guest editorial
Expectations Met
A refractive surgeon becomes a refractive patient, having a multifocal IOL implanted in each eye.

I first experienced the advantages of a multifocal IOL through the eyes of my patients in 1989. Back then, the lens in use had a varying radius of curvature on the anterior surface and worked well in the few patients I implanted. However, FDA approval was delayed, and George Wright ultimately sold Wright Medical, the company developing the lens.

After the Array multifocal lens was re-introduced by AMO (Allergan at the time), and subsequently approved by the FDA in September 1997, surgeons held varied opinions about its "side effects" on patient vision.

Popularity was stunted. This version of the lens uses concentric circles of varying power rather than anterior surface curvature variation to achieve multifocality. Therefore, circles are created around lights at night, and these circles extend adaptation time for patients. After several years of listening to the pros and cons, I decided to investigate the visual effects for myself.

The Idea is Planted

Vicki Williams with AMO had been encouraging me for at least 2 years to try the lens. She told me in 2000 that Andy Watkins, M.D., was implanting the lens and was so happy with the results that he had implanted them into almost 1,000 eyes. I was off to Houston in my Beechcraft Bonanza to interview Andy's patients.

The trip to his office was quite an "eye opener." Since returning to Austin, I have been implanting the Array in all of my patients with very few exceptions.

Seeing is Believing

The fact that my cataract patients have been so happy with their vision, whether they're binocularly implanted, monocularly implanted, or implanted with a monofocal lens in the fellow eye, resulted in a life-changing decision for me.

On May 20, 2003, I flew my Bonanza to Alexandria, La., to have Bruce Wallace, M.D., perform a refractive lensectomy on my right eye that same afternoon.

I was 20/20 and J1 the morning following my procedure. Therefore, I could legally fly my airplane home that day. I was seeing patients in my office the following morning without using any glasses to read their charts. I also realized that I could shave without glasses for the first time in 20 years.

The left eye followed suit and the rest is history.

My preoperative vision was best corrected to 20/15+ with +1.75, and to J1+ with an add of +2.25 in each eye with no glare disability. Without correction I was 20/60 and J16 in each eye.

My uncorrected distance vision is currently 20/20+ in each eye and at near it is J2+ in the right eye and J1 in the left eye. With a correction of plano +0.50 axis 010 in the right eye, my vision is 20/15. In the left eye, with a -0.50 sphere I see 20/15+. With this distance correction and no add, my vision is J1+ in my right eye and J1 in my left eye.

Some of my colleagues and friends ask me why, when my vision was so good in glasses, did I have the operations? The answer is simply that I did not want to wear glasses and I had confidence in the procedure and the lens.

One Good Technology Deserves Another

Cataract surgery is the most frequently performed and successful surgery in the United States today. This success is largely the result of Dr. Charles Kelman's development of phacoemulsification, not because it works most of the time, but because it works almost every time.

This knowledge -- coupled with what I've heard for more than 3 years from my Array patients about their vision -- made the decision very straightforward.

Dr. Knolle, a past president of the American Society of Cataract and Refractive Surgery, practices in Austin, Texas. He enjoys scuba diving, water-skiing, fishing, and photography, but especially flying airplanes.