Extended Depth-of-Focus IOLs Ranked High on Vision Quality, Low on Glare, Halos

Extended depth-of-focus IOL patients report high satisfaction, despite some continued spectacle dependence.

Patient satisfaction with extended depth-of-focus (EDOFs) intraocular lenses (IOLs) is high when compared with other presbyopia-correcting implants, according to the analysis of a study published in the Journal of Cataract and Refractive Surgery. The research shows that patients report better quality-of-vision with the EDOF lenses compared with trifocal and panfocal IOLs under all lighting conditions. Optical phenomena and contrast sensitivity was similar with all 3 implantable lens types.

The researchers surveyed patients following cataract or refractive lens exchange surgery who received 1 of 3 diffractive multifocal IOLs.The researchers assessed patient self-rated quality of vision (SQV) and intensity of optical phenomena 3 months following implantation using a questionnaire. The survey accounted for photopic, mesopic, and scotopic lighting conditions.

Patients were also asked to rank their experiences with the lenses with regard to everyday lifestyle activities using a second questionnaire. That questionnaire asked patients to evaluate (on a scale of 1 [very good] to 6 [very bad]) their visual experiences with driving (day and night), theater/concert going, television watching, computer use, home activities, cooking, playing a musical instrument, domestic work, and reading. It also accounted for spectacle independence and whether the patient would choose the IOL again. Clinicians also performed examinations to monitor patients’ postoperative visual acuity and binocular contrast sensitivity.  

The research included 108 eyes of 54 participants (18 with EDOFs, 18 trifocals, and 18 panfocals). All 3 cohorts had adequate scores on the total SVQ (9.8±6.67, 22.2±7.09, 19.6±16.25 visual analog scale, respectively). 

The fact that all EDOF patients would choose the same lens, although a significant number of them need reading spectacles, shows from patients’ feedback that [spectacle independence] at near distance may not be the main factor that determines patients’ selection of their lens.

The reporting also shows that everyday lifestyle activities of near and intermediate distance activities were typically good to very good for all 3 patient groups, but that patients implanted with EDOF lenses had superior night driving scores.

All the patients who received EDOF lenses said they would select the same implant again, compared with 83% from the panfocal cohort, and 94%  from the trifocal cohort. However, 100% of patients who received panfocal and trifocal implants achieved complete spectacle independence, while in theEDOF cohort, 44% achieved spectacle independence. No significant differences were observed between lens types for contrast sensitivity in any lighting condition. No significant differences in reporting of optical phenomena were found between cohorts (P >.05), with an overall rating of mild to moderate symptom reporting in all lighting conditions. 

Clinical evaluations at the 3-month postoperative exam showed no difference in  uncorrected or distance corrected VA between groups (P =.553 and P =.326, respectively). However, at 80 cm, distance corrected and uncorrected intermediate VA was significantly worse for patients implanted with the panfocal IOL than the trifocal and EDOF IOLs (P <.001). At 60 cm, the panfocal IOL had significantly better distance corrected intermediate VA compared with the EDOF lenses (P =.015). At 40 cm, the EDOF IOL demonstrated significantly worse uncorrected near visual acuity and distance-corrected near visual acuity compared with the trifocal and panfocal IOLs (P <.001 each).

The investigators report no significant differences in contrast sensitivity between the lenses in photopic (P =.393), mesopic (P =.508), or mesopic with glare (P =.078) conditions. The panfocal IOL, however, had slightly worse results in all lighting conditions compared with the EDOF and trifocal options.

All 3 lens types provide adequate vision correction with limited perceived differences in symptom severity of optical phenomena of contract sensitivity. 

“The fact that all EDOF patients would choose the same lens, although a significant number of them need reading spectacles, shows from patients’ feedback that [spectacle independence] at near distance may not be the main factor that determines patients’ selection of their lens,” the investigators report. “This finding is in line with a recently published study of our group showing that VA at 40 cm and 80 cm has a lower impact on satisfaction compared with distant and 60 cm intermediate VA.”

The inconsistency of cataract and refractive lens exchange surgeries in each cohort is a limitation of this study. The small sample size and lack of randomization are also limitations.

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


Bohm M, Hemkeppler E, Kohnen T. Self-rated quality of vision oand optical phenomena intensity of diffractive presbyopia-correcting IOLs: EDoF, trifocal vs panfocal. J Cataract Refract Surg. 2022;48(8):877-886. doi:10.1097/j.jcrs.0000000000000862