Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.
Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland.
Graefes Arch Clin Exp Ophthalmol. 2020 Apr;258(4):805-813. doi: 10.1007/s00417-020-04603-0. Epub 2020 Jan 18.
Multifocal intraocular lenses (MIOLs) are often discouraged in patients with or at risk of retinal disorders (including diabetic retinopathy, age-related macular degeneration, and epiretinal membranes), as MIOLs are believed to reduce contrast sensitivity (CS). Concerns with MIOLs have also been raised in individuals with visual field defects, fixation instability or eccentric preferred retinal locations. The aim of this study is to review the influence of MIOL on quality of vision in patients with retinal diseases.
We reviewed the PubMed and Web of Science databases to identify relevant studies using the following keywords: multifocal intraocular lens, cataract surgery, cataract extraction, lens exchange, diabetic retinopathy, age-related macular degeneration, and contrast sensitivity.
Studies evaluating CS in MIOLs present conflicting results: MIOLs either did not influence CS or resulted in worse performance under low-illuminance conditions and higher spatial frequencies when compared to monofocal IOLs. Nevertheless, MIOLs preserved CS levels within the age-matched normal range. Two studies reported that patients with concurrent retinal diseases receiving a MIOL, both unilaterally and bilaterally, reported a significant improvement in visual-related outcomes. Individuals with a monofocal IOL in one eye and a MIOL in the fellow eye reported greater subjective satisfaction with the MIOL.
We were unable to find evidence suggesting that patients with retinal diseases should be advised against MIOLs. Nevertheless, more research is needed to address the aforementioned concerns and to optimize the use of MIOLs in eyes with retinal disease.
多焦点人工晶状体（MIOL）通常不建议用于患有或有视网膜疾病风险的患者（包括糖尿病视网膜病变、年龄相关性黄斑变性和视网膜前膜），因为 MIOL 被认为会降低对比敏感度（CS）。对于视野缺损、固视不稳定或偏心最佳视网膜位置的个体，也对 MIOL 提出了担忧。本研究旨在综述 MIOL 对视网膜疾病患者视力质量的影响。
我们检索了 PubMed 和 Web of Science 数据库，使用以下关键词识别相关研究：多焦点人工晶状体、白内障手术、白内障摘除术、晶状体置换术、糖尿病视网膜病变、年龄相关性黄斑变性和对比敏感度。
评估 MIOL 中 CS 的研究结果存在矛盾：MIOL 要么不影响 CS，要么在低光照条件下和较高空间频率下表现更差，与单焦点 IOL 相比。然而，MIOL 保持了 CS 水平在年龄匹配的正常范围内。两项研究报告称，同时患有视网膜疾病的患者接受 MIOL 治疗，无论是单侧还是双侧，均报告视觉相关结局有显著改善。一只眼接受单焦点 IOL，另一只眼接受 MIOL 的个体对 MIOL 的主观满意度更高。
我们未能发现证据表明患有视网膜疾病的患者不应使用 MIOL。然而，需要进一步研究以解决上述问题，并优化 MIOL 在视网膜疾病眼中的应用。
