Clinical Scorecard: Factors Contributing to Patient Dissatisfaction Following the Use of Extended Depth-of-Focus and Trifocal Intraocular Lenses: A Retrospective Analysis

At a Glance

Key Highlights

• Trifocal IOLs redistribute light energy across three focal points to improve near and intermediate vision.
• EDOF IOLs extend focal range by elongating depth of focus using wavefront-shaping or diffractive technologies.
• Postoperative dissatisfaction may manifest as blurred vision, visual disturbances, or ocular discomfort despite satisfactory visual acuity.

Guideline-Based Recommendations

Diagnosis

• Comprehensive preoperative ophthalmic examination including visual acuity, corneal properties, and ocular biometry.
• Postoperative assessments at 3 days, 1 month, and 3 months including slit-lamp microscopy, refraction, and visual acuity testing.
• Use of visual quality analyzers and ocular surface analysis for patients reporting subjective symptoms.
• Classification of dissatisfaction causes based on objective findings when no organic lesions or refractive errors are present.

Management

• Femtosecond laser-assisted phacoemulsification with appropriate IOL selection based on patient ocular parameters.
• Postoperative medication regimen including levofloxacin, prednisolone acetate eye drops, and tobramycin-dexamethasone ointment.
• Address residual refractive errors and ocular surface disease as potential contributors to dissatisfaction.

Monitoring & Follow-up

• Regular postoperative follow-up visits with comprehensive ocular examinations and visual function assessments.
• Monitoring for posterior capsular opacification, IOL position, and ocular surface health.
• Use of advanced imaging and functional analyzers to detect subtle causes of dissatisfaction.

Risks

• Residual refractive errors leading to blurred vision.
• Optical phenomena related to multifocal or EDOF lens designs causing visual disturbances.
• Ocular surface disease contributing to discomfort and reduced visual quality.
• Postoperative complications affecting visual outcomes.

Patient & Prescribing Data

Patients receiving either AcrySof IQ Vivity (EDOF) or PanOptix TFNT00 (trifocal) IOLs after cataract surgery

Target refractive power set close to zero for trifocal IOLs; EDOF IOLs targeted at zero or slight myopic offset in non-primary eye to optimize binocular vision and patient satisfaction

Clinical Best Practices

• Careful patient selection adhering to established clinical consensus guidelines for multifocal IOL implantation.
• Preoperative identification of dominant eye and precise IOL power calculation using Barrett Universal II or Barrett True-K formulas.
• Standardized surgical technique with femtosecond laser assistance performed by experienced surgeons.
• Comprehensive postoperative follow-up with objective and subjective assessments to identify and manage dissatisfaction causes.
• Utilization of ocular surface evaluation and visual quality metrics to guide targeted interventions.

References

• Clinical Consensus on the Clinical Application of Multifocal Intraocular Lenses in China (2019)
• Declaration of Helsinki