Alper Can YILMAZ, Bağım Ayçin ÇAKIR İNCE, Önder AYYILDIZ, Fatih Mehmet MUTLU
Gulhane Medical Journal - 2026;68(3):160-166
Aims: No data exist in the literature regarding suitability screening for multifocal intraocular lenses (MFIOLs), which are generally not covered by health insurance in public hospitals in Türkiye. This study aims to determine the proportion of patients unsuitable for MFIOL and to identify restrictive ocular comorbidities among patients undergoing cataract surgery at a tertiary public hospital. Methods: This retrospective observational study included patients aged 40 years and older who underwent cataract surgery at a tertiary teaching hospital during an approximately 10-month period. Patients with a monofocal intraocular lens in one eye or those without indications for bilateral cataract surgery were excluded from the study. Before surgery, patients underwent comprehensive ophthalmological examinations, optical biometry measurements, and other necessary tests. Based on these assessments, ocular comorbidities were identified. The primary endpoint was to determine and analyze the proportions and characteristics of patients who were or were not suitable for MFIOL implantation, according to indications and contraindications defined in the current literature. Results: Of the 1476 patients evaluated in the study, 721 (48.8%, mean age 71.5+/-8.7 years; 55.6% female) had undergone bilateral cataract surgery. Of these, 289 patients (40.1%) were found ineligible for MFIOL implantation based on predefined contraindications. The remaining 432 patients (59.9%) were found to be eligible for MFIOL. Of the 289 patients who met ineligibility criteria for MFIOL in one or both eyes, 6 (2.1%) had ocular surface and corneal disease, 13 (4.5%) had pupil abnormalities, 80 (27.7%) had retinal disease, 25 (8.7%) had glaucoma or optic neuropathy, and 118 (40.8%) had combined causes. Conclusions: Ocular comorbidities were identified as restrictive factors for MFIOL in 40% of patients. It appears that if MFIOLs were covered by health insurance in public hospitals, approximately two-thirds of patients could benefit from MFIOLs.
