No. Mild glaucoma, properly defined, is not a contraindication to trifocal intraocular lens (IOL) implantation. It is a reason for careful selection, not for automatic refusal. The confusion arises because historical guidance grouped all glaucoma patients together¹, often on the basis of trial exclusion criteria written when diffractive optics were less refined than they are now and when ganglion cell imaging was less precise.
The clinically meaningful definition of mild glaucoma in this context is intraocular pressure (IOP, the fluid pressure inside the eye) well controlled on minimal medication, an optic disc with localised neuroretinal rim thinning but preserved central function, a Humphrey 24-2 visual field (a standard automated test of the central 24 degrees of vision) with a mean deviation (MD, the average loss of sensitivity across the field) typically better than -6 dB (decibels, a unit of visual sensitivity loss), no paracentral or central scotoma on a 10-2 field (a more detailed test of the central 10 degrees), and disease that has been demonstrably stable across at least two reliable assessments. A patient who meets all of those criteria has a retina capable of accepting the modest contrast cost a trifocal optic introduces².
Two Cautions Even in Mild Disease
Two cautions remain even in mild disease. First, glaucoma is by definition a progressive condition, and a lens chosen today must remain appropriate for the patient’s likely visual function in ten years. Trifocal implantation in mild but rapidly progressing disease is a different decision from implantation in mild and stable disease. Second, pseudoexfoliation alters the calculation independently of field loss, because zonular weakness threatens long-term lens centration and any decentration disproportionately degrades multifocal image quality.
Mild glaucoma is therefore a green light with conditions, not a red light. The conditions are documented stability and a defensible reason to expect that stability to continue.
References
- Mills RP, Budenz DL, Lee PP, Noecker RJ, Walt JG, Siegartel LR, Evans SJ, Doyle JJ. Categorizing the stage of glaucoma from pre-diagnosis to end-stage disease. Am J Ophthalmol. 2006;141(1):24-30.
- Yoo YS, Whang WJ, Byun YS, Piao JJ, Kim DY, Joo CK, Yoon G. Wavefront-guided versus diffractive multifocal intraocular lens implantation in patients with mild glaucoma. Sci Rep. 2020;10(1):14021.
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