/20 visual acuity prior to cataracts. Elected for Multifocal IOLs. Has struggled with them since day 1. Offered exchange, but has stuck it out. Has never been happy with them, even though 20/20 OU uncorrected at distance and near. Decid...

I would offer an extended depth of focus lens like DIBOO. I would counsel the patient that they are not a good candidate for a diffractive multifocal IOL.