The Importance of IOL Selection in Patients With Young-age Cataracts: a Case Report

Abstract

Background: A cataract is a type of degenerative change of the lens, which is characterized by the clouding of the lens followed by symptoms of optical deterioration. Over 70 years ago, Sir Harold Ridley implanted the first useable modern-day intraocular lens (IOL) implant. A lot has happened since then. The IOL is arguably the most life-changing and innovative implant in the history of medicine. Currently, there are several types of intraocular lenses on the market. The main classification could be monofocal lenses, multifocal, trifocal, extended depth of focus (EDOF) lenses, and toric lenses. Objective: The aim of this case report is to report the importance of IOL selection in patients with young-age cataracts. Case report: A 35-year-old patient presented first time at our Clinic. In the last six months, he noticed poor vision in his left eye, even with spectacles. The right eye was operated on in another institution in 2020, due to the presence of a young-age cataract. After a complete preoperative ophthalmological examination, we discovered the presence of a cataract in the left eye. UDVA of the left eye was 0.4, and CDVA was +0.50/+0.50/30°=0.5. UNVA and DCNVA was J2. We decided to implant TECNIS Synergy™ IOL (Johnson & Johnson Vision, Santa Ana, CA, USA) during the cataract surgery. That EDOF IOL bridges the gap between the performance of monofocal and multifocal IOLs and delivers continuous high-contrast vision for patients with cataracts from far through near, even in low-light conditions. There were no intraoperative or postoperative complications. On a 7-day, check-up UDVA of the left eye was 1.0, and UNVA was J1. The patient was satisfied with the vision in the left eye, so he wanted to correct the vision of the right eye which was implanted with SENSAR® IOL (Johnson & Johnson Vision, Santa Ana, CA, USA), with a residual diopter of +2.00/+1.00/120 for distance, and +4.50/+1.00/120 for near vision. This choice of IOL in the other institution was not an ideal solution for this patient due to his young age and occupation. The capsular bag was already in slight fibrosis, so the explantation of the existing IOL and implantation of the new one was not a reasonable option. We decided to go with the multifocal AddOn® toric lens (1stQ GmbH, Mannheim, Germany), the refractive-surgery platform for vision enhancement of pseudophakic eyes, that also correct residual astigmatism. On a 7-day check-up, this patient’s UDVA was 1.0 and UNVA was J1. The result was a happy patient, who could go back to his everyday life without spectacle independence. Conclusion: Good unaided distance visual acuity (VA) is now a realistic expectation following cataract surgery and intraocular lens (IOL) implantation.  We should be aware of patient expectations and demands, especially when having a patient with young-age cataracts. Often more time should be spent on preoperative IOL planning than cataract surgery itself.