Multifocal Intraocular Lens Usage in Epiretinal Membrane Patients

The demand for near and intermediate vision in elderly patients has increased, leading to wider use of multifocal intraocular lenses (MIOLs) to reduce spectacle dependence after cataract surgery. However, retinal diseases such as epiretinal membrane (ERM) are considered relative contraindications due to potential loss of contrast sensitivity and dysphotopsia. This review summarizes current evidence on MIOL use in ERM patients. Visual acuity at all distances can improve after combined cataract and vitrectomy surgery, but outcomes may be limited in advanced ERM with inner retinal changes. MIOLs generally reduce contrast sensitivity, and this effect may be more pronounced in ERM, though partial compensation by neural adaptation is possible. Dysphotopsia and metamorphopsia have been reported, yet patient satisfaction remains favorable in mild ERM. From a surgical perspective, MIOL optics may interfere with visualization, prolong membrane peeling, and increase the risk of iatrogenic tears. A survey of Korean retinal specialists showed predominantly cautious or negative views on MIOL implantation in ERM eyes. In conclusion, MIOLs may provide functional benefits in selected mild ERM patients, but careful optical coherence tomography evaluation, patient counseling, and consideration of surgical difficulty are essential before implantation.