Extended Depth-of-Focus IOLs Produce Milder Halos Than Other Lenses

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Patients reported the EDOFs are better for night driving than panfocals or trifocals.

Choosing an intraocular lens (IOL) is largely a one-shot decision for most cataract patients, so matching the type of IOL to lifestyle and activities becomes especially vital. Provider guidance for newly diagnosed individuals may be enriched by knowing more about the main factors that have influenced patient satisfaction with various lenses after a few months of practical use.

Investigators at the Department of Ophthalmology, Goethe-University Frankfurt, Germany examined self-rated quality of vision (SQV) and optical phenomena incidence for 108 eyes of 54 individuals at 3 months after bilateral refractive lens exchange (RLE) or cataract surgery, or both. The prospective case series is published in Journal of Cataract & Refractive Surgery. Patients selected diffractive multifocal intraocular lenses (mIOLs) prior to the study: 18 had chosen extended depth-of-focus (EDOF.), 18 opted for a trifocal lens and 18 selected a panfocal lens.

Participants each completed 2 questionnaires; the first on SQV and visual disturbances such as glare, halos, ghosting, starbursts, and blurred vision; and the second about everyday activities and satisfaction. Visual acuity was assessed, and contrast sensitivity tested in 3 different light levels. “Our results suggest that diffractive EDOF patients on average report a slightly better self-rated total SQV compared to trifocal and panfocal patients under all lighting conditions, however all three lenses providing a good total SQV rating,” according to the investigation.

The 3 cohorts achieved comparable corrected distance visual acuity (P =.326) and uncorrected visual acuity (P =.553). At 80 cm, panfocals did not perform as well as the other lenses for uncorrected and corrected intermediate visual acuity; however at 60 cm, panfocals provided significantly better outcomes for distance-corrected intermediate visual acuity than EDOFs. At near, 40 cm, trifocal and panfocal IOLs proved superior to EDOFs.

The percentage of participants reporting disturbances such as halos or glare was similar among the 3 IOL groups (P >.05), but those with EDOF rated halos as milder (P <.05). In the everyday activities survey, patients with EDOFs expressed their night-driving experience was “good” and those with the two remaining IOLs rated this activity as only “satisfactory.”

Although 100% of participants with panfocals reached spectacle independence, 17% would not choose the same IOLs again or recommend it to others. Conversely, 44% of those in the EDOF group still needed reading glasses, but 100% with EDOFs said they would choose the same lens again and recommend it. Also, 2 patients with trifocals, or 11%, continued to need reading glasses and would not recommend the IOL — 1 would not again choose this lens.

Study limitations included a lack of randomization, and an unvalidated vision quality questionnaire. Also, 2 groups included cataract and RLE surgeries, while the EDOF cohort comprised only cataract patients. The investigation notes that results agree with prior research suggesting clear vision at 40 cm and 80 cm affects satisfaction less than far distance and 60 cm intermediate focus. “Looking at the unhappy patients of this study that would not choose the IOL again seems to underline the importance of good contrast sensitivity, optical phenomena and driving ability, particularly at night,” the analysis concludes.

Disclosures: The study authors have declared affiliations with the biomedical, pharmaceutical, and optical device industries. Please see the original reference for a full list of authors’ disclosures.


Böhm M, Hemkeppler E, Kohnen T. Self-rated quality of vision and optical phenomena intensity of diffractive presbyopia-correcting intraocular lenses: EDOF, trifocal versus panfocal. J Cataract Refract Surg. Published online November 21, 2021. doi:10.1097/j.jcrs.0000000000000862