23/04/2025
Ophthalmic Ethical Oath on the Use of Multifocal Intraocular Lenses (IOLs)
As an ethical and responsible ophthalmologist, I solemnly pledge that:
1. I will not advocate or implant multifocal IOLs in patients with compromised ocular surfaces, such as those with severe dry eye syndrome, autoimmune-related keratopathy, or ocular surface disease, where visual quality may be unpredictably reduced.
2. I will not recommend multifocal IOLs in patients with any degree of uncontrolled or advanced glaucoma, especially where glaucomatous optic neuropathy is present, or visual field defects could be compounded by the contrast sensitivity reduction associated with multifocal lenses.
3. I will avoid implanting multifocal IOLs in patients with narrow angles, where potential angle-closure risks or the need for long-term IOP-lowering therapy may make multifocal lenses suboptimal and risky.
4. I will not perform pterygium excision and cataract extraction with multifocal IOL implantation in the same surgical session, acknowledging the risk of induced astigmatism, inflammation, and suboptimal refractive outcomes.
5. I will not recommend multifocal IOLs to patients with severe diabetic retinopathy, including those with macular edema, proliferative changes, or poor metabolic control, as retinal compromise will likely negate the optical benefits of multifocality.
6. I will not implant multifocal IOLs in patients with macular pathology, including age-related macular degeneration, epiretinal membranes, or inherited maculopathies, where central visual quality cannot support the lens design.
7. I will refrain from recommending multifocal IOLs to patients with unrealistic expectations or poor neuroadaptation capability, including those with significant anxiety, perfectionism, or known psychiatric illness that affects visual perception tolerance.
8. I will avoid multifocal IOLs in eyes with previous refractive surgery unless thorough counseling and corneal topographic evaluation confirms suitability, recognizing the potential for irregular astigmatism, higher-order aberrations, and complex biometry.
9. I will not implant multifocal IOLs in monocular patients or those with only one functioning eye, as the loss of contrast sensitivity and potential visual side effects can pose significant functional risk in the absence of binocular compensation.
10. I will not implant multifocal IOLs in patients with a history of uveitis or chronic intraocular inflammation, understanding that these lenses may increase the risk of postoperative complications and may not tolerate fluctuating intraocular environments.
11. I will not consider implanting a multifocal IOL solely based on the patient’s request for “the best” lens, without thoroughly explaining the trade-offs, including potential glare, halos, loss of contrast sensitivity, and neuroadaptation challenges.
12. I will not recommend or implant a multifocal IOL just because the patient has the financial capacity, if they do not meet the clinical criteria or have contraindications. Ethical medical decision-making will always take precedence over financial considerations or patient pressure.
“Good vision starts with good judgment”
