Refracting the pseudophakic patient

5 May 2015
Volume 16, Issue 2

This article explores the different intraocular lens (IOL) types available, provide guidance on refracting presbyopes, and examines the additional tests necessary to establish visual needs and outcomes following IOL implantation.


Pseudophakic patients are frequently encountered in optometric practice, often the result of cataract extraction but also of presbyopia correction. Given advances in technology and surgery, the demand for intraocular lenses for correcting a variety of refractive requirements has increased owing to an ageing population. Based on the patient’s needs, fixed-focus, toric, accommodating or multifocal intraocular lenses (IOLs) may be implanted. During optometric examination, attention should be drawn to a history of IOLs and the potential complications they may cause in order to manage them effectively, particularly where sight is threatened. Although objective and subjective refraction does not differ greatly between phakic and pseudophakic patients, care should be taken to set the patient up correctly and the reflex during retinoscopy observed for posterior subcapsular opacification. Additional tests, such as reading speed and glare and contrast sensitivity, are necessary to determine the outcome of IOL surgery and detect potential problems associated with multifocal and accommodating IOLs. Based upon the results of these tests, refraction and type of IOL, contact lens or spectacle correction may be required to meet the visual demands of the patient.

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