Visual Performance after a Unilateral or Bilateral Implantation of Enlarged Depth-of-Focus Intraocular Lens in Patients with Cataract: A Prospective Clinical Trial

Visual Performance After Unilateral Implantation of an Extended Depth-of-Focus Intraocular Lens in Patients With Unilateral Cataract

PURPOSE

To investigate the visual performance after unilateral implantation of an extended depth-of-focus intraocular lens (IOL) in patients with unilateral cataracts.

METHODS

In this prospective study, uneventful phacoemulsification with LuxSmart IOL (Bausch & Lomb) implantation was performed in 25 eyes of 25 patients with unilateral cataracts. At postoperative 1, 4, 12, and 24 weeks, uncorrected and corrected visual acuity at far, intermediate, and near distances and the spherical equivalent in manifest refraction were measured. A Visual Function Index and modified Visual Function Index questionnaire were used to investigate glare, spectacle dependence, and satisfaction at 24 weeks in the eye that had surgery.

RESULTS

At 6 months postoperatively, uncorrected distance visual acuity was 20/20 (0.0 logMAR) in 96% of cases, distance corrected intermediate visual acuity was 20/32 (0.2 logMAR) in all cases (60 cm), and distance corrected near visual acuity was 20/32 (0.2 logMAR) in 60% of cases (40 cm). The patient satisfaction score was 100% based on the Visual Function Index questionnaire for far and intermediate distance, respectively. No patients complained of the permanent photic phenomenon. No patients reported bilateral imbalance. All of the patients became spectacle independent for most of their intermediate activities at 60 cm. A total of 96% of the patients reported 100% contrast sensitivity in the Pelli-Robson test.

CONCLUSIONS

The unilateral implantation of this EDOF IOL seems to be tolerated and effective in improving the visual function of patients with unilateral cataract with limited optical side effects such as halos or glare, providing spectacle-independent vision from far to intermediate object distances. [J Refract Surg. 2023;39(8):518-523.].

Results of an Extended Depth-of-Focus Intraocular Lens Implantation in the Second Eye of Monofocal Pseudophakic Patients: A Pilot Study

PURPOSE

The purpose of this study was to investigate the visual results and patient satisfaction after implantation of an extended depth-of-focus (EDOF) intraocular lens (IOL) in the second eye of patients implanted previously with a monofocal IOL in the first eye.

METHODS

The medical records and self-reported questionnaires from patients who were implanted with monofocal IOLs in the first eye and EDOF IOLs in the second eye (group A) and from patients implanted bilaterally with EDOF IOLs (group B) were compared for visual acuity (VA), spectacle independence, patient satisfaction, and photic phenomena.

RESULTS

Group A (23 eyes of 23 patients) had similar distance uncorrected VA and intermediate uncorrected VA compared with group B (72 eyes of 36 patients) (0.03±0.05 vs. 0.04±0.16; P =0.136 and 0.660, respectively). There was a tendency toward a better near uncorrected VA in group A compared with group B (0.15±0.14 vs. 0.23±0.17; P =0.074). Patients' perception of their VA was similar between groups. Spectacle independence for distance vision was reported by 16/17 (94.1%) and 35/36 (97.2%) patients ( P =0.543), 13/17 (76.5%) and 32/36 (88.9%) patients ( P =0.252) for intermediate vision, and 4/17 (23.6%) and 22/36 (61.1%) patients for near vision ( P =0.011), in groups A and B, respectively. There was no difference in complaints of photic phenomena between groups.

CONCLUSIONS

Patients previously implanted with a monofocal IOL in 1 eye who are interested in improving their spectacle independence can be considered for an EDOF IOL implantation in the second eye and may have similar results to those implanted bilaterally with EDOF IOLs.

Measures of visual disturbance in patients receiving extended depth-of-focus or trifocal intraocular lenses

The degree of visual disturbance associated with a particular model of intraocular lens (IOL) depends on several factors, including IOL optic, material, and mechanics. Characterization of visual disturbance profiles is paramount for informing clinical IOL selection. Although many studies evaluating presbyopia-correcting IOLs include subjective assessment of visual symptoms, the types of patient-reported outcome measures (PROMs) used to capture these outcomes are inconsistent across studies, complicating data contextualization. Furthermore, some tools produce more meaningful results than others. This review presents a discussion on the scientific literature published on the subjective and semiobjective (halo and glare simulator, light-distortion analyzer, vision monitor, and halometers) methods used to assess visual disturbances in patients implanted with trifocal or extended depth-of-focus IOLs, highlighting their advantages and limitations. It underscores the importance of between-study comparisons and the need for standardized PROMs in clinical IOL research to provide more accurate information for IOL selection.

A Comparative Evaluation of Visual, Refractive, and Patient-Reported Outcomes of Three Extended Depth of Focus (EDOF) Intraocular Lenses

Objective

To compare visual, refractive, and patient-reported outcomes of patients implanted with one of three types of extended depth of focus (EDOF) intraocular lenses.

Setting

Asian Eye Institute, Philippines.

Design

Retrospective cohort study.

Methods

Subjects implanted with Symfony (Johnson and Johnson, USA), IC-8 (AcuFocus, USA), and WIOL (Medicem, Czech Republic) EDOF intraocular lenses were recruited. Spherical equivalent, uncorrected and corrected visual acuity, defocus curve, and modulation-transfer function, Strehl ratio, and visual Strehl optical transfer function values, photic phenomena, and questionnaire answers were measured and assessed.

Results

A total of 32 eyes with the Symfony lens, 30 with the IC-8 lens, and 32 with the WIOL lens were included in the study. Mean postoperative spherical equivalent was -0.24 D for the Symfony, -0.17 D for the IC-8, and 0.27 D for WIOL. There were no significant differences in postoperative monocular and binocular uncorrected and corrected visual acuity. On a monocular defocus curve, the IC-8 and Symfony showed significantly better vision than WIOL. The Symfony had significantly better modulation-transfer function, Strehl ratio, and visual Strehl optical transfer function. No difference was seen among the three lenses with regard to glare or starburst, while patient satisfaction remained high in all groups for far, intermediate, and near vision.

Conclusion

All eyes implanted with the three EDOF designs achieved excellent far and intermediate vision, with acceptable near vision. The IC-8 and Symfony exhibited a better range of vision on defocus-curve testing. The Symfony showed superior results in quality of vision. Patient satisfaction was high in all three EDOF groups.