Extended Depth of Focus Intraocular Lenses for Presbyopia

Sruti S. Akella; Viral V. Juthani


Curr Opin Ophthalmol. 2018;29(4):318-322. 

In This Article

Patient Outcomes

Literature on patient outcomes is relatively limited given the novelty of these lenses, but a few studies show promising results.

Attia et al. analyzed 30 eyes with the EDOF and showed excellent uncorrected visual acuities at near (0.20 logMAR), intermediate (-0.03 logMAR), and distance (0.03 logMAR) with high rates of patient satisfaction and spectacle independence.[3] Compared to a monofocal lens, the Symfony IOL has been shown to achieve significantly better postoperative uncorrected vision for distance, intermediate, and near targets compared to a monofocal lens (P > 0.013).[1]

Currently, the only large prospective multicenter study in the literature was performed in 411 patients with bilateral implantation of the Symfony lens. One group aimed for micromonovision (-0.50 to 0.75D of residual myopia in the nondominant eye) and the other group was targeted for emmetropia. Targeting for micromonovision improved uncorrected distance visual acuity (UDVA) and spectacle independence as well as patient satisfaction with near vision. Overall, only 14.4% of patients required spectacles postoperatively and more than 90% said they would recommend the same procedure to their friends and family.[2] Significantly, more than 90% of patients reported no or mild glare, halos, and starbursts, which is in contrast to a previous study[18] in which multifocal and EDOF lenses presented halos with comparable intensities.

Other studies[19] have examined the benefits of 'blended EDOF', meaning that one eye is implanted with a traditional EDOF lens and the other with a multifocal or bifocal IOL. De Medeiros et al. found that the combination of a Symfony lens with diffractive bifocal IOL exhibited better UDVA but slightly worse UNVA and UIVA than patients with bilateral trifocal lenses. However, the mixed EDF group performed better under mesopic conditions.[19]

One case report recently published showed satisfactory patient outcomes (UDVA 20/20; UIVA 20/20; UNVA 20/16) after bilateral implantation of the Symfony lens in post-LASIK patients,[20] but no large-scale studies have yet been performed in this population.

To date, the largest study of the IC-8 IOL is a multicenter prospective study of 105 patients who underwent IC-8 lens implantation in one eye and an aspheric monofocal IOL in the fellow, dominant eye. More than 95% of patients achieved 20/32 vision or better with binocular UDVA and UIVA; 79% of patients reached a binocular UNVA of 20/32 or better. The authors also found that patients with the IC-8 lens can tolerate up to 1.5 D of astigmatism with UNVA and UIVA better than 20/32.[16]

Only one study has been published on the Xtrafocus IOL.[17] A total of 21 pseudophakic patients with irregular corneal astigmatism underwent implantation, with statistically significant improvement in uncorrected and corrected distance visual acuities from a median of 20/200 to a new median of 20/50.[17]

It should be noted that none of these published studies satisfies all the requirements of the 2017 American Academy of Ophthalmology taskforce consensus statement on EDOF lenses, which requires: 1) a minimum of 100 patients with EDOF lenses; 2) depth of focus defined as the interval of nonpositive defocus values with a mean visual acuity of at least 0.2 logMAR; and 3) a depth of focus set at least 0.5 D wider than for the monofocal control group at 0.2 logMAR.[21]