Reply: Self-rated quality of vision and optical phenomena intensity of diffractive presbyopia-correcting IOLs: EDOF, trifocal vs panfocal.

Abstract

We thank Gurnani et al. for the attentive reading of our study on quality of vision and optical phenomena of three presbyopia-correcting intraocular lenses (IOLs). This prospective comparative study consecutively included patients after bilateral IOL implantation of presbyopia-correcting IOLs from 2013 to 2017 at the Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany. All patients signed an informed consent form for participation in research and were consecutively included three months after bilateral lens exchange. The study design did not include randomization of patients or blinding of the surgeon/counsellor because this would not have been possible in clinical practice. The surgeon (T.K.) who performed all surgeries and counseled patients for their particular IOL type was an experienced surgeon with over 20 years of experience in this kind of surgery. The surgeon counseled the patients for the particular IOL type depending on the patients’ preferences and his experience with that particular IOL type. We agree with the authors that optical phenomena are the leading cause of concern and dissatisfaction after implantation of presbyopia-correcting IOLs. However, patients need to be counselled in the early-postoperative stage that the process of neuroadaptation can take up to 12 months postoperatively. Previous studies show that owing to the process of neuroadaptation, the difficulties associated with photopic phenomena decrease significantly over time.1,2 Thus, analyzing optical phenomena in very early-postoperative periods, for example, one week postoperatively, is not purposeful, but rather studying the development of optical phenomena in later-postoperative periods makes sense. Moreover, in early-postoperative stages, often surface problems as dry-eye-disease obscure the evaluation of the perception of optical phenomena. All patients filled out the first questionnaire themselves to assess the self-rated quality of vision at the 3-month postoperative visit. It included the intensity of the optical symptoms “glare,” “halos,” “starbursts,” “blurred vision,” and “ghosting” under three different lighting conditions.3 The second patient questionnaire interviewed the patient for “everyday lifestyle activities” and spectacle dependency.4 Finally, you mention a good point about subgroup analysis of cataract and refractive lens exchange patients at different ages. About the type of surgery (cataract vs refractive), we performed a subgroup analysis of patients with cataract only. A subgroup analysis of refractive patients only would not have led to a statistically meaningful outcome because the sample size would have been too small. We agree with the authors that future studies analyzing the performance of these IOLs categorizing groups about surgery type, age, and profession of patients would be meaningful and of great interest to the audience.