Intraocular Lens Choice May Determine Effectiveness in Presbyopia Correction

Dong Hui Lim, MD, PhD

The bilateral implantation of trifocal intraocular lenses (IOLs) may be the optimal option for patients who need correction for presbyopia considering multifocal lenses, according to a new meta-analysis.

Both trifocal and extended depth-of-field IOLs demonstrated better visual performance in overall range of distances studied, with trifocal lenses providing better visual acuity than monofocal IOLS in particular.

Additioally, bilateral implantation was found to be beneficial with best near visual acuity and good intermediate visual acuity, without a significant decrease in contrast sensitivity or increase in glare and halos.

“However, this finding does not imply that trifocal IOLs should be used for patients merely because they afford better near and intermediate visual acuities without added glare or halos,” added study author Dong Hui Lim, MD, PhD, Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine.

Multifocal IOLs may minimize dependency on spectacles after cataract surgery, but patients can experience difficulties, including glare or blurred vision, due to the structural principles of the lenses.

To determine the benefit of multifocal lenses on visual quality, investigators conducted a systematic review and bayesian network meta-analysis (NMA) to simultaneously compare various type of multifocal IOLs. They searched randomized clinical trials to assess multifocal IOLs in patients who underwent bilateral cataract extraction on Medline and the Cochrane Central Register of Controlled Trials in May 2021 from inception.

A focus was set on binocular visual acuity, contrast sensitivity, and patient-reported outcomes. Investigators classified IOLs into monofocal, bifocal diffractive (old/new), bifocal refractive (old/new), accommodative, trifocal, or extended depth-of-focus (EDOF).

Investigators presented NMA estimates as mean differences for visual acuity and contrast sensitivity, risk ratios for glare, halos, and spectacle independence and estimated 95% credible intervals (CrIs) and ranks of interventions.

The study included a total of 27 RCTS comparing binocular visual outcomes or optical quality for NMA comprising 2605 patients. The most reported outcome measures were uncorrected near visual acuity (UNVA) and uncorrected distant visual acuity (UDVA).

For UNVA, the studies suggest trifocal IOLs showed the largest difference to monofocal IOLs (mean difference, –0.32 [85% CrI, –0.46 to –0.19]), followed by old-generation bifocal diffractive lenses with a value of -0.33 (95% CrI, –0.50 to –0.14).

Then, in uncorrected intermediate visual acuity (UIVA), data suggest extended depth-of-focus IOLs provided better visual acuity than monofocal IOLs and new-generation bifocal IOLs. Investigators added there were no differences between extended depth-of-focus and trifocal diffractive IOLs in pairwise comparison.

For UDVA, all IOLs had similar surface under the cumulative ranking curve (SUCRA) values, except for old- and new-generation bifocal diffractive IOLs. The comparisons between monofocal and other IOLs showed small mean differences compared with other distances.

In sensitivity analyses, all multifocal IOLs, except for old-generation bifocal refractive IOLs, provided better UNVA than monofocal IOLs. Investigators noted there were no statistical differences between multifocal and monofocal IOLs regarding contrast sensitivity, glare, or halos.

“Further studies are warranted to evaluate which IOLs are most effective for presbyopia correction across various distances,” Lim concluded.

The study, “Visual Outcomes and Optical Quality of Accomodative, Multifocal, Extended Depth-of-Focus, and Monofocal Intraocular Lenses in Presbyopia-Correcting Cataract Surgery,” was published in JAMA Ophthalmology.