Fortunately, “premium” IOL patients are among our most satisfied patients after cataract surgery.  There are occasions when patients have an undesired side effect, particularly with multifocal optics either from a mult-zone or diffractive optic configuration.  Making sure you have hit a target refraction within a half diopter of emmetropia with minimal (<0.5D) astigmatism along with a clear posterior capsule and optimized ocular surface are all requirements before recommending removal and exchange.  Fortunately, these IOLs are relatively easy to remove and here is a simplified technique for exchanging these IOLs when necessary.  For more information, contact Alan Carlson, MD at the Duke Eye Center, Durham, NC.  Or call 919-681-4089.