Extended depth of focus versus trifocal for intraocular lens implantation: An updated systematic review and meta‐analysis

Abstract

Aims/Purpose: To compare the extended depth of focus (EDOF) versus trifocal intraocular lenses (IOLs) in patients undergoing IOL implantation.Methods: An electronic search was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines to include studies comparing EDOF versus trifocal IOLs. Refraction and visual acuity were primary outcomes. Secondary outcomes included defocus curves, intraocular aberrations, contrast sensitivity (CS), quality of vision (QoV) questionnaire score, haloes and glare, spectacle independence and patient satisfaction.Results: A total of 22 studies enrolling 2200 eyes were identified. Trifocal IOL showed a significant improvement in sphere (mean difference [MD] = −0.23; p = 0.001) and spherical equivalence (MD = −0.11, p = 0.0001) compared to EDOF IOL. No difference was observed in cylinder (MD = −0.03, p = 0.25) or astigmatism. Trifocal IOL had superior near visual acuity outcomes, namely uncorrected near visual acuity (MD = 0.12, p < 0.00001) and distance‐corrected near visual acuity (MD = 0.12, p = 0.002). Post‐operative corrected distance visual acuity (MD = −0.01, p = 0.01) was significantly improved for the EDOF group, although no difference was noted in post‐operative uncorrected distance visual acuity (MD = 0.00, p = 0.84), uncorrected intermediate visual acuity (MD = 0.01, p = 0.68) or distance‐corrected intermediate visual acuity (MD = −0.01, p = 0.39). Defocus curve favoured trifocal IOLs at near vision and EDOF IOLs at intermediate vision. Ocular aberration, CS, haloes (odds ratio = 0.64, p = 0.10), glare and patient satisfaction were not statistically significant between the groups. The trifocal IOL was associated with an improved QoV questionnaire score (MD = 1.24, p = 0.03) and spectacle independence (odds ratio = 0.26, p = 0.02).Conclusions: Trifocal IOLs improved uncorrected near visual acuity compared to EDOF IOLs. Uncorrected distance and intermediate visual acuity, halos and glare were not statistically different between both groups.