The short clinical answer is yes, but only some of them, and only after a structured selection process. Glaucoma is not a single condition, and a label on a referral letter does not, on its own, exclude a patient from receiving a diffractive trifocal intraocular lens (IOL). What excludes the patient is the state of their optic nerve, the depth and location of their visual field defects, the stability of their disease, and the adequacy of their ocular surface.
Diffractive trifocal IOLs work by splitting incoming light across three focal points: distance, intermediate, and near. This split costs the eye a small but real amount of contrast at every focal distance¹. A healthy retina and optic nerve absorb that cost without the patient noticing. A glaucomatous nerve with reduced ganglion cell function (loss of the retinal cells that send visual signals to the brain) has less reserve, and the same contrast cost is felt more keenly. The clinical question is therefore not whether glaucoma exists, but whether the nerve has enough remaining function to tolerate the optical compromise the lens introduces.
Who Is and Is Not an Appropriate Candidate
Patients with mild, well-controlled, stable primary open-angle glaucoma with full or near-full central fields, a healthy ocular surface, and realistic expectations can be appropriate candidates for a trifocal IOL². Patients with moderate-to-advanced disease, paracentral or central field defects (visual field loss within 10 degrees of fixation), progressive disease on treatment, or pseudoexfoliation (a condition causing weakness of the fibres that hold the lens in place) with zonular compromise are not.
The decision is individual, made on the eye in front of the surgeon, not on the diagnosis at the top of the chart.
References
- Ouchi M, Shiba T. Diffractive multifocal intraocular lens implantation in eyes with a small-diameter pupil. Sci Rep. 2018;8(1):11686.
- Ang RE. Visual performance of a diffractive trifocal intraocular lens in patients with glaucoma. Clin Ophthalmol. 2021;15:493-501.
Related Topics
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- 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?
