The effect and comfortable after extended depth of focus, multifocal and monofocal intraocular lenses implantation

doi:10.21203/rs.3.rs-3552283/v1

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The effect and comfortable after extended depth of focus, multifocal and monofocal intraocular lenses implantation

https://doi.org/10.21203/rs.3.rs-3552283/v1

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Background: Premium intraocular lens (IOL) can provide a fixed distance of near vision, which may be affected for patients who prefer different near distances. Thus, this study evaluate the effects and comfortable after implantation of extended depth of focus (EDOF), multifocal (Multi) and monofocal (Mono) intraocular lenses (IOLs).

Methods: Seventy eligibleparticipants were implanted with their preferred IOL and completed the relevant follow-up.Assessments focused on uncorrected distance, intermediate, and near visual acuity (UCDVA, UCIVA, and UCNVA, respectively), best corrected distance visual acuity (BCDVA), the fluctuations of comfortable near distance, the ability to see at comfortable or standard near distance and visual comfort during the 3-month postoperative follow-up.

Results: The EDOF and Multi groups were followed up for 3 months and showed noninferiority to the Mono group in the UCDVA (P > 0.05) and BCDVA but superiority in the UCNVA (P < 0.001). The UCIVA was best in the EDOF group, with comparable vision in the Multi and Mono groups. The comfortable near distance in the three groups was nonsharp between the pre- and postoperative periods. The comfortable near-distance visual acuity (CNDVA) was lower than the UCNVA in the three groups, particularly for the EDOF and Multi recipients (P < 0.05). The comfortable near distance effectively improved patients’ near visual comfort and visual clarity, except for one patient in the Multi group who complained of severe fatigue and was unable to tolerate the experience at month 3.

Conclusion: The EDOF and Multi IOLs achieved excellent visual quality and superior UCNVA versus the Mono IOL, but the CDNVA was significantly inferior to the UCNVA. Patients' near visual experience can be effectively increased at their comfortable near distances.

Cataract

intraocular lens

comfortable distance near vision

visual quality

The pioneering implantation of the intraocular lens (IOL) by Harold Ridley in 1949 marked the beginning of a momentous change in the practice of ophthalmology¹. With the refinement of cataract surgery, there has been a notable evolution in the field, with an emphasis on achieving a full range of vision and keeping visual comfort as the primary concern of development. Conventional monofocal IOLs have limitations in terms of their ability to provide patients with optimal near vision due to the lack of accommodation². This result has promoted the development of multifocal intraocular lenses (MIOLs). The principles underlying MIOL technology are diffraction and refraction of light, adding specific diopters (D) to facilitate the convergence of light at numerous foci^{3, 4}. The brain then identifies a clear point to provide visual clarity at a certain and usually fixed distance.

Although MIOLs have offered a wealth of options and greater opportunity for spectacle independence for patients beyond the monofocal IOL selections, the fixed refractive diopters limit the flexibility of MIOLs, restricting patients to a fixed range of near vision. There will be a major challenge in the design of MIOLs for those patients who prefer different distances, such as the comfortable near distance, to work. Visual comfort enhanced efficiency in close-range tasks⁵. The comfortable near distance can be measured before surgery and directly impact IOL powers. However, most studies on MIOL implantation have focused on near vision at 33cm or 40cm, while visual outcomes at their comfortable near distance has been reported in fewer studies⁶. Liu⁷ reported that EDOF and Multi group can demonstrate equal near vision at 33 cm and 40 cm. Thus, we selected 40 cm as the standard near distances to compare and implemented a study to assess the effect and comfortable of recipients undergoing cataract surgery for placement in EDOF and multifocal IOLs.

The extended depth of focus (EDOF) IOL (TECNIS® Symfony, ZXR00V, Johnson & Johnson Surgical Vision, Inc., Santa Ana, CA, USA) is an elongated focus optic pattern that incorporates a diffractive echelette design, which allows light to be continuously focused to restore vision from intermediate to distant, while near vision is deficient^8–10. The incidence of dysphotopsias is declined by reducing the overlap of near and far images¹¹.

The diffraction multifocal IOL (MIOL) (TECNIS® Multifocal IOL + 4.0 D, ZMB, Johnson & Johnson Surgical Vision, Inc., Santa Ana, CA, USA) is primarily characterized by including two focal points in the optical zone to provide superior far and near vision by adding + 4.0 D and thereby reduce spectacle dependency¹².

From October 2021 to March 2023, this study recruited 100 eyes of 70 cataract patients fulfilling the inclusion and exclusion criteria at the Affiliated Hospital of Nantong University. Inclusion criteria for participants were age-related cataract at 35 years of age or older, both angle kappa and alpha values of less than 0.5, and estimated postoperative corneal astigmatism ≤ 1.0 D in eyes. Exclusion criteria involved clinical corneal diseases, ocular inflammation, glaucoma, diabetic retinopathy, vision-limiting ocular comorbidities, such as amblyopia and macular disease, and previous ocular surgery. In addition, patients who had psychological disorders such as depression and anxiety were excluded. The study program was approved by the Ethics Committees of the Affiliated Hospital of Nantong University (approval ID: 2019-K068), and enrollment and written informed consent were performed according to the tenets of the Declaration of Helsinki.

