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. Serious postoperative complications were rare, with no adverse events were reported in most studies. 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.

Comparison of trifocal or hybrid multifocal-extended depth of focus intraocular lenses: a systematic review and meta-analysis

“…Consequently, the conclusions of most studies were inconsistent or with inadequate methodology. In contrast with the previous meta-analysis 26 , our results showed a higher incidence of halos in trifocal IOLs. Trifocal IOLs, by design, were inevitably associated with 18% to 20% loss in light transmission, leading to a relatively blurred image 35 .…”

“…Intermediate distance VA has been given heightened importance since most daily routine activities, such as driving, working and operating electronic devices, are performed at an intermediate distance. In the present meta-analysis, the hybrid multifocal-EDOF IOL yielded better UIVA than trifocal IOLs, which was not observed in the previous meta-analysis 26 . This finding was supported by the defocus curve in some studies, which showed that the hybrid multifocal-EDOF IOL performed better at the defocus level from -1.5D to -1D 4 , 11 , 13 , 19 , 20 .…”

“…Although several prospective trials have compared the clinical outcomes of trifocal and the hybrid multifocal-EDOF IOLs in recent years, there is still debate on which type of IOLs could offer the maximum benefits 4 , 13 , 19 – 25 . Furthermore, while a previous meta-analysis relied on a small sample size and inadequate parameters 26 , in the present study, we included data from populations in Europe, Asia and South America and stratified the data according to the different types of IOL. Therefore, we have conducted an up-to-date and comprehensive meta-analysis of the existing randomized controlled trials (RCTs) and prospective cohorts to compare the visual performance, spectacle independence and photic disturbance of trifocal IOLs and the hybrid multifocal-EDOF IOL after cataract or RLE surgeries.…”

Straylight in Different Types of Intraocular Lenses

“…[11][12][13] In addition, their impact on the quality of vision has been clinically studied through the visual acuity and contrast sensitivity, as well as the incidence rate of photic phenomena (e.g., halos, flashes, starbursts, and glare). [14][15][16] The three IOLs were taken from random batches. Figure 3a shows the normalized central intensities of the recorded disks as function of their radius for each IOL and the reference lens (as baseline) in their main focal planes.…”

Clinical Outcomes with a Novel Extended Depth of Focus Presbyopia-Correcting Intraocular Lens: Pilot Study

“… 1 , 2 Extended depth of focus (EDOF) IOLs is one of these options for presbyopia correction that has experienced a prolific development in recent years. 3 The basic principle behind these IOLs is to create a single elongated focal point to enhance the depth of focus or range of vision, allowing a functional vision at different distances in presbyopia. 4 This effect can be achieved by inducing controlled levels of spherical aberration, 5 combining refractive and diffractive surfaces to optimize achromatic and chromatic aberrations 6 , 7 or using a pinhole design.…”