Multifocal IOLs for presbyopia

Reply: Versteeg is quite right in pointing out the risk for halos with anterior chamber IOLs for the correction of presbyopia. Indeed, all IOLs that are multifocal present this risk; it is related to the technology. In our study, we did not think the phenomenon was serious enough to question the validity of the procedure. We even observed that the halos were not as disturbing as with the AMO Array IOL. Six months postoperatively, most patients who mentioned the presence of halos immediately after surgery no longer considered them extremely disturbing. It is obvious there will be fewer problems if the optical system is correctly centered. I believe this is another opportunity to underline the importance of internal measurement of the anterior chamber to adapt the IOL to the most satisfactory axis. It may even be possible to imagine “customized” IOLs, but this is not yet possible because of the difficulties facing the manufacturing companies. We will shortly publish our results on the evaluation of the internal diameter of the anterior chamber. We have noticed that in 75% of cases, the anterior chamber is not a circle but an oval with a large vertical axis. This notion will have to be taken into account when using angle-supported IOLs, particularly in relation to the dimensions of the IOL and the axis of insertion. George Baïkoff MD