Comparison of Patient Outcomes following Implantation of Trifocal and Extended Depth of Focus Intraocular Lenses: A Systematic Review and Meta-Analysis

Abstract

Purpose. The purpose is to compare the outcomes of implantation of trifocal intraocular lenses (TIOLs) and extended depth of focus (EDOF) intraocular lenses (IOLs). Methods. A comprehensive search of PubMed, Cochrane Library, EMBASE, and ClinicalTrial.gov was conducted in March 2020 to identify relevant studies. A meta-analysis of the results was performed. Patients implanted with EDOF IOLs or TIOLs in previous studies were included. The primary outcomes of the study were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), and defocus curve. Results. TIOLs and EDOF IOLs provided comparable binocular UDVA (MD = -0.01, 95% CI: -0.04, 0.03, logMAR). However, EDOF IOLs provided better UIVA (MD: -0.08, 95% CI: -0.14, -0.01, logMAR) and worse UNVA (MD: 0.10, 95% CI: 0.06, 0.14, logMAR) than TIOLs. Fewer patients achieved spectacle independence after implantation of EDOF IOLs (RR: 0.74, 95% CI: 0.63, 0.87) than after implantation of TIOLs, especially for near vision (RR = 0.82, 95% CI: 0.68, 0.99). There was no statistically significant difference in contrast sensitivity (CS) under photopic or mesopic conditions with both IOLs. Patient satisfaction after implantation of both IOLs was high. Conclusion. EDOF IOLs and TIOLs provide comparable distance vision. However, EDOF IOLs provide better intermediate vision and worse near vision than TIOLs. The advantages of EDOF IOLs over TIOLs in terms of CS, aberrations, and visual disturbance are not significant. Patients are satisfied with both types of IOLs.

Comparative efficacy and safety of all kinds of intraocular lenses in presbyopia-correcting cataract surgery: a systematic review and meta-analysis

“…In terms of CS, significant decreases were observed in other IOL groups compared to monofocal and enhanced monofocal IOLs under both photopic and mesopic conditions, with bifocal and AT LISAtri 839MP IOLs exhibiting the most noticeable effects. The CS of both EDOF and FineVision POD F IOLs increased with frequency, and EDOF IOLs have better CS only at lower spatial frequencies, with no significant difference at higher spatial frequencies, in line with previous reports [ 67 , 68 ]. This aligns with the findings of an RCT related to a multifocal IOL reported by Gil, MÁ in 2022 [ 69 , 70 ].…”

Head-to-Head Comparison of Intermediate Vision of Two Monofocal Intraocular Lenses

“…In contrast, the Eyhance monofocal IOL specifically aims to extend the range of acceptable intermediate vision by modifying the anterior surface of its monofocal analog IOL (ZCB00). 6 However, it is important to distinguish between the clinically validated functions of an IOL (or any medical device) and any additional design goals, commonly referred to as “designed to” or “aims to”. While these phrases may imply clinical value, they require cautious interpretation as they are not necessarily synonymous with empirically proven patient benefits.…”

Dysphotopsias or Unwanted Visual Phenomena after Cataract Surgery

“…In the last years, extended depth-of-focus IOLs (EDOF) have been introduced as presbyopia-correcting IOLs with the possibility of reducing PD occurrence [ 61 , 62 ]. However, a 2021 meta-analysis study comparing EDOF and MFIOL implantation outcomes could not find significant advantages of EDOFs compared to MFIOLs [ 63 ]. Monovision surgical techniques for correcting presbyopia may induce less PD compared to MFIOL implantation [ 64 ].…”