Cole Eye Clinic, Cleveland Clinic Foundation

Editor’s Note: Pediatric cataract surgery is a challenge for every ophthalmic surgeon because of the difficulties in the surgical approach; ie, the young, delicate tissue of a child and the selection of the IOL—material, size, and design. Of particular interest are the near and intermediate visual acuities as these are the primary working areas of a child. To comment on the use of multifocal IOLs in pediatric ophthalmology, we invited Paul Rychwalski, MD, to reflect on the article by Cristóbal et al., which reports the results of a limited number of multifocal IOLs for unilateral cataracts in children.

I believe the main limitations to the use of multifocal IOLs in children are (1) IOL calculation predictability, (2) refractive stability (as the young eye is still growing), (3) visual development of the pediatric eye with a nonoptimum optic (multifocality), and (4) potential for higher amblyopia in unilateral cataracts. From the experience with multifocal IOLs in adults, the major complaints of unhappy patients are based on residual refractive errors, deterioration of the optical media (corneal irregularities, low endothelial cell count, macular diseases), and optical phenomena. Some of these entities can be corrected after multifocal IOL implantation, and some can be explained to patients; however, this is not the case with children. Further investigation using prospective studies is needed before the sophisticated system of a multifocal IOL should be implanted in a child’s eye after cataract removal. We thank Dr. Rychwalski for his insights about this important IOL topic.

Thomas Kohnen, MD, PhD, FEBO