Multifocal and EDOF IOLs: My Rationale for Use in Patients With Glaucoma

These technologies can be safe and perform well in glaucomatous eyes.

John P. Berdahl, MD

Glaucoma Today

Key Takeaways Conventional thinking has suggested that only pristine eyes qualify for the use of multifocal and extended-depth-of-focus (EDOF) IOLs in cataract surgery. Ophthalmologists, however, must think beyond the limited data sets and combine a solid understanding of the existing evidence with logic, with experience, and with what they would want for their own eyes. When stacking the minimal contrast sensitivity loss that occurs with multifocal and EDOF IOLs on the modest contrast sensitivity loss seen in early glaucoma, patients can be happy and achieve their visual goals with these lenses. Conventional thinking has suggested that only pristine eyes qualify for the use of multifocal and extended depth of focus (EDOF) IOLs in cataract surgery. This belief is partially evidence-based due to a paucity of randomized controlled clinical trial data—the highest-quality evidence does not exist to support their implantation in eyes with corneal aberrations. That said, ample research has demonstrated that multifocal and EDOF IOLs are safe and can perform well in patients with mild and probably moderate primary open-angle glaucoma (POAG).1-5 My own experience has shown this to be true. To challenge conventional thinking, ophthalmologists must think beyond the limited data sets and combine a solid understanding of the existing evidence with logic, with experience, and with what they would want for their own eyes. It is also important to consider the exit strategy: Is this an IOL that can be easily exchanged if necessary? Given the minimal contrast sensitivity loss that occurs with multifocal IOLs and EDOF IOLs and the modest contrast sensitivity loss seen in early glaucoma, patients can be happy and achieve their visual goals with these lenses. This article details considerations for their use in patients with POAG.

Research Briefs

Modern Optometry

AI Chatbots in the Retina Clinic

Large language models are not coming for your job. But they may redefine what your job looks like.

Fares Antaki, MDCM

Retina Today

KEY TAKEAWAYS Large language models have embedded ophthalmic knowledge that is improving rapidly with each model generation. Practical applications for retina specialists span two categories: workflow improvement (electronic health record documentation, report generation) and clinical assistance (triage, decision support). Vibe coding allows retina specialists without programming experience to build custom clinical tools using large language models. AI has been in ophthalmology for years, and most retina specialists are familiar with AI as it relates to image analysis. Algorithms that detect diabetic retinopathy (DR) from fundus photographs or segment fluid on OCT have received the most attention and, in the case of autonomous DR screening, regulatory clearance.1,2 However, a second wave of AI is reaching the clinic, and this version can read, write, and reason with text. These large language models (LLMs) power the chatbots that are quietly changing how physicians work.3 WHAT ARE LARGE LANGUAGE MODELS? LLMs are a class of AI designed to understand and generate human language. The technology behind products such as ChatGPT (OpenAI), Gemini (Google), and Claude (Anthropic) is conceptually straightforward. During training, a model is shown massive amounts of text and learns to predict the next word in a sequence.4 Consider the phrase attributed to Heraclitus: “The only constant in life is change.”5 A model in training would see “The only constant in life is…” and learn to predict “change.” This process is repeated billions of times across the entirety of the internet, books, and encyclopedias. The result is a system with a broad representation of human knowledge.