Problems with IOL Decentration

1) OPTICAL/ VISUAL PROBLEMS

-Induced higher-order aberrations (HOAs) – especially coma and spherical aberration

-Reduced visual acuity – especially in low light or for near vision

-Loss of contrast sensitivity – due to distorted optical pathway

-Glare and halos – particularly at night

-Diplopia or monocular polyopia – if decentration is significant

2) IOL Type–Specific Issues

MULTIFOCAL IOLs:

-Even small decentrations (≥0.5 mm) can cause major visual quality deterioration

-Increased glare/halos due to misalignment of concentric rings

TORIC IOLs:

-Decentration or tilt can cause astigmatism not corrected, or new refractive error

ASPHERIC IOLs:

-Designed to reduce spherical aberration; decentration neutralizes or worsens aberration correction

3) REFRACTIVE CONSEQUENCES

-Residual refractive error (especially astigmatism)

-Anisometropia if unilateral or asymmetric decentration

-Poor predictability of refractive outcomes

4) MECHANICAL/ ANATOMICAL ISSUES

-Iris chafing → pigment dispersion, uveitis, secondary glaucoma

-Pupil capture (IOL optic slipping into pupillary aperture)

-Zonular stress → progressive zonular weakness, subluxation, or dislocation

-Capsular bag problems – capsular contraction syndrome worsening decentration

5) PATIENT-REPORTED ISSUES

-Subjective dissatisfaction despite good visual acuity

-Visual disturbances affecting daily activities (driving, reading, night vision)

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