Efficacy and safety of extended depth of focus intraocular lenses in cataract surgery: a systematic review and meta-analysis

Abstract

Background This study aims to evaluate the efficacy and safety of extended depth of focus (EDOF) intraocular lenes (IOLs) in cataract surgery. Methods All comparative clinical trials that involved bilaterally implanting EDOF IOLs in patients with cataract were retrieved from the literature database. We used random effects models to pool weighted mean differences (WMD) and risk ratio (RR) for continuous and dichotomous variables, respectively. Results Nine studies with a total of 1336 eyes were identified. The subgroup analysis was conducted according to the type of IOLs used in the control group. Compared with monofocal IOLs, EDOF IOLs produced better uncorrected intermediate visual acuity (WMD: -0.17, 95% CI: -0.26 to -0.08, P = 0.0001) and uncorrected near visual acuity (WMD: -0.17, 95% CI: -0.21 to -0.12, P < 0.00001). EDOF IOLs resulted in reduced contrast sensitivity, more frequent halos, however, higher spectacle independence (RR: 2.81, 95% CI: 1.06 to 7.46, P = 0.04) than monofocal IOLs. Compared with trifocal IOLs, EDOF IOLs produced worse near visual acuity (MD: 0.10, 95% CI: 0.07 to 0.13, P<0.0001). EDOF IOLs performed better than trifocal IOls in contrast sensitivity, and there were no significant difference in halos and spectacle independence. Conclusions Increasing the risk of contrast reduction and more frequent halos, EDOF IOLs provided better intermediate and near VAs than monofocal IOLs. At the expense of near vision, patients receiving EDOF IOLs have better contrast sensitivity than those receiving trifocal IOLs. Halo incidence and spectacle independence of EDOF IOLs were similar to those of trifocal IOLs.

Deadbolt cataract due to misplanted minishunt

“…Given preexisting amblyopia, drusen, ERM with macular pucker, and known glaucomatous structural and functional defects, diffractive optic IOL options (eg, multifocal and EDOF), and nondiffractive EDOF options (eg, Vivity [Alcon Laboratories, Inc.]) could potentially further degrade her contrast sensitivity. 3,4 Enhanced monofocal technology IOLs (eg, Eyhance [Johnson & Johnson], and its toric versions) may provide some intermediate vision without sacrificing contrast—and would be my recommended choice today—but were commercially unavailable at the time of surgery (2020). Given high amounts of regular and symmetric astigmatism and its refractive impact, a toric IOL would be feasible and highly desirable only if intracapsular support and zonular integrity remained, considered likely with fibrotic changes and meticulous surgery.…”

“…Therefore, multifocal and EDOF IOLs would not be our recommendation for this patient. 3 We would select a toric IOL to correct her refraction as much as possible, considering the presence of regular astigmatism. As the patient currently tolerates anisometropia and has interest in correcting presbyopia, we would implant a toric IOL and plan for minimonovision, aiming the left eye for intermediate (−1.5 D) and the right eye for distance.…”

“…Although elegant techniques for EX-PRESS shunt removal have been described, I would leave the shunt alone in this case as implantation was performed several years ago and a degree of capsular fibrosis will likely prevent extension of the capsular defect intraoperatively. 3,4 One should still prepare for this possibility by having a backup 3-piece IOL and anterior vitrectomy instrumentation readily available. In this case, I would refrain from hydrodissection as this may propagate the existing capsular defect and, instead, would perform ample hydrodilineation to mobilize the endonucleus.…”

A Cost-Effectiveness Analysis of AcrySof IQ Vivity Intraocular Lens (IOL) from Private Health Fund Perspective in Australia

“…5,6 During cataract surgery, standard monofocal intraocular lenses (IOLs) are typically implanted, which have a single focal point for distance vision correction; however, many patients may end up with life-long dependency on glasses for near and/or intermediate vision correction. 7 Multifocal IOLs have more than one focal point and provide vision over a range of distances (near, intermediate, and distance focal points), thereby reducing spectacle dependence. 8 However, diffractive multifocal IOLs are associated with increased risk of visual disturbances and reduced contrast sensitivity compared to monofocal IOLs.…”

Topical lipoic acid choline ester eye drop for improvement of near visual acuity in subjects with presbyopia: a safety and preliminary efficacy trial

“…External ocular lenses, such as spectacles or contact lenses, are typically used to correct vision [1]. Ocular surgery and surgical devices, such as corneal inlays [3], multifocal or extended depth of field (EDOF) intra-ocular lenses [4][5][6] and refractive laser [7,8] can also be used as treatment options, but these are invasive procedures, they are expensive and some treatments can only treat one eye (monovision) with a loss of optical summation from binocular vision [1,[3][4][5][6][7][8]. Access to spectacles is also problematic in developing countries, where 94% of presbyopic subjects reside [2].…”