What are multifocal lens implants, and who are they most suited for?

Written by: Mr Vaughan Tanner
Published: | Updated: 07/12/2022
Edited by: Conor Lynch

In this article below, multifocal lens implants are the topic of discussion as highly distinguished and experienced consultant ophthalmologist, Mr Vaughan Tanner, explains what multifocal lens implants are, and who they are best suited to.

What are multifocal lens implants?

The standard lens used in cataract surgery is a monofocal implant designed to provide patients with good vision at either near or distance, with glasses required for the rest of focused vision. Multifocal implants are designed to reduce the requirement for spectacles at more than one distance. 

 

Most patients having either cataract surgery or refractive lens exchange would choose to be set predominantly for distance vision without glasses. The use of a multifocal implant or an extended depth of focus implant would then be aimed at decreasing the need for glasses to focus on intermediate vision (dashboard, large print, computer use) and near vision (reading smaller print). 

 

Multifocal lenses aim to reduce the overall requirement for spectacles at all distances, but are associated with greater side effects than extended depth of focus implants, which aim to reduce requirement for distance and intermediate glasses.

 

Who are they most suited for?

Multifocal implants are only suitable in those with otherwise perfect eyes and whose eyes are prepared to tolerate the most common side effect of glare and halo around bright lights. Extended depth of focus implants are more forgiving in terms of side effects and are suitable for more people, including those with other minor eye problems. 

 

How is extended depth of focus achieved?

Both multifocal and extended depth of focus implants work by splitting light energy into a distance, intermediate or near focus point. There have been great advances made recently, particularly in extended depth of focus implants. 

 

My current implant of choice is the Alcon Vivity extended depth of focus implant. This uses what Alcon refer to as X-Wave technology to create two smooth surface transition elements on the surface of the lens that stretch and shift the wavefront of light. 

 

This allows a wider range of focused image compared with a monofocal lens, helps decrease the need for spectacles, and avoids the side effects associated with stronger multifocal implants.  Approximately 90 per cent of patients with the Vivity implant rarely or never need to wear glasses for distance and intermediate work, with around 50 per cent of patients not requiring glasses for near-distance work. 

 

How long do they last?

Implants are usually lifelong with no requirement for replacement.

 

Are there any risks or side effects?

True multifocal implants (trifocal) are associated with visual disturbances such as glare, rings around headlights at night, starbursts, and some problems in dim lighting. However, the Vivity extended depth of focus implant has a much better side effect profile. In fact, the rate of visual disturbance with the Vivity implant is only very slightly higher than that seen in patients with a standard single focus lens. 

 

If you are considering multifocal lens implants, don’t forget you can book a consultation with Mr Vaughan Tanner via his Top Doctors profile today

By Mr Vaughan Tanner
Ophthalmology

Mr Vaughan Tanner has over 20 years experience as a senior consultant ophthalmic surgeon to The Royal Berkshire Hospital, Reading and King Edward VII Hospital, Windsor. During that time, he led the Berkshire-wide vitreo-retinal surgical service, established a sub-specialist age-related macular degeneration service, provided a micro-incision cataract service and headed a general ophthalmic team providing care for acute and routine eye conditions. He now focuses on providing a private practice, centre of excellence for both cataract and retinal surgery. His subspecialist interests and recent advances include the introduction of sub-2mm micro-incision cataract extraction with multifocal and toric lens implants designed to significantly reduce spectacle dependence following cataract surgery.
 
He has also developed sutureless small incision vitrectomy techniques for the repair of retinal detachment, epiretinal membrane, macular hole and other vitreoretinal diseases. Mr Tanner’s extensive surgical experience includes the performance or supervision of over 15,000 major intraocular cataract and retinal procedures.

Mr Tanner has led the introduction of many new retinal treatments including Faricimab, Lucentis, Eylea anti-growth factor, intravitreal injections and Ozurdex steroid implants. These innovations have significantly improved vision for many patients suffering from age-related macular degeneration, diabetic retinopathy, retinal vein occlusion and other retinal problems.

In the private sector, he has developed a comprehensive service aiming to provide the highest level of personal care using the latest surgical techniques available. His main practice covers Berkshire, Oxfordshire, Surrey, Buckinghamshire, Hampshire and London with many national and international referrals. Private consultations and treatments are available at the following The Princess Margaret Hospital, Windsor, Dunedin Hospital, Reading and Circle Hospital, Reading.

His undergraduate study was at St George’s Hospital Medical School, London where he was awarded Medical Research Council funding in addition to his medical degree. His completion of higher surgical training at the Oxford Eye Hospital led to the award of the Fellowship of the Royal College of Ophthalmologists. He then completed three years of advanced, sub-specialist fellowships at both Moorfields Eye Hospital, London and St Thomas’ Hospital, London. During this period he gained expertise in the surgical and medical management of all retinal disorders including macular surgery. He has co-authored “Diseases of the Ocular Fundus” which was awarded first prize as “Best Authored Post Graduate Textbook” by the Royal Society of Medicine and the Royal Society of Authors. He has previously hosted both the Southern and National Annual Meetings of the British and Eire Association of Vitreo-Retinal Surgeons. He is an invited scientific reviewer for the British Journal of Ophthalmology.

Furthermore, Mr Tanner was a consultant clinical supervisor for The Oxford Deanery School of Ophthalmology responsible for post-graduate training and also led a fellowship training programme in advanced vitreo-retinal surgical techniques for surgeons becoming consultants in this sub-specialty. He has previously been appointed both lead clinician and clinical governance lead for the ophthalmology department, Royal Berkshire Hospital and has been awarded three NHS clinical excellence awards. He is currently appointed ophthalmology lead for the Medical Advisory Committee at Princess Margaret Hospital, Windsor.

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