The cataract surgery has seen, in recent decades, extraordinary progress in instrumentation, materials, surgical techniques and technology, leading to excellent visual results in total safety.
A decisive contribution to the success of modern cataract surgery has been made by the evolution in intraocular lens technology and design (IOL) the wide range available on the market today can, in fact, potentially satisfy any patient. The success of cataract surgery strongly depends on both the thorough the surgeon's knowledge of commercially available IOLs and their characteristics, in order to select those most suitable for the patient, but also from the appropriate patient selection same.
The ideal candidate for IOL implantation is, first and foremost, one who understands the capabilities and limitations of the technology.
 
Specifically, the selection of a candidate for the implantation of IOLs for presbyopia correction involves the analysis of factors such as the presence of ocular diseases, pupil size and refractive errors, but there are first of all 2 key issues to be addressed: the first is understand the needs dictated by the patient's lifestyle and visual expectationsthe second is select a particular IOL on the basis of its functional benefits.
Understanding the patient's needs requires careful pre-operative counselling during which a detailed investigation of its work and leisure activitiesthe amount of time spent doing one or the other and the relative importance of these activities for the patient. Another part of preoperative counselling concerns the potential postoperative improvementsIt is necessary to make the patient aware of possible refractive surprises or small residual errors that may require the use of glasses or, in some cases, a second operation to achieve the optimal result.
Making the patient aware will help to avoid dissatisfaction, animosity or the perception that something was not done correctly during the intervention.
Expectations must be understood of patients and identify patients who may not be satisfied with lens limitations despite successful surgery. Therefore, it is important to consider the occupational needs of the candidate: for example, pilots and night drivers are unsuitable candidates for multifocal IOLs due to the increased risk of night-time photopic phenomena. Also age plays a crucial role in patient selection. In fact, some conditions become more relevant with advancing years, such as optic neuropathy, macular degeneration and dry eye, factors that can exacerbate the loss of contrast sensitivity. Other problems in patients with presbyopia can be dry eye syndrome and Meibomian gland dysfunction, conditions that can be exacerbated following cataract surgery.
Appropriately selected patients can achieve spectacle independence and good visual results at all distances, so preoperative clinical assessment is a key step.
Sources
-Rosa Braga-Mele et al. Multifocal intraocular lenses: Relative indications and contraindications for implantation. J Cataract Refract Surg 2014; 40:313-322
-Bonnie Henderson et al. Presbyopia-Correcting IOLs: Patient Selection and Satisfaction. Bonnie Henderson et al. In book: Intraocular Lens Surgery: Selection, Complications, and Complex Cases, Edition: 1, Chapter: 9, Publisher: Thieme Medical, Editors: Bradley Randleman, Iqbal Ike K. Ahmed
Dr. Carmelo Chines
Direttore responsabile
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