Maximizing satisfaction with presbyopia-correcting intraocular lenses: the missing links.

PURPOSE To critically analyze recent studies of presbyopia-correcting intraocular lenses (IOLs) and to examine opportunities to enhance patient satisfaction further. DESIGN Perspective. METHODS Literature review and commentary. RESULTS Although overall patient satisfaction with the currently available presbyopia-correcting IOLs remains high, it is not uniform. Current accommodating or multifocal IOL designs are hampered by limited accommodative ability or reduced contrast sensitivity and photic phenomenon, respectively. Toric IOLs and IOLs inserted through smaller incisions minimize postoperative wound healing changes. Better assessment of total ocular characteristics, including corneal wavefront and pupil size and dynamics, will allow further IOL customization to each patient. CONCLUSIONS Postoperative modification of IOLs may offset variations in postoperative healing that cannot be predicted before surgery. Further methods to assess and modify neural adaptive capability are needed. Newer IOL designs may enhance functional depth of field further without compromising contrast sensitivity or inducing photic phenomena.