Patient reported outcomes after implementation of an enhanced depth of focus intraocular lens with low postoperative myopia

Background: Enhanced depth-of- focus intraocular lenses (EDOF IOL) have filled the gap between monofocal and multifocal intraocular implants with optical qualities of monofocal lenses and usually minor dysphotopsias typical for multifocal lenses. The purpose of this study was to evaluate visual outcomes after bilateral implantation of a new EDOF IOL in patients with requirements for perfect near and intermediate vision. Methods: The study included 15 patients (29 eyes as one was amblyopic) with bilateral implantation of LUX- SMART EDOF IOL (Bausch & Lomb) with a targeted myopia (between -0.25 and -0.50D) in both eyes. Monocular corrected and uncorrected visual acuity for far, intermediate and near as well as refractive outcomes were evaluated at 1, 3, 6 and 12 months after the surgery. Additionally, binocular visual acuity, contrast sensitivity and defocus curve were measured at the final follow-up visit. At 12 months' visit patients completed a questionnaire evaluating patient satisfaction, spectacle independence and presence of dysphotopsias. Results: Binocular uncorrected visual acuities at 12 month's visit were 0.13 f 0.16, 0.06 f 0.08, 0.07 f 0.09 and 0.15 f 0.09 logMAR for far distance, 80 cm, 66 cm and 40 cm respectively. Corrected binocular visual acuities at 12 months were 0.00 f 0.00, 0.05 f 0.07, 0.05 f 0.06, 0.13 f 0.16 respectively for distance, 80 cm, 66 cm and 40 cm. Automated refraction spherical equivalent at 12 months' visit stood at -0.70 f 0.48D, which was 0.46D less than calculated biometric target, however spherical equivalent of subjective refraction at 12 months equaled -0.49 f 0.46D, which was closer to preoperative biometric target. Defocus curve had gentle shape without peaks typical for monofocal IOLs. Binocular contrast sensitivity results were superior to average results for that age group and equaled 1.78 f 0.16 logMAR without correction and 1.81 f 0.13 logMAR with correction. Spectacle independence for near and intermediate distances was achieved in all patients and for far distance in 73.3% of patients. Burdensome dysphotopsias were not reported in any case. Conclusions: EDOF IOLs targeted bilaterally at low myopia can provide excellent near and intermediate visual acuity and independence of any optical correction in majority of cases. This approach can be used in selected patients who are focused on stationary activities.