Cataract Surgery Satisfaction Lower With Premium Than Monofocal IOLs

Cataract surgery satisfaction, as well as frequency of visual symptoms, may be partially dependent on the type of intraocular lens (IOL) a patient receives, according to a study published in Ophthalmology. Patients who receive premium IOLs report more visual symptoms and less satisfaction than those implanted with monofocal lenses, the report shows.

Researchers conducted a prospective observational study to understand cataract surgery satisfaction and the frequency of visual symptoms in patients undergoing cataract surgery with placement of monofocal and premium IOLs. 

The main outcome measures of the study were symptom severity and level of symptom bother, satisfaction with vision, quality of vision, and ability to see without corrective lenses or eyeglasses.

The researchers took into account 554 patients who underwent implantation of the same IOL in both eyes and explored their surgery satisfaction by asking them to complete an 86-item questionnaire (Assessment of Intraocular Lens Implant Symptoms [AIOLIS]) preoperatively and postoperatively at 4 to 6 months. The recently developed questionnaire has standardized images assessing the 14 symptoms (such as halos, starbursts, glare, and rings) and cataract surgery satisfaction.

Among all patients, the report of visual symptoms significantly decreased after cataract surgery, except for dark crescent-shaped shadows. The best uncorrected binocular visual acuity improved from 0.47±0.35 logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.12±0.12 logMAR postoperatively. 

The study shows patients’ ratings of intermediate vision as good, very good, or excellent improved from 12% preoperatively to 71% postoperatively and ratings of distance vision as good, very good, or excellent improved from 15% preoperatively to 85% postoperatively. 

However, the monofocal IOL group had larger postoperative reductions of visual symptoms compared with the premium IOL group, including halos (difference, -36% and -20%), starburst (-44% and -23%), glare (-52% and -36%), and rings (-26% and -3%). 

Most patients (84%) ranked their cataract surgery satisfaction as somewhat, very, or completely satisfied, and most patients (88%) reported that they could see pretty well, very well, or perfectly well without corrective lenses after surgery.

“Patients receiving premium IOLs probably have higher criteria for meeting satisfaction, because they have requirements not only for distance vision, but also for intermediate vision and near vision, and for eyeglass independence, in addition to an out-of-pocket expense for the device,” according to researchers. “There are still factors associated with dissatisfaction and symptoms that cannot be explained by visual acuity alone. The role of neural adaption could vary by patient and by type of IOL, accounting for unexplained optical phenomenon causing dissatisfaction, and the 4- to 6-month postoperative period for reassessment might not be long enough for neural adaption.”

Limitations of the study included lack of auditing of clinical data accompanying patient responses and inability for 6% of patients to receive their second IOL due to the COVID-19 pandemic.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.