Wavefront-guided refractive surgery after multifocal lens implantation

Purpose of review To examine whether wavefront-guided refractive surgery has a role in correcting ametropia after implantation of multifocal intraocular lenses (IOLs). Recent findings This review begins with an oversight of various multifocal IOLs to help understand how a wavefront might return from the IOL and be captured by an aberrometer. The accuracy of the wavefront may be compromised in eyes with multifocal IOLs by the fact that such lenses provide simultaneous vision – that is, a simultaneous projection of in-focus and out-of-focus images of an object on the retina – and hence returning wavefronts theoretically could be captured in a similar manner by an aberrometer. However, in isolated small series, reproducible wavefront refractions – in which the manifest refraction closely approximates the wavefront refraction and good results after refractive surgery – are attained in eyes with diffractive multifocal IOLs. Summary Small studies suggest that it is possible to perform wavefront-guided excimer light amplification by stimulated emission of radiation (LASER) to correct ametropia following multifocal lens implantation. Larger studies with longer follow-up are needed to determine whether eyes with multifocal lenses derive an added benefit from wavefront-guided refractive surgery over conventional surgery. These studies may help determine whether some IOLs are better suited for subsequent refractive surgery. The age of the patient may affect the outcome of refractive surgery after multifocal IOL implantation.