Visual and refractive outcomes, spectacle independence and patient satisfaction after extended depth-of-focus intraocular lens implantation: a retrospective singlecentre case series of 45 eyes

Abstract

Purpose: To describe uncorrected distance visual acuity over the first 6 months, and postoperative intermediate and near acuity, refraction, spectacle use, photic phenomena and satisfaction, after cataract surgery with an extended depth-of-focus (EDOF) intraocular lens (IOL). Setting: Private eye centre, Dammam, Saudi Arabia. Design: Retrospective single-centre case series. Methods: Forty-five eyes of 25 patients (mean age 53.4 ± 9.6 years) underwent phacoemulsification with implantation of one of two EDOF IOLs (Bi-Flex ELON, Medicontur; Synthesis+, Cutting Edge) between August 2022 and September 2023. Uncorrected distance visual acuity (UDVA) was recorded before surgery and at 2 weeks and 1, 3 and 6 months. Intermediate and near acuity, binocular acuity, refraction, satisfaction, spectacle use and photic phenomena were recorded at one further postoperative assessment. Inferential analyses used the first operated eye of each patient (n = 25); results for all 45 eyes are descriptive. Results: In first eyes, mean UDVA improved from 0.45 ± 0.23 to 0.07 ± 0.09 logMAR (change −0.38, 95% confidence interval [CI] −0.47 to −0.28; p < 0.001), and 85% of this change had occurred by 1 month. At 6 months, 73% of all eyes had UDVA of 20/25 or better. Uncorrected intermediate and near acuity were 20/25 or better in 67% and 76% of eyes (84% and 89% with distance correction). Postoperative spherical equivalent was −0.30 ± 0.72 D and was within ±0.50 D of emmetropia in 58% of eyes. Twenty-two of 25 patients (88%) reported needing no spectacles for daily activities, and 24 (96%) were fully or fairly satisfied with distance vision. Eleven patients (44%) reported at least one photic phenomenon, most often halos (28%). The eight eyes with previous radial keratotomy, vitrectomy or amblyopia had a mean 6-month UDVA of 0.23 logMAR, compared with 0.06 logMAR in the other 37 eyes. Conclusions: After EDOF IOL implantation, about three quarters of eyes reached uncorrected acuity of 20/25 or better at distance and near, and most patients reported not needing spectacles. Photic phenomena were reported by 44% of patients. Without a control group, these outcomes cannot be attributed to the lens designs.