Non-organic Visual Loss in Patients with Multifocal Intraocular Lenses
A 73-year-old woman underwent sequential cataract surgery in February and March 2010 in her left and right eyes with implantation of AcrySof ReSTOR (Alcon Laboratories, Fort Worth, Texas, USA) IOLs in both eyes. Following surgery on the right eye, she noted a “veil” obscuring vision in both eyes. On return to her surgeon, no problems were noted regarding the position of the multifocal IOLs. She consulted three additional refractive surgeons and two of them raised the possibility of IOL exchange.\nDue to a prior complaint of dizziness in February 2008, she underwent MRI of the brain, head and neck, all of which were normal.\nNeuro-ophthalmic examination in November 2010 revealed uncorrected visual acuity of 20/40 and 20/50 in her right and left eyes by a technician. When the test was repeated by a neuro-ophthalmologist 15 minutes later, uncorrected visual acuity was 20/20 at distance and J1 at near, bilaterally. She was able to identify 10 of 10 Ishihara pseudoisochromatic color plates with each eye and both pupils were brisk without a relative afferent pupillary defect. Confrontation visual fields were full bilaterally, however automated perimetry demonstrated superior arcuate defects with a large number of false negative errors in both eyes (, upper image). Kinetic perimetry was performed as previously described and revealed a target pattern with variability of responses and overlapping isopters in both eyes (, lower image); all findings were consistent with NOVL. Ocular motility was normal and the patient was orthotropic in primary position with alternate cover testing. Slit lamp examination showed well-positioned posterior chamber multifocal IOLs in both eyes. Funduscopy was normal with a cup/disc ratio of 0.4, bilaterally. Additionally, full field electroretinography and visual evoked responses were normal on both sides.