Som Prasad MS FRCSEd FRCOphth FACS
Consultant Eye Surgeon
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Secondary Add-on IOL implantation
 
Advances in IOL and surgical technology have now made it possible to fine-tune the visual outcome for some patients who have had cataract surgery but not achieved the desired visual outcome. The original implant surgery may have been done recently or years ago.
 
Special intra-ocular lenses designed for implantation on top of the previously placed lens are available, which allow vision to be fine tuned at a secondary procedure.
 
There are three main situations where this procedure may be used:
 
1. Anisometropia - this means that the patient has a residual refractive error after previous IOL implantation. For example, although the desired outcome was to achieve good distance vision without glasses, good distance vision can only be achieved with spectacle or contact lens correction.
 
2. Astigmatism - Conventional IOLs do not correct for pre-existing astigmatism. Thus, after initial lens implantation the patient may still require both distance and near glasses to optimise vision as thier pre-existing astigmatism has not been corrected, and in some uncommon cases, the astigmatism may have been caused by the surgery itself. If the patient wants to reduce thier astigmatism, so that the vision without glasses can be improved, this is a good option to consider.
 
3. Multifocal implant - If multifocal implants were not considered at the time of initial surgery, but later on the patient wants to be spectacle free for many task, it is possible to use an Add-on multifocal lens to achieve this, so that both and distance nd near vision is possible in most situations without the need for glasses. 
 
Studies with these procedures show high level of patient satisfaction:
 
  1. 96% of patients who have chosen an add-on lens would opt for this procedure again (1)
  2. The Add-on IOL is a safe (..and..) useful procedure for correcting postoperative pseudophakic ametropia (2)
  3. The binocular near uncorrected visual acuity achieved allowed all patients to read newspapers (1)
  4. The additional implantation of a diffractive sulcus IOL is a safe and effective method for the improvement of near visual acuity after monofocal IOL implantation (1)
 
 
2. First experience with the Add-on IOL system. Presentation at ESCRS 2008. D Holland, D Uthoff
 
 
 
  
 
This page was last modified on Saturday, June 06, 2009