I understand that multifocal lasik is now available in the United States but that most surgeons have not been trained on it so do not adverstise it.

First, when will this be generally available?

Second, I'd be mad as hell if I got lasik, either regular or monovision, and then found out that there was something better out there that could correct for my near and far vision.

I go to a doctor in NYC and it was like pulling teeth to get them to prescribe multifocal contact lenses with astigmatism correction that just went on the market. They actually work very well.

Multifocal LASIK is NOT available. It is still being worked on, but I am skeptical it will end up being a popular option. We know that certain multifocal intraocular lenses in the past were less than ideal (although the new Restor multifocal intraocular lens seems to have solved some of the previous problems).

I hope this helps

Bill Trattler MD
Miami, FL

Why would multifocal lasik not be a popular option?

Also, there is a Dr. Epstein in Illinois who is claiming to already perform it. What gives?

Multifocal LASIK is currently not available in the US. Multifocal intraocular lenses have been used in the US after cataract surgery for a number of years. While some patients have excellent success with them, other patients have trouble with glare and halos. The same holds true for multifocal LASIK. The difficulty is that it can be hard to predict preoperatively which patients will have problems postoperatively. I am not familiar with which surgeries Dr. Epstein is performing.

I hope this information is helpful.
Michael H. Goldstein, MD

The potential problems with multifocal LASIK are vast and undeniable. Let me point out just a few.

Current cornea tracking systems in today’s excimer lasers are accurate to within about 0.5mm. That is excellent for conventional and even wavefront-guided LASIK, but is a gap of monumental proportions for multifocal ablations which require significantly greater ablation accuracy.

There is virtually NO possibility of secondary enhancement surgery to correct any of the problems (undercorrection, overcorrection, induced aberrations) commonly induced by initial LASIK. Once it is ablated in the cornea, about the only way to fully remove the multifocal ablation is to remove the ablated section of the cornea in a lamellar transplant.

Secondary enhancement surgery to “fine tune” initial monofocal LASIK runs from an incidence of about 5% to as much as 20% depending upon the patient’s preoperative situation. If multifocal LASIK were as successful as monofocal LASIK, then somewhere between 5-20% of multifocal patients would have an unsatisfactory correction that cannot be corrected without significantly more invasive surgery. It is not very likely that multifocal LASIK would be as successful as monofocal LASIK, so the number of people with (semi)permanent impaired vision after multifocal LASIK would probably be much greater.

As testament to the fact that multifocal LASIK is prone to failure, one only needs to look at the inability of the current clinical trials to get qualified patients. The FDA is requiring that all patients in the clinical trial first be successful with multifocal contact lenses. So few people who have tried the multifocal contact lens have had successful vision that at present, fewer than 8 patients are in the multifocal LASIK clinical trial.

If approved, the FDA would undoubtedly include a multifocal contact lens trial in the labeling for multifocal LASIK, however doctors often go “off label”. If doctors do not allow patients to verify that multifocal vision is acceptable with contact lenses and just ablate it into the cornea, the percentage of unsatisfied patients would be astronomical.

Multifocal contact lenses and intraocular lenses have the advantage that the optics are being machined on a plastic or silicone material that has a very small molecular structure and is very stable. The sharp edges necessary to make good optics possible are able to be created well and they will stay in place. Multifocal LASIK is ablation of biological tissue that is subject to different healing properties from person to person and somewhat unpredictable biomechanical changes. On top of that a 100-160 micron flap of tissue placed over the ablation. Sharp edges are an impossibility.

If anyone wants to consider multifocal LASIK as a probable success, they need only look at the long trail of the sad remains of multifocal lens attempts over the past several decades. At least with contacts and IOLs, they can be removed. Multifocal LASIK does not have this advantage.

Glenn Hagele
http://www.USAEyes.org

I am not a doctor.