What is your approach to using multifocal or extended depth of focus IOLs in patients with preperimetric glaucoma?

As a glaucoma specialist, my approach may be viewed as more conservative. I completely avoid multifocal lenses in anyone with glaucoma and am very hesitant to recommend EDOF lenses unless there is a compelling argument in favor (patient wants to maximize spectacle independence for distance and inter...

Glaucoma diagnosed via progressive optic nerve damage and not showing perimetry changes is still going to give contrast sensitivity issues. Since MFIOLs also have a reduction in contrast sensitivity, I tend to stay away from this type of lens in patients with glaucoma or highly suspicious for glauco...

IOLs are always about patient selection. There is no one-size-fits-all answer.

I would consider an EDOF lens like the Rayner EMV or Eyehance, but not Synergy or Symfony.

As for multifocal, without any other pathology and well-controlled disease, they could be considered, especially if they are a cur...

Per research, the issue is one of contrast sensitivity loss with MTF IOLs in particular, but also, to a middle lesser degree, EDOF lenses.

In my experience, I have actually placed an MTF lens in a concert bass player for an orchestra because he demanded the full range of vision. He is one of my happ...

I typically use a refractive EDOF IOL. I find it most forgiving with a potential glaucoma defect, which may or may not become an issue. Remember, an EDOF IOL creates a stable point spread function of a small circle across an increased depth of field, typically 18-20” to infinity. I use a refractive ...

I believe it is a quality-of-life issue for the patient. While it is true that MF and EDOF IOLs reduce contrast sensitivity, the patient may not experience significant loss of contrast sensitivity for years, and those are years that the patient may experience improved quality of life by not requirin...

I agree that even diffractive multifocal IOLs should not be reflexively taken off the table for patients with glaucoma. This may have made sense 10-20 years ago when IOL technologies were less refined and when interventional glaucoma treatments were not as widespread and accessible.

Nowadays, there ...

Interesting to see the diversity of opinion. I have no issue implanting the PanOptix lens in patients with visual field loss down to -10MD. Obviously, I'll consider proximity to fixation, but I don't see a reason to penalize my glaucoma patients given the excellent contrast sensitivity of current mu...