CASE OVERVIEW:
Mike Palmateer, a 66-year-old former fan-favourite goaltender for the Toronto Maple Leafs, considered one of the top 100 Leafs of all time, was referred to the Bochner Eye Institute for consideration of vision correction surgery. He required glasses for both distance and near vision.
PRE-OPERATIVE ASSESSMENT:
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Right Eye: Refractive error of +1.25 -0.50 at 75, achieving 20/20 vision.
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Left Eye: Refractive error of +1.75 -0.75 at 60, achieving 20/20 vision.
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Cornea: Clear with minimal nuclear sclerotic lens changes
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Fundus Examination & OCT of the Macula: Normal.
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Corneal Thickness: 540 microns (right eye), 536 microns (left eye).
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Computerized Topography: No evidence of irregular astigmatism.
Palmateer was interested in improving both his distance and near vision, aiming for optimal binocular sight to continue enjoying his passions, including golf and occasional hockey. After discussing the risks and benefits, he opted for a refractive lens exchange.
SURGICAL PROCEDURE:
A refractive lens exchange was performed with the Catalys femtosecond laser used to:
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Create a perfectly round capsulorhexis centered on the line of sight.
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Fragment the lens into six pieces for easy removal.
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Correct the astigmatism by small arcuate cuts in the corneal periphery.
The surgery was completed by aspiration of the crystalline lens without the use of phacoemulsification. A multifocal intraocular lens was inserted in the capsular bag. There were no complications.
POST-OPERATIVE OUTCOME:
- Day 1 Results: 20/20 vision in each eye, with near vision of J2.
- 3 year Results: As above.
- Patient Satisfaction: Palmateer was pleased with his everyday vision and especially his ability to see his golf ball and follow a hockey puck clearly.
KEY LEARNING POINTS:
1. ADVANCES IN MULTIFOCAL LENS DESIGN:
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Modern multifocal lenses provide a full range of vision and high patient satisfaction.
2. CORNEAL CONTRAINDICATIONS:
Multifocal lenses may not be suitable for patients with:
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Epithelial basement membrane dystrophy
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Salzmann’s nodular degeneration
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Keratoconus
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Pellucid marginal degeneration
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Corneal scarring with irregular astigmatism
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Previous radial keratotomy (RK)
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3. RETINAL CONTRAINDICATIONS:
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Age-related macular degeneration
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Macular hole
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Epiretinal membrane
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Myopic macular degeneration.
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4. OPTIC NERVE & BRAIN-RELATED CONTRAINDICATIONS:
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Glaucoma with central field loss
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Amblyopia
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Optic neuropathy
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5. PERSONALITY-RELATED CONTRAINDICATIONS:
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Patients with neurotic personality disorders may have difficulty adapting to multifocal lenses.
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FINAL THOUGHTS
This case highlights the success of multifocal intraocular lens technology in providing excellent visual outcomes for an active individual who desired both distance and near vision improvement.
