Frequently, and without apology. A monofocal aspheric intraocular lens (IOL) is not a downgrade. It is the implant that delivers the highest possible contrast image at its target focal distance, with the gentlest dysphotopsia profile and the most predictable behaviour over a lifetime of follow-up¹. For a substantial proportion of glaucoma patients, it is the correct lens, not the compromise lens.
The clearest indications are advanced or rapidly progressing disease, mean deviation worse than approximately -12 dB, central or paracentral field involvement on 10-2 testing, pseudoexfoliation with zonular weakness, and any setting in which long-term centration of the implant cannot be guaranteed. In each of these the priority is to preserve the brightest, sharpest image the remaining retinal function can produce, and to avoid imposing an optical tax the eye cannot afford.
Practical Advantages for the Glaucoma Population
Monofocal optics also offer practical advantages in the glaucoma population². Visual field interpretation is unaffected. Future surgical interventions, trabeculectomy, minimally invasive glaucoma surgery, drainage tube implantation, vitreoretinal procedures, proceed without the additional optical considerations a multifocal lens introduces. The patient retains the simplest possible visual system, which is itself a clinical good in a disease that may require multiple downstream interventions.
Choosing a monofocal lens for a glaucoma patient is not a failure of ambition. It is a clinical decision made on the eye in front of the surgeon, and at Blue Fin Vision® it is framed to the patient exactly that way: this is the right lens for your eye, for reasons that will hold up for the rest of your life. That framing is the difference between a satisfied monofocal patient and an aggrieved one.
References
- Realini T. Selecting an intraocular lens for the patient with glaucoma. Curr Opin Ophthalmol. 2018;29(2):164-170.
- Ichhpujani P, Bhartiya S, Sharma A. Premium IOLs in glaucoma. J Curr Glaucoma Pract. 2013;7(2):54-57.
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?
