The choice of intraocular lenses can determine the effectiveness of presbyopia correction

Bilateral trifocal intraocular lens (IOL) implantation may be the optimal option for patients who need correction for presbyopia when considering multifocal lenses, according to a new meta-analysis.

Both trifocal and extended depth of field intraocular lenses demonstrated better visual performance across the overall range of distances studied, with trifocal lenses providing better visual acuity than monofocal intraocular lenses in particular.

In addition, bilateral implantation proved beneficial with better near visual acuity and good intermediate visual acuity, without significant decrease in contrast sensitivity or increase in glare and halos.

“However, this finding does not imply that trifocal IOLs should be used for patients simply because they provide better near and intermediate visual acuities without additional glare or halos,” added study author Dong Hui. Lim, MD, PhD, Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine.

Multifocal IOLs can minimize reliance on glasses after cataract surgery, but patients may experience difficulties, including glare or blurred vision, due to the structural principles of the lenses.

To determine the benefit of multifocal lenses on visual quality, researchers conducted a systematic review and Bayesian network meta-analysis (NMA) to simultaneously compare different types of multifocal IOLs. They searched for randomized clinical trials to evaluate multifocal IOLs in patients who underwent bilateral cataract extraction on Medline and the Cochrane Central Register of Controlled Trials in May 2021 since inception.

Emphasis was placed on binocular visual acuity, contrast sensitivity and patient-reported outcomes. Investigators categorized IOLs as monofocal, diffractive bifocal (old/new), refractive bifocal (old/new), accommodative, trifocal, or extended depth of field (EDOF).

Investigators presented NMA estimates as mean differences for visual acuity and contrast sensitivity, hazard ratios for glare, halos, and glasses independence and estimated credibility intervals (CIr ) at 95% and the ranks of the interventions.

The study included a total of 27 RCTs comparing binocular visual outcomes or optical quality for NMA comprising 2605 patients. The most reported outcome measures were uncorrected near visual acuity (UNVA) and uncorrected distance visual acuity (UDVA).

For UNVA, studies suggest that trifocal IOLs showed the greatest difference from monofocal IOLs (mean difference, -0.32 [85% CrI, –0.46 to –0.19]), followed by older generation bifocal diffractive lenses with a value of -0.33 (95% CrI, -0.50 to -0.14).

Next, in uncorrected intermediate visual acuity (UIVA), data suggests that extended depth-of-field IOLs provide better visual acuity than monofocal IOLs and next-generation bifocal IOLs. The investigators added that there was no difference between extended depth of field IOLs and trifocal diffractive IOLs in the pairwise comparison.

For UDVA, all IOLs had a similar area under the cumulative grading curve (SUCRA) values, except for the older and newer generation bifocal diffractive IOLs. Comparisons between monofocal IOLs and other IOLs showed small mean differences compared to other distances.

In sensitivity analyses, all multifocal IOLs except older generation bifocal refractive IOLs provided better UNVA than monofocal IOLs. Investigators noted that there were no statistical differences between multifocal and monofocal IOLs regarding contrast sensitivity, glare, or halos.

“Further studies are warranted to assess which IOLs are most effective for presbyopia correction over different distances,” Lim concluded.

The study, “Visual Outcomes and Optical Quality of Accomodative, Multifocal, Extended Depth-of-Focus, and Monofocal Intraocular Lenses in Presbyopia-Correcting Cataract Surgery,” was published in JAMA Ophthalmology.

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