Refractive lens exchange in younger and older presbyopes: comparison of complication rates, 3 months clinical and patient-reported outcomes

Figures & data

Table 1 IOL types in first and second eyes

	45–49 years	50–54 years	55–59 years	60–64 years
IOL in first eye: Lentis Mplus with 3.0 D near add in all cases (model LS-313 MF30 [non-toric] or LU-313 MF30T [toric])
IOL in second eye: (number of eyes [%])
Lentis Mplus with 3.0 D near add (model LS-313 MF30 [non-toric] or LU-313 MF30T [toric])	250 (78.1%)	248 (77.5%)	235 (73.4%)	251 (78.4%)
Lentis MplusX with 3.0 D near add (model LS-313 MF30 [non-toric] or LU-313 MF30T [toric])	45 (14.1%)	40 (12.5%)	50 (15.6%)	33 (10.3%)
Lentis Mplus with low near add (+1.5 or +2.0 D) (model LS-313 MF15 or LS-313 MF20)	13 (4.1%)	15 (4.7%)	26 (8.1%)	24 (7.5%)
Other multifocal IOL	3 (0.9%)	2 (0.6%)	4 (1.3%)	4 (1.3%)
Monofocal IOL	9 (2.8%)	12 (3.8%)	3 (0.9%)	8 (2.5%)
Did not proceed with second eye (not an intention)	0 (0%)	1 (0.3%)	2 (0.6%)	0 (0%)
Did not proceed with second eye (unhappy with first eye)	0 (0%)	2 (0.6%)	0 (0%)	0 (0%)

Abbreviation: IOL, intraocular lens.

Figure 1 Distribution of preoperative manifest spherical equivalent.

Table 2 Preoperative and postoperative clinical data

Age category	45–49 years	50–54 years	55–59 years	60–65 years	P-value
Number of patients (eyes)	320 (640)	320 (637)	320 (638)	320 (640)
Age	47.6±1.3	52.1±1.4	56.9±1.5	62.4±1.7	<0.01
Mean ± SD
Female/male	60%/40%	53.5%/46.5%	59.3%/40.7%	58.4%/41.6%	0.08
Preoperative data
Sphere	+1.75±2.48	+1.73±2.56	+1.75±2.56	+1.67±2.59	0.93
Mean ± SD (range) [D]	(−7.75 to +7.25)	(−10.5 to +7.50)	(−7.25 to +7.5)	(−13.5 to +7.25)
Cylinder	−0.76±0.92	−0.69±0.85	−0.75±0.76	−0.79±0.84	0.18
Mean ± SD (range) [D]	(−7.00 to 0.00)	(−7.50 to 0.00)	(−6.00 to 0.00)	(−5.50 to 0.00)
MSE	+1.37±2.49	+1.39±2.61	+1.37±2.53	+1.27±2.63	0.85
Mean ± SD (range) [D]	(−8.38 to +6.25)	(−10.63 to +7.25)	(−8.5 to +7.00)	(−15.25 to +6.50)
CDVA	−0.06±0.05	−0.06±0.05	−0.06±0.04	−0.05±0.06	0.01
Mean ± SD (range) [logMAR]	(−0.18 to 0.00)	(−0.18 to 0.00)	(−0.18 to 0.00)	(−0.18 to 0.00)
Postoperative data
Sphere	+0.12±0.45	+0.15±0.41	+0.16±0.44	+0.15±0.43	0.28
Mean ± SD (range) [D]	(−2.00 to +2.75)	(−2.00 to +1.25)	(−1.75 to +1.75)	(−2 to +2.25)
Cylinder	−0.38±0.45	−0.36±0.40	−0.37±0.42	−0.39±0.43	0.57
Mean ± SD (range) [D]	(−4.25 to 0.00)	(−2.25 to 0.00)	(−2.25 to 0.00)	(−2.25 to 0.00)
MSE	−0.07±0.43	−0.03±0.41	−0.02±0.43	−0.05±0.4	0.11
Mean ± SD (range) [D]	(−2.13 to +1.38)	(−2.38 to +1.25)	(−2.13 to +1.63)	(−2.13 to +1.25)
Monocular UDVA	0.00±0.12	−0.01±0.11	0.00±0.11	0.01±0.12	0.10
Mean ± SD (range) [logMAR]	(−0.18 to 0.80)	(−0.18 to 0.80)	(−0.2 to 0.60)	(−0.18 to 0.70)
Binocular UDVA	−0.05±0.08	−0.06±0.07	−0.05±0.08	−0.05±0.08	0.09
Mean ± SD (range) [logMAR]	(−0.18 to 0.4)	(−0.18 to 0.3)	(−0.18 to 0.3)	(−0.18 to 0.52)
Monocular UNVA	0.21±0.16	0.21±0.15	0.22±0.16	0.21±0.17	0.57
Mean ± SD (range) [logMAR]	(−0.3 to 0.8)	(−0.08 to 0.9)	(−0.08 to 0.9)	(−0.3 to 1.0)
Binocular UNVA	0.16±0.13	0.16±0.12	0.17±0.13	0.17±0.14	0.36
Mean ± SD (range) [logMAR]	(−0.3 to 0.7)	(−0.1 to 0.8)	(−0.10 to 0.78)	(−0.3 to 0.76)
Monocular CDVA	−0.05±0.06	−0.06±0.06	−0.05±0.06	−0.05±0.07	0.03
Mean ± SD (range) [logMAR]	(−0.18 to 0.3)	(−0.18 to 0.4)	(−0.2 to 0.4)	(−0.18 to 0.4)

