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.
Highlights
Lens extraction combined with implantation of intraocular lenses (IOLs), which is an established and effective procedure, improves visual quality after cataract surgery [1,2,3]
Intraocular aberrations: (i) With a 3.0 mm pupil diameters (PD), primary spherical aberration was significantly higher with the extended depth of focus (EDOF) IOL than with the trifocal IOL. (ii) With a 5.0 mm PD, the RMS of HOAs was significantly higher with the EDOF IOL than with the trifocal IOL
The mean Quality of Vision (QoV) score was not statistically significant between groups [31, 38], except in the study by Escandon-Garcıa et al, in which patients implanted with Symfony IOLs showed higher values in all categories than patients implanted with trifocal intraocular lenses (TIOLs); the difference was statistically significant for the “bothersome” subscale
Summary
Lens extraction combined with implantation of intraocular lenses (IOLs), which is an established and effective procedure, improves visual quality after cataract surgery [1,2,3]. Patients implanted with MIOLs have better intermediate and near visual acuity and higher spectacle independence than those implanted with monofocal IOLs [2]. Patients implanted with MIOLs can see objects at different distances, they still cannot have satisfying visual quality between the separate foci [9]. The distribution of light in multiple focal points reduces postoperative contrast sensitivity (CS) and increases the incidence rate of disturbing photic phenomena such as halos and glare [10, 11]. To combat this problem, extended depth of focus (EDOF) IOLs were introduced
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