In a well-matched sample group, patients with higher levels of postoperative astigmatism reported a greater improvement in quality of life and a greater rate of willingness to have the procedure again if they received an Extended Depth of Focus IOL compared to patients receiving a low-add, multifocal IOL, despite similar postoperative clinical and patient reported performance.
By Steve Lenier; Reviewed by Stephen J. Hannan, OD
Patients with higher levels of postoperative astigmatism reported a greater improvement in quality of life and a greater willingness to have the surgical procedure again if they received an extended depth of focus intraocular lens (EDOF IOL), compared to patients receiving a low-add multifocal lens.
A study conducted by David Teenan, FRCOphth, and Stephen Hannan, OD, Optical Express, Glasgow, UK, compared the effect of postoperative residual astigmatism on clinical and patient-reported outcomes in patients implanted with an EDOF lens (Symfony, Johnson & Johnson Vision), and a segmental-add, multifocal intraocular lens (MF20, Oculentis). The preoperative and demographic characteristics of the two groups were similar and there were no statistically significant differences (See Figure 1).
The researchers found that at 3 months, the lenses had similar postoperative clinical and patient-reported performance. However, in the group of patients who had higher levels of postoperative residual astigmatism (>1 D), the EDOF group reported greater satisfaction with their quality of life and willingness to undergo the procedure again than those receiving the multifocal IOL.
At 3 months, residual astigmatism was not different between the IOL types, and there was no significant difference in the mean change in astigmatism (See Figure 2). There was also no statistically significant difference for the overall distribution of postoperative uncorrected distance visual acuities.
It is possible some disparity or breakout may be present between the 2 lenses at the higher level of visual acuity, i.e. 20/16 (See Figure 3). Similarly, there was no statistically significant difference for the overall distribution of postoperative uncorrected near visual acuities, with some disparity or breakout possibly present between the 2 lenses at the higher level (See Figure 4).
Overall, there was almost no difference when patients were asked if the surgery improved their quality of life. For the patients with the EDOF lens, 90% responded yes, and for the patients with multifocal lens, 89% said yes.
However, in patients who had higher levels of postoperative astigmatism, patients with the EDOF lens said their quality of life improved (86%), more than those with the multifocal lens (68%) (See Figure 5).
The same results were seen when patients were asked if they would have the operation again if they had it to do over. For both groups, 90% of patients said yes. Again, patients with higher levels of residual astigmatism reported a greater rate of willingness to have the procedure again if they had the EDOF lens (90%) over the multifocal lens (79%) (See Figure 6).
The authors pointed out that a limitation of this study is that the proportion of patients with residual astigmatism for both groups is relatively small in this dataset, about 5%. They said their next step is to examine a larger sample of treatment data so the subgroup with higher levels of astigmatism can be examined further.
Dr. Hannan added that with increasing patient expectation being found today, factors such as an understanding of patient tolerance for low levels of residual astigmatism will play a greater role in the lens selection decisions made by surgeons.
David Teenan, FRCOphth
Stephen Hannan, OD
This article was adapted from a presentatrion that Dr. Hannan presented at 2017 American Society of Cataract and Refractive Surgery meeting. Drs. Teenan and Hannan reported no financial disclosures regarding this study.