Abbreviations: MSE, manifest spherical equivalent; UDVA, uncorrected distance visual acuity, UNVA, uncorrected near visual acuity; CDVA, corrected distance visual acuity.

Figure 2 Refractive outcomes: distribution of 3 month postoperative manifest spherical equivalent.

Figure 3 Cumulative monocular uncorrected distance visual acuity.

Note: Follow-up 3 months.

Figure 4 Cumulative monocular uncorrected near visual acuity.

Note: Follow-up 3 months.

Figure 5 Comparison of preoperative and postoperative corrected distance visual acuity.

Note: Follow-up 3 months.

Table 3 IOL explants

Age category	45–49 years	50–54 years	55–59 years	60–64 years
IOL explant due to quality of vision issues (Secondary IOL: monofocal or low near add multifocal IOL)	4 eyes (0.6%) of 4 patients (1.3%)	1 eye (0.2%) of 1 patient (0.3%)	2 eyes (0.3%) of 2 patients (0.6%)	1 eye (0.2%) of 1 patient (0.3%)
IOL exchange due to near vision issues (Secondary IOL: different type of multifocal IOL)	–	–	–	1 eye (0.2%) of 1 patient (0.3%)
IOL exchange for other reasons (IOL opacification)	–	–	2 eyes (0.3%) of 1 patient (0.3%)	–
Total number of IOL explants	4 eyes (0.6%) of 4 patients (1.3%)	1 eye (0.2%) of 1 patient (0.3%)	4 eyes (0.6%) of 3 patients (0.9%)	2 eyes (0.3%) of 2 patients (0.6%)

Abbreviation: IOL, intraocular lens.

Table 4 Postoperative complications

	45–49 years number of eyes [%]	50–54 years number of eyes [%]	55–59 years number of eyes [%]	60–65 years number of eyes [%]	P-value
Mean follow-up ± SD (months)	12.4±8.4	12.1±9.0	12.2±8.3	12.9±8.5	0.24
Corneal abrasion	0 [0]	4 [0.6]	6 [0.9]	5 [0.8]	0.13
Corneal edema	4 [0.6]	2 [0.3]	6 [0.9]	7 [1.1]	0.38
Elevated intraocular pressure	3 [0.5]	0 [0]	1 [0.2]	3 [0.5]	0.28
Cystoid macular edema	3 [0.5]	4 [0.6]	5 [0.8]	3 [0.5]	0.86
Iritis	7 [1.1]	19 [3]	5 [0.8]	9 [1.4]	0.008
Retinal detachment	0 [0]	0 [0]	0 [0]	1 [0.2]	0.39
Endophthalmitis	0 [0]	0 [0]	0 [0]	0 [0]	–
Posterior capsular opacification	74 [11.6]	62 [9.7]	60 [9.4]	62 [9.7]	0.56
(Underwent nd:YAG capsulotomy)	(54 [8.4])	(49 [7.7])	(46 [7.2])	(47 [7.3])	(0.84)

Table S1 Postoperative patient-reported outcomes according to age category

Age category	45–49 years (n=320 patients)	50–54 years (n=320 patients)	55–59 years (n=320 patients)	60–65 years (n=320 patients)	P-value
Thinking about your vision during the last week, how satisfied are you with your vision?
(1= very satisfied, 2= satisfied, 3= neither, 4= dissatisfied, 5= very dissatisfied)
Satisfied (score 1 & 2)	87.5%	86.9%	89.4%	89.4%	0.26
Neither (score 3)	6.9%	5.0%	6.9%	4.7%
Dissatisfied (score 4 & 5)	5.6%	8.1%	3.8%	5.9%
Would you recommend vision correction surgery to your friends and relatives?
Yes/no	91.9%/8.1%	93.1%/6.9%	94.4%/5.6%	92.8%/7.2%	0.66
Has surgery improved your quality of life?
Yes/no	91.6%/8.4%	91.9%/8.1%	92.8%/7.2%	91.6%/8.4%	0.93
If you had to do it over, would you have vision correction surgery again?
Yes/no	91.3%/8.8%	94.1%/5.9%	94.4%/5.6%	93.8%/6.3%	0.37
Think about your vision during the last week. Please rate the degree of difficulty you experienced with each of the visual symptoms/dry eyes.
(Measured on discrete scale from 1= no difficulty to 7= severe difficulty).
Starburst
No or little difficulty	61.3%	60.0%	56.6%	62.2%	0.26
Moderate difficulty	32.8%	30.0%	36.6%	31.3%
Significant difficulty	5.9%	10.0%	6.9%	6.6%
Glare
No or little difficulty	59.7%	57.2%	56.6%	57.8%	0.69
Moderate difficulty	32.2%	32.5%	36.3%	35.0%
Significant difficulty	8.1%	10.3%	7.2%	7.2%
Halo
No or little difficulty	58.8%	58.4%	59.1%	62.5%	0.57
Moderate difficulty	33.1%	30.9%	33.1%	31.3%
Significant difficulty	8.1%	10.6%	7.8%	6.3%
Ghosting/double vision
No or little difficulty	75.9%	72.5%	72.5%	75.6%	0.90
Moderate difficulty	19.7%	22.2%	23.1%	20.0%
Significant difficulty	4.4%	5.3%	4.4%	4.4%
Dry eyes
No or little difficulty	72.8%	69.7%	72.8%	67.8%	0.40
Moderate difficulty	24.7%	26.6%	25.9%	29.4%
Significant difficulty	2.5%	3.8%	1.3%	2.8%
No or little difficulty (score 0, 1), Moderate difficulty (score 3, 4, 5), Significant difficulty (score 6, 7)
Because of your eyesight, how much difficulty do you have with the following activities?
(1= No difficulty, 2= A little difficulty, 3= Moderate difficulty, 4= A lot of difficulty, 5= Never try to do this because of my vision, 6= Never do this for other reasons)
Driving at night
No or little difficulty	73.2%	71.8%	72.5%	73.9%	0.55
Moderate difficulty	15.7%	16.8%	16.8%	19.1%
Significant difficulty	11.2%	11.3%	10.7%	7.0%
Doing work or hobbies that require you to see well up close, such as cooking, fixing things around the house, sewing, using hand tools, or working with a computer
No or little difficulty	91.2%	89.3%	90.9%	89.7%	0.88
Moderate difficulty	6.0%	7.8%	7.2%	6.9%
Significant difficulty	2.8%	2.8%	1.9%	3.4%
Taking part in active sports or other outdoor activities that you enjoy (like hiking, swimming, aerobics, team sports, or jogging)
No or little difficulty	95.2%	95.1%	96.6%	96.3%	0.88
Moderate difficulty	3.5%	4.2%	2.7%	3.0%
Significant difficulty	1.3%	0.6%	0.7%	0.7%
No or little difficulty (score 0, 1), Moderate difficulty (score 3), Significant difficulty (score 4, 5)

Table S2 Patient-reported outcomes: difference between postoperative and preoperative scores

Age category	45–49 years (n=146 patients)	50–54 years (n=153 patients)	55–59 years (n=162 patients)	60–65 years (n=161 patients)	P-value
Think about your vision during the last week. Please rate the degree of difficulty you experienced with each of the visual symptoms/dry eyes.
(Measured on discrete scale from 1= no difficulty to 7= severe difficulty).
Starburst
Worse	20.5%	22.9%	24.1%	19.9%	0.71
Unchanged	78.8%	75.8%	75.3%	77.6%
Better	0.7%	1.3%	0.6%	2.5%
Glare
Worse	19.9%	23.5%	22.8%	18.6%	0.76
Unchanged	78.8%	74.5%	76.5%	78.9%
Better	1.4%	2.0%	0.6%	2.5%
Halo
Worse	22.6%	22.2%	22.2%	21.7%	0.63
Unchanged	75.3%	77.8%	77.2%	77.6%
Better	2.1%	0.0%	0.6%	0.6%
Ghosting/double vision
Worse	15.1%	12.4%	11.7%	16.1%	0.43
Unchanged	82.9%	87.6%	87%	81.4%
Better	2.1%	0.0%	1.2%	2.5%
Dry eyes
Worse	13.0%	14.4%	12.3%	16.8%	0.87
Unchanged	84.2%	83.7%	86.4%	81.4%
Better	2.7%	2.0%	1.2%	1.9%
Worse: increase in symptoms by more than 2 scores
Unchanged: preoperative minus postoperative score 0±2 scores
Better: decrease in symptoms by more than 2 scores
Because of your eyesight, how much difficulty do you have with the following activities?
(1= No difficulty, 2= A little difficulty, 3= Moderate difficulty, 4= A lot of difficulty, 5= Never try to do this because of my vision, 6= never do this for other reasons)
Driving at night
Worse	21.7%	17%	17.8%	12.0%	0.35
Unchanged	72.7%	76.9%	73.0%	81.7%
Better	5.6%	6.1%	9.2%	6.3%
Doing work or hobbies that require you to see well up close, such as cooking, fixing things around the house, sewing, using hand tools, or working with a computer
Worse	6.3%	4.6%	1.3%	3.8%	0.34
Unchanged	72.7%	69.1%	75%	74.8%
Better	21%	26.3%	23.8%	21.4%
Taking part in active sports or other outdoor activities that you enjoy (like hiking, swimming, aerobics, team sports, or jogging)
Worse	2.9%	1.3%	0.0%	1.4%	0.25
Unchanged	79.7%	80.5%	74.3%	79.7%
Better	17.4%	18.1%	25.7%	18.9%
Worse: increase in symptoms by more than 1 score
Unchanged: preoperative minus postoperative score 0±1 score
Better: decrease in symptoms by more than 1 score

Notes: Patients rated their preoperative symptoms/difficulties with best spectacle/contact lens correction; postoperative symptoms were rated without any spectacle/contact lens correction.