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  • AAO OTAC Refractive Management/Intervention Panel, Hoskins Center for Quality Eye Care

    A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Refractive Management/Intervention Panel

    Julie M. Schallhorn, MD,1 Seth M. Pantanelli, MD,2 Charles C. Lin, MD,3 Zaina Al-Mohtaseb, MD,4 Marcony R. Santhiago, MD,5 Walter Allan Steigleman III, MD,6 Aaron M. Waite, MD,7 Jennifer R. Rose-Nussbaumer, MD8

    Ophthalmology, Vol. 128, 1469-1482 © 2021 by the American Academy of Ophthalmology. Click here for free access to the OTA.

    Purpose: To review the published literature assessing the efficacy and safety of presbyopia-correcting intraocular lenses (IOLs) for the treatment of presbyopia after cataract removal.

    Methods: Literature searches were undertaken in January 2018 and September 2020 in the PubMed, Medline, and Cochrane Library databases. This yielded 761 articles, of which 34 met the criteria for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist. Thirteen studies were rated level I and 21 studies were rated level II.

    Results: Presbyopia-correcting lenses were effective at improving distance and near visual acuity after cataract surgery. Near acuity at different focal lengths was related directly to the effective add power of multifocal and extended depth-of-focus (EDOF) IOLs. Most multifocal and EDOF lenses that were compared with a control monofocal lens demonstrated that patient-reported spectacle independence was superior to the monofocal lens. All patients who had multifocal and EDOF lenses implanted showed decreased contrast sensitivity and reported more visual phenomena as compared with control participants who received monofocal lenses.

    Conclusions: Presbyopia-correcting lenses improve uncorrected near and distance visual acuity and decrease spectacle dependence after cataract surgery. Mesopic contrast sensitivity is decreased compared with monofocal lenses, and patient-reported visual phenomena are more likely in patients receiving multifocal or EDOF lenses.

    1Francis I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, California

    2Penn State College of Medicine, Hershey, Pennsylvania

    3Byers Eye Institute, Stanford University, Palo Alto, California

    4Baylor College of Medicine, Houston, Texas

    5Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    6University of Florida College of Medicine, Gainesville, Florida

    7Francis I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, California

    8Division of Research Kaiser Permanente Northern California and Francis I Proctor Foundation University of California, San Francisco, California