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  • Multifocal and EDOF IOLs offer good visual acuity, reduced contrast sensitivity

    Cataract/Anterior Segment

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    Review of: Multifocal and accommodating intraocular lenses for the treatment of presbyopia: A report by the American Academy of Ophthalmology

    Schallhorn J, Pantanelli S, Lin C, et al. Ophthalmology, October 2021

    A literature review was undertaken to assess the level of distance and near visual acuity provided by implantation of either a multifocal or accommodating intraocular lens (IOL), and the reported rates of spectacle independence, patient-reported visual symptoms, and patient satisfaction with the lenses available in the United States.

    Study design

    Two independent literature searches were conducted in multiple databases, and 34 studies met the criteria for inclusion in this assessment. The review was retrospective in nature and compared outcomes between multifocal and accommodating/extended depth-of-focus (EDOF) IOLs.

    Outcomes

    Similar outcomes in distance and near visual acuity following cataract removal were noted with multifocal and EDOF IOLs, and both were effective in reducing spectacle dependence. Due to the fact that each multifocal implant is configured for a specific focal point, the surgeon should ask patients about the near activities they routinely perform and take this into consideration when selecting an IOL. Both multifocal and EDOF IOLs led to reduced contrast sensitivity compared with monofocal IOLs.

    Limitations

    Shortcomings with this literature review, as noted by the investigators, include a lack of a standard, validated method of assessing patient-reported outcomes in presbyopia-correcting multifocal and EDOF IOLs and a paucity of published data comparing visual symptoms between the 2 types of IOLs. Surgeons would benefit knowing the similarities and differences between the lenses.There are several lenses available and little comparative data to help guide patients to the best option.

    Clinical significance

    As surgeons, we want to know what is best for our patients, but we have limited anecdotal evidence available on the efficacy of various types of IOLs. Independent research with conclusive data about which lens would be best would revolutionize our preoperative discussions and likely lead to a happier patient. This review suggests that physicians should consider the near activities the patient routinely engages in and also counsel the patient regarding the possibility of reduced contrast sensitivity.