Visual Outcomes and Subjective Experience After Combined Implantation of Extended Depth of Focus and Trifocal IOLs

Abstract

PURPOSE: To evaluate postoperative visual performance and patient-reported outcomes following combined implantation of an extended depth of focus (EDOF) intraocular lens (IOL) and a trifocal IOL. METHODS: The study enrolled consecutive patients undergoing refractive lens extraction or cataract surgery with combined implantation of an EDOF IOL (dominant eye) and a trifocal IOL in the nondominant eye. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, uncorrected intermediate (UIVA) and near (UNVA) visual acuities, defocus curves, and subjective questionnaires were evaluated 1 month postoperatively. RESULTS: The study enrolled 100 consecutive patients (200 eyes). The postoperative mean binocular UDVA, UIVA, and UNVA were −0.08 ± 0.07, 0.13 ± 0.12, and 0.17 ± 0.11 logMAR, respectively. The percentage of eyes within ±0.50 and ±1.00 diopters of the refractive target was 65% and 96% with EDOF IOLs, and 76% and 99% with trifocal IOLs, respectively. Of all patients, 91% were satisfied or more than satisfied with the procedure, and 87% of patients were spectacle free for near vision. On a scale from 0 (not at all) to 3 (very), mean scores of 0.52 ± 0.83, 0.71 ± 0.83, and 0.34 ± 0.73 were reported for glare, halos, and starbursts. The mean daytime and nighttime Quality of Vision scores were 9.13 ± 0.91 and 7.96 ± 1.57, respectively. CONCLUSIONS: The combination of an EDOF IOL and a trifocal IOL provides good unaided visual acuity for distance and near. This IOL combination provides high postoperative satisfaction and functional vision, but some early visual side effects were reported. [ J Refract Surg . 2020;36(5):326–333.]

Visual outcomes and patient satisfaction 1 and 12 months after combined implantation of extended depth of focus and trifocal intraocular lenses

“…As found in our previous study [7], there is a hyperopic tendency at both postoperative assessments with the EDOF IOL (Fig. 4), which may be due keratometric changes or to the IOL moving posteriorly due to capsular contractions [18,19], and direct assessment of IOL shift would further help explain the cause.…”

“…Various methodologies have been introduced in modern day lens-based surgery to provide a range of clear vision [1][2][3][4][5][6] with the least amount of visual side effects. Our recent study [7] sought to outline the clinical and patient-reported outcomes at an early postoperative period of the latest extended depth of focus (EDOF) technology, thought to provide superior intermediate vision with fewer unwanted visual phenomena, implanted in combination with a trifocal intraocular lens (IOL). The EDOF IOL was used in the dominant eye to provide good distance, intermediate and improve near vision and produce fewer unwanted visual phenomena, with the trifocal IOL implanted in the nondominant eye to provide adequate reading vision.…”

“…The EDOF IOL was used in the dominant eye to provide good distance, intermediate and improve near vision and produce fewer unwanted visual phenomena, with the trifocal IOL implanted in the nondominant eye to provide adequate reading vision. This recent study [ 7 ] reported that the combination of an EDOF and trifocal IOL provides good unaided visual acuity for distance, and near distances, providing high postoperative satisfaction and functional vision, at an early postoperative stage. This current study sought to outline the objective visual and refractive outcomes, and patient satisfaction of this IOL combination in a cohort of patients at a longer postoperative period of 1 year, and to determine whether the objective and subjective outcomes altered over this postoperative period.…”

Clinical Outcomes of Combined Implantation of an Extended Depth of Focus IOL and a Trifocal IOL in a Korean Population

“…Spectacle independence at far and intermediate distances was achieved in all patients, while the rate of spectacle independence was just slightly lower at the near distance (96%). Although there was a small number of patients who still needed spectacles for working in the near distance, a very high degree of spectacle independence was achieved with similar outcomes compared to rates in previous studies with the same IOLs [ 27 ].…”

“…The binocular defocus curve showed significantly better visual acuity results compared to the AT LISA tri IOL eyes at defocus levels of −1.0 D and −1.5 D ( P =0.008 and P =0.002, respectively) and the AT LARA IOL eyes at defocus levels of −3.0, −3.5 D, and −4.0 D ( P =0.019, P =0.019, and P =0.035, respectively). Richard et al showed a similar defocus curve in patients with combined IOL implantation and also presented better visual acuity results at defocus levels of −1.0 D in patients with bilateral EDoF IOL implantation [ 27 ]. However, there were only 5 patients with bilateral EDoF IOLs, and no other information is available.…”