Combining EDOF and Monofocal IOLs

Implanting EDOF in second eye may improve vision outcomes. Howard Larkin reports. Patients implanted with an extended depth of focus (EDOF) intraocular lens in the second eye after receiving a monofocal IOL in the first may reap similar vision benefits as those implanted with EDOF lenses bilaterally, reported Guy Kleinmann MD. The usual recommendation is to implant EDOF lenses in both eyes, Dr Kleinmann said. But occasionally, patients already implanted with a monofocal don’t like it, don’t want monovision, and ask for another solution. THREE GROUPS COMPARED The retrospective study compared 18 patients implanted with an AcrySof® SN60WF/SA60AT (Alcon) monofocal lens in one eye and a TECNIS Symfony™ (Johnson & Johnson Vision) EDOF lens in the other. Thirty-six patients were implanted bilaterally with the Symfony and 22 implanted bilaterally with the AcrySof lenses. All patients had their vision examined and answered a questionnaire at least three weeks after surgery. Mean uncorrected distance visual acuity outcomes were similar between the eyes implanted with an EDOF and a monofocal, at about 20/21, and those with the EDOF lens bilaterally, at about 20/22 (p=0.043). The bilateral monofocal group achieved about 20/25, which was significantly worse than the mixed implant group (p=0.002). Both the mixed implant and the bilateral EDOF groups had a mean intermediate uncorrected vision of about 20/25. Intermediate vision results were not reported for the bilateral monofocal group. Mean uncorrected near vision was 20/25, 20/32, and 20/40 in the three groups respectively, with no significant difference in spherical equivalent among them. More than 84% of patients in all groups rated their distance vision “good” or “excellent,” with 61.5%, 72%, and half of patients in the three groups (EDOF and monofocal, bilateral EDOF, and bilateral monofocal, respectively) saying the same of intermediate vision, results that were not statistically significant, Dr Kleinmann reported. However, both groups receiving EDOF lenses reported significantly better near vision than the bilateral monofocal group. Glare and halo reports were low in all groups. Overall spectacle independence for any distance was 61% for the mixed lens group, 78% for the bilateral EDOF group, and 50% for the bilateral monofocal group. These differences were not statistically significant. “Patients implanted with a monofocal IOL in previous cataract surgery who are interested in improving their visual outcomes and do not like monovision can be considered for implantation of an EDOF IOL in the second surgery,” Dr Kleinmann concluded. This presentation was made at the 39th Congress of the ESCRS in Amsterdam.