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  • Refractive Mgmt/Intervention

    Review of: Visual and patient-reported factors leading to satisfaction after implantation of diffractive extended depth-of-focus and trifocal intraocular lenses

    Lwowski C, Pawlowicz K, Petermann K, et al. Journal of Cataract and Refractive Surgery, April 2022

    A patient survey on IOLs revealed which factors led to more satisfaction. The researchers assessed uncorrected distance visual acuities (UDVA) and uncorrected intermediate visual acuities (UIVA) of satisfied and unsatisfied patients. Patients with significantly better UDVA were more satisfied and patients with Increased optical phenomena were more dissatisfied.  

    Study design

    This German, single-center observational case study reports a survey administered to patients 3 months after receiving bilateral diffractive extended depth of focus or trifocal IOLs. Twenty-five patients had Symfony, 20 had AT LARA, 24 had PanOptix, and 25 had AT LISAtri. The questionnaires included questions about visual disturbances / photopic phenomena, lifestyle / activities, spectacle independence, and satisfaction. Patients were eligible if they had either cataract surgery or refractive lens exchange and received the same IOL in each eye.


    Satisfied patients (n = 82) had statistically significantly better UDVA (logMAR -0.03 v. 0.03) and UIVA at 60 cm (logMAR 0.08 v. 0.24) than dissatisfied patients (n = 12), with no difference for UIVA at 80 cm or uncorrected near at 40 cm. Generally, increased optical phenomena correlated with reduced satisfaction and being less likely to choose the same IOL again.


    The patients were not randomized to the IOL but instead chose the IOL they received, making subjective responses and satisfaction a reflection of their own expectations and choices. Although the authors have used this questionnaire in other studies, it has not been validated. The dissatisfied group included only 12 patients, and responses were not broken down by IOL. Although the study did not find meaningful differences between cataract and refractive lens exchange patients, this could reflect sample characteristics because the latter group had a different preoperative visual status and was younger.

    Clinical significance

    As IOL technology changes, the ability to provide good UDVA along with UIVA of around 60 cm with minimal optical phenomena may satisfy a higher percentage of patients than providing good uncorrected near visual acuities with more optical phenomena.