Extended Depth Of Focus Lens As An Option How To Increase The Spectacle Independence In Eyes With Mildly To Moderately Abnormal Cornea

The aim of our study is to evaluate the quality of vision and complications in eyes who underwent the implantation of the Extended Depth of Focus (EDOF) IOL and have a corneal pathology or previous corneal trauma or surgery. 

The absence of corneal pathologies is one of the requirements for the successful implantation of trifocal IOLs. EDOF lenses with their less demanding design may be an option not only for drivers, but also for patients with corneal abnormalities, but good visual acuity. 

All patients have been informed about the condition of their cornea, limited selection of IOLs that are suitable for their condition as well as the expected reduced performance of the lens. They also accepted that laser enhancement will not be possible.

All patients underwent the implantation of the Acrysof IQ Vivity IOL, Alcon in Eye Clinic Zlin in 2021. 10 eyes of 7 patients, age 53 to 71, 5 men, 2 women, BCVA  0,7 and better, clear central cornea, stable corneal topography, no retinal pathology. 2 eyes with scars following trauma with the knife in the corneal periphery, 2 patients with grade 0-1 corneal haze following hyperopic PRK 20+ years ago, 2 cases of forme fruste keratoconus and 1 case of corneal scaring due to metallic particles. 

Prior the surgery has been performed a thorough ophthalmological examination. BCVA has been examined for both distance and near. Cornea has been evaluated with a slit lamp as well as with IOL Master 700, Verion, Pentacam HR and endothelial microscopy. OCT examination has been performed to exclude retinal pathologies. 

All patients have been informed about the condition of their cornea, limited IOL selection as well as the possible reduced performance of the lens.

One surgeon. Uneventful surgery.

After the surgery the UCVA and BCVA was examined for near, intermediate and near. Any adverse effects and visual disturbances have been recorded. The level of spectacle independence have been questioned. Follow-up was at least 2 months.

All patients reached UCNVA 0,5 and better, 1 patient 0,8. UCIVA was 0,6 and better. UCDVA was in all but one case 0,7 and better. In one case was 0,6 (BCVA 0,8) due to haze. Glasses for astigmatism have been prescribed for driving. 

Patients were generally satisfied with the surgery, there were no complaints about visual disturbances after healing has been completed. The only complaints were mild symptoms of dry eye (face mask were obligatory during pandemics and majority of patients suffered from mild dry eye prior the surgery).

 

Patient who had previous corneal trauma have reported an equal level of visual discomfort due to scarring as prior surgery with glasses. 

EDOF IOLs may be an appreciated option how to help patients with corneal scaring and mild corneal diseases. These patients may not be capable to gain the full range of function of EDOF IOL as a healthy eye, but when the patients have realistic expectations and a certain level of tolerance, EDOF IOLs may provide a high level of spectacle independence without increasing visual disturbances, that are often present prior surgery. 

These eyes are more challenging from the perspective of biometry, dry eye management and general assessment. Also more chair time and patience is required from both doctors and patients.

In more complicated cases, monofocal IOLs will probably still remain the gold standard of treatment.