Non-organic Visual Loss in Patients with Multifocal Intraocular Lenses
A 63-year-old woman underwent sequential cataract surgery in July and September 2010 in the right and left eyes respectively. She too received AcrySof ReSTOR (Alcon Laboratories, Fort Worth, Texas, USA) IOLs in both eyes. Following cataract surgery in the second eye she complained of decreased vision in both eyes. She revisited her surgeon and also consulted a retina specialist who noted no abnormalities to explain her complaints. Her surgeon suggested that she could have the multifocal IOLs exchanged and replaced by single focal lenses. Another refractive surgeon, whom she visited later, also brought up the possibility of IOL exchange.\nNeuro-ophthalmic examination in December 2010 revealed bilateral uncorrected visual acuity of 20/200 when the technician tested her; 30 minutes later, when she was re-evaluated by a neuro-ophthalmologist, uncorrected visual acuity was 20/30 in both eyes. Color vision was 2/10 Ishihara pseudoisochromatic color plates on each side but on repetition 30 minutes later, it was found to be 5/10 and 8/10 in her right and left eyes, respectively. Confrontation visual fields were full on both sides, nevertheless automated perimetry (, upper image) showed diffuse constriction with a large number of false negative errors in both eyes. Kinetic perimetry (, lower image) revealed a target pattern with variability of responses and overlapping isopters in both eyes, findings consistent with NOVL. Ocular motility was normal and she was orthotropic in primary position with alternate cover testing. Slit lamp examination revealed well-positioned posterior chamber multifocal IOLs in both eyes. Funduscopy was normal on both sides with a cup/disc ratio of 0.1, bilaterally.