Yes, but the surgeon must know what they are looking at, and the patient must be told before surgery that monitoring will continue lifelong. Implantation of a diffractive trifocal intraocular lens (IOL) does not preclude meaningful glaucoma surveillance. It does change the interpretation of two specific tests, and it raises the importance of a third.
Visual field testing remains valid after trifocal implantation. Some patients show a small, generalised reduction in retinal sensitivity on standard automated perimetry attributable to the lens’s light split, not to disease progression¹. The pattern deviation map, which corrects for diffuse loss, is therefore more informative than the total deviation map for tracking glaucoma change post-operatively². Serial fields rather than single fields, and 10-2 testing where central function is at risk, remain the standard.
Why OCT and Lifelong Follow-Up Become More Important
Optic disc and retinal nerve fibre layer (RNFL, the layer of nerve fibres carrying signals from the retina to the optic nerve) imaging by spectral domain OCT (optical coherence tomography, a high-resolution scan of the retina) is largely unaffected by the implanted lens and remains the most reliable structural marker of progression. Ganglion cell layer analysis is particularly valuable because it reports on the cells whose loss is most directly threatening to central function. These structural data sets carry more interpretive weight after multifocal implantation than they did before.
The patient-facing point is straightforward. A trifocal lens is not a discharge from glaucoma care. It is an optical decision taken in parallel with continuing surveillance. At Blue Fin Vision®, glaucoma patients receiving any premium IOL are explicitly told that lifelong follow-up continues unchanged, that we expect to see them at defined intervals, and that the implant does not alter the natural history of their disease.
References
- Aychoua N, Junoy Montolio FG, Jansonius NM. Influence of multifocal intraocular lenses on standard automated perimetry test results. JAMA Ophthalmol. 2013;131(4):481-485.
- Farid M, Chak G, Garg S, Steinert RF. Reduction in mean deviation values in automated perimetry in eyes with multifocal compared to monofocal intraocular lens implants. Am J Ophthalmol. 2014;158(2):227-231.
Related Topics
- Why Trifocal Lenses Are the Lens of Choice for the Glaucoma Patient Wanting Spectacle Independence
- Why Ocular Surface Disease Matters Before Premium Lens Surgery
- What Is a Goal-Lens Mismatch in Cataract Surgery?
- Can Glaucoma Patients Have Trifocal Lenses?
- Is Mild Glaucoma a Contraindication to Trifocal IOLs?
- What Level of Glaucoma Is Suitable for Premium IOLs?
- Do Trifocal IOLs Reduce Contrast Sensitivity?
- Do EDOF Lenses Give True Spectacle Independence?
- Is an EDOF Lens the Right Choice for a Glaucoma Patient?
- Can You Monitor Glaucoma After a Trifocal IOL?
- When Is a Monofocal IOL the Right Lens for a Glaucoma Patient?