The preoperative data were mainly collected by biomicroscopy, fundoscopy, optical coherence tomography (Cirrus HD- 5000, Germany), uncorrected distance visual acuity (UCDVA) at 5 m, best corrected distance visual acuity (BCDVA) at 5 m, corneal astigmatism (Pentacam; Oculus, Inc.), angle kappa and alpha, corneal spherical aberration (iTrace; Tracey Technologies Corp., Inc.), axial length and IOL power (which was calculated using the Barrett Universal II formula) (Lenstar; LS900, Inc.).

The IOL participants chose their preferred lens to be implanted into eyes after qualification was confirmed. The duration of the patients' follow-up was 3 months (1 days, 7 days, 30 days, and 90 days). Emmetropia was targeted in both the Multi and Mono groups of eyes, but the EDOF group maintained − 1.0 D, out of prudence and after discussion with the recipients. The postoperative visual outcomes were UCDVA and BCDVA at 5 m, uncorrected intermediate visual acuity (UCIVA) at 80 cm, and uncorrected near visual acuity (UCNVA) at 40 cm at every examination; the defocus curve was measured from − 4.00 D to + 2.00 D in -0.5 D defocus steps under best-corrected distance refraction at 3 months.

Measurement of comfortable near distance visual acuity (CNDVA) was done subjectively: covering their nontest eyes, the patients were required to read the orientation of each E letter from left to right and from top to bottom, until the letters appeared blurred, focusing on the standard logarithmic visual acuity chart of 40 cm at the best comfortable working distance, such as using a phone or reading. The visual outcomes and distances were recorded. The conversion formula for comfortable near real visual acuity was CNDVA = comfortable near distance/standard examination distance * measured vision.

The evaluation of near visual comfort involved participants focusing on the minimum distinguishable letter size and actively rating their visual experience at a comfortable near distance compared to a standard near distance. Subsequently, a visual disturbance questionnaire was developed, encompassing aspects such as letter clarity and visual health and comfort (VICO)¹³. A 5-point reaction scale ranging from "none" to "intense" was utilized to gauge the severity of the participants' most pronounced eye fatigue.

Statistical analysis

All quantitative variables are expressed herein as the mean ± standard deviation, and qualitative variables are expressed as the number (n) and frequency (%). The mean visual acuity was calculated by converting the decimal forms to the logarithm of the minimal angle of resolution. Statistical analysis was performed using SPSS for Windows software (v. 23.0, IBM Corp.). Of the three groups, normally distributed variables were compared with one-way ANOVA, and nonnormally distributed variables were compared with the Kruskal–Wallis test. A P value less than 0.05 was considered statistically significant.

A total of 70 patients participated in this study (Table 1). Of these, 30 patients underwent cataract surgery in both eyes and were implanted with the same intraocular lens, and 100 eligible eyes were implanted successfully with EDOF IOLs (n = 33), multifocal IOLs (n = 34) or monofocal IOLs (n = 33). The baseline characteristics of the three groups, including age, sex distribution, axial length, corneal and lens thickness, corneal astigmatism, anterior chamber depth, angle alpha and kappa, were comparable.

Table 1

Demographic Statistics and Preoperative Ocular Characteristics
	EDOF group (n = 33)	Multi group (n = 34)	Mono group (n = 33)	P
Age	57.21(8.94)	59.74(10.32)	62.68(7.52)	0.051
Male:female	12/21	12/22	7/26	0.330
Right:left	20/13	15/19	19/14	0.312
Eye measurements,mean(SD)
Axial length(mm)	23.83(1.40)	23.63(0.88)	23.60(1.04)	0.916
Lens thickness(mm)	4.22(0.76)	4.10(0.58)	4.25(0.48)	0.347
Corneal thickness (µm)	536.00(33.83)	537.88 (33.40)	531.48(34.62)	0.696
Corneal astigmatism(D)	0.55(0.33)	0.59(0.34)	0.73(0.37)	0.081
Anterior chamber depth (mm)	2.69(0.40)	2.72(0.54)	2.70(0.34)	0.723
Angle alpha(mm)	0.35(0.12)	0.40(0.11)	0.37(0.11)	0.455
Angle kappa(mm)	0.29(0.11)	0.31(0.10)	0.30(0.11)	0.704
D = diopter, SD = standard deviation, EDOF = extended depth-of- focus, Multi = multifocal, Mono = monofocal, P value is statistically significant ( P < 0.05 )

Visual acuity

Subjective monocular vision was measured at 3 months after surgery (Table 2). The visual acuity was affected because the recipients experienced corneal edema; this was not regarded as a meaningful clinical indicator at 1 day postoperatively. In addition, the three groups achieved excellent mean monocular UCDVA less than 0.1 logMAR and BCDVA less than 0.0 logMAR at 1 week, 1 month and 3 months postoperatively. The obvious difference in the EDOF group compared with the Multi and Mono groups for mean BCDVA was not clinically significant at month 3. The EDOF group established a significant difference in mean UCIVA versus that in the Multi and Mono groups (P < 0.001). The mean UCNVA in the EDOF group was noninferior to that