<p>Optimum Refractive Target in Patients with Bilateral Implantation of Extended Depth of Focus Intraocular Lenses</p>

Abstract

Purpose: To determine the refractive target of extended depth of focus (EDOF) intraocular lenses in dominant and non-dominant eyes which provides the best binocular vision at all ranges after cataract surgery. Patients and Methods: This retrospective, single-center, non-comparative study included 47 patients who had undergone bilateral cataract surgery with implantation of EDOF IOLs (Tecnis Symfony or Tecnis Symfony Toric) targeting emmetropia in both eyes. Binocular uncorrected visual acuity at distance (UDVA), near (UNVA), intermediate (UIVA), and manifest refraction spherical equivalent (MRSE) were recorded between 1 and 3 months after the second-eye cataract surgery. Scattergrams for combined binocular UDVA, UIVA, UNVA and postoperative MRSE were plotted and the points of minima of the quadratic regression curve for the dominant and non-dominant eyes were considered as the optimum MRSE corresponding to the best overall visual acuity. Subgroup analysis of patients who achieved UDVA and UIVA ≥20/20 and UNVA ≥20/30 was also performed. Results: For the overall group, the optimum MRSE was −0.08 D for dominant and −0.63 D for non-dominant eyes. In a subset of 17 patients who achieved excellent acuity at all distances, the mean MRSE for the dominant and non-dominant eyes was −0.07 ± 0.14 D and −0.21 ± 0.24 D, respectively. Conclusion: Excellent visual acuity at all ranges can be achieved with bilateral EDOF intraocular lenses implanted after cataract surgery. Our results indicate the best results when the dominant eye is targeted at emmetropia and the nondominant eye is targeted between −0.21D and −0.63D, with excellent results shown with mild myopia of −0.21 in the non-dominant eyes. Future studies with larger sample sizes and subjective patient-reported outcomes may validate current study outcomes.

Influence of ocular biometric factors on the defocus curve in an enlarged depth-of-focus intraocular lens

“…In addition, subjective optimal correction and postoperative patient satisfaction were high. The studies published over the last two years are in line with the current findings, highlighting good visual outcomes after Tecnis Symfony implantation [8][9][10][11][12]. However, most authors agree that near vision might be limited in some patients.…”

“…Even with distance corrected refraction, it has been observed that some patients achieve good visual acuities (≤ 0.1 LogMAR or 0.8 decimal) as near as 20 cm, whereas others only reach a sharp vision until one meter. Some authors have suggested that targeting a mild myopia in non-dominant eye improves postoperative outcomes [ 10 ]. The variability in the range of clear vision with multifocal IOL has been attributed to several factors, but the influence on extended focus IOLs has not been extensively explored.…”

Clinical Outcomes of a New Non-Diffractive Extended Depth-of-Focus Intraocular Lens Targeted for Mini-Monovision

“…We applied mini-monovision in all patients, with a target of −0.50 D in the non-dominant eye and achieved a postoperative MRSE of −0.46±0.35 D. Figure 1 shows that the postoperative MRSE of the dominant and mini-monovision eyes was close to their respective target refractions (0 and −0.50 D). A target refraction between −0.21 D and −0.63 D was reported by Jackson et al 21 as the optimal range for nondominant eyes implanted with the Tecnis Symfony IOL (Johnson and Johnson) during bilateral cataract surgery. Using the same EDOF IOL with mini-monovision (target −0.50 D).…”

The relationship between patient satisfaction and visual and optical outcome after bilateral implantation of an extended depth of focus multifocal intraocular lens

“…In order to achieve a better near functional vision, a slightly myopic correction (mini-monovision) in the non-dominant eye has been recommended by the experts. 8 , 14 , 28 Although most patients in our study had a good distance and intermediate functional visual acuity using this approach, only 18% have respectively achieved complete spectacle independence. This percentage might seem very low, but it has to be considered, that we decidedly encouraged our patients to use reading glasses for long-term reading to avoid fatigue, even when they had a good functional reading vison in one eye.…”