Visual Outcomes, Visual Quality and Patient Satisfaction: Comparing a Blended Bifocal Approach to Bilateral Extended Depth of Focus Intraocular Lens Implantation

Abstract

Purpose

To compare visual outcomes, quality of vision and patient satisfaction between a blended apodized diffractive bifocal lens combination and bilateral implantation of an extended depth of focus intraocular lens (IOL).

Patients and methods

Subjects implanted with either the blended bifocal (Blended) or bilateral extended depth of focus (EDOF) IOL combinations were examined 3 to 24 months after second eye surgery. The primary outcome measure was the patient’s best distance-corrected near visual acuity (VA) at 40cm. The secondary outcome measures were scores on the Quality of Vision Survey, the Catquest-9SF and the Visual Functioning Questionnaires, uncorrected binocular intermediate and near VA at 4–6m, 60cm and 40cm, the manifest refraction and the best-corrected monocular and binocular distance VA.

Results

Twenty-five EDOF subjects and 23 blended subjects were analyzed. The uncorrected and best-distance corrected intermediate VA was statistically significantly better in the EDOF group (p < 0.05); no other significant differences were noted at distance or near. The EDOF group had significantly higher percentage of patients having no difficulty with hobbies and handicrafts (p < 0.05). Eighty-seven percent of the blended subjects and 79% of the EDOF subjects were “very” or “fairly” satisfied with their vision (p = 0.52). The frequency, severity and degree of bother from visual disturbances were comparable between the two groups; however, more subjects in the EDOF group reported severe disturbances (36% vs 4%).

Conclusion

Distance and near VA are similar with both IOL designs, but intermediate VA was better with the EDOF IOL resulting in lower difficulty with intermediate tasks such as hobbies and handicrafts. Despite the difference at intermediate VA, satisfaction was similar between the two groups and there were greater reports of severe visual disturbances in the EDOF group.

Keywords:

• ReSTOR
• Symfony
• multifocal
• extended range of vision
• cataract surgery

Acknowledgments

Amy Crump, OD of Swagel Wooten Eye Institute, assisted in the data collection for this study. Sarah Makari, OD of Science in Vision aided in the preparation of this manuscript.

Disclosure

Swagel Wootton Eye Institute (Hammond) received an investigator-initiated trial grant from Alcon (Fort Worth, TX) to conduct the study: IIT#41669787. Science in Vision received funding from Swagel Wootton Eye Institute to assist in preparing the study and the resulting manuscript. Dr Richard Potvin reports personal fees from Alcon, outside the submitted work. The authors report no other conflicts of interest in this work.