Prognostic factors for dysphotopsia and spectacle-independent visual function after implantation of non-diffractive extending focus intraocular lenses

Background Intraocular lenses (IOLs) employing extending focus and multifocality technologies are becoming increasingly popular in cataract and lens surgeries. However, research on the preoperative factors affecting subjective surgical outcomes remains elusive. Methods 188 emmetropic bilaterally operated patients were analysed. We compared the outcomes of non-diffractive enhanced monofocal Tecnis Eyhance (N = 86) and non-diffractive extended depth-of-focus AcrySof Vivity (N = 102) IOLs in terms of visual acuities, dysphotopsia (graded from 0 to 100) and spectacle-independent visual function index (VF)-14 questionnaire scores. Next, we analysed correlations between the baseline ocular parameters and refractive outcomes with the dysphotopsia and VF-14 scores. Multivariable linear regression analyses were adjusted for patient age, sex and IOL type. Results Acrysof Vivity provided better uncorrected near (0.19 +/- 0.12 vs. 0.27 +/- 0.13 LogMAR units, p < 0.001) and uncorrected intermediate visual acuities (0.11 +/- 0.10 vs. 0.15 +/- 0.10 LogMAR units, p = 0.033), and better spectacle-independent VF-14 scores (93.2 +/- 5.7 vs. 80.9 +/- 12.2; p < 0.001), but higher glare scores (8.60 +/- 17.2 vs. 2.16 +/- 5.74; p = 0.035) compared to Tecnis Eyhance. Photopic (r = 0.283; B 9.39, 95% CI 4.66 to 14.1; p = 0.006) and mesopic pupil size (r = 0.263; B 6.35, 95% CI 2.91 to 9.79; p = 0.045) were associated with overall dysphotopsia scores. The axial length of the eye (r = -0.374; B -3.47, 95% CI -4.73 to -2.22; p < 0.001), total corneal irregular astigmatism (r = -0.388; B -27.3, 95% CI -39.2 to -15.5; p < 0.001), and corneal higher-order aberrations (r = -0.219; B -14.3, 95% CI -26.5 to -1.98; p = 0.023) inversely associated with VF-14 scores. Angles kappa and alpha were not associated with the levels of dysphotopsia or VF-14 scores. Conclusions Patient-related factors, including corneal irregularity, pupil size and axial length of the eye, may explain the high patient-reported outcome measures variability after the implantation of non-diffractive extending focus IOLs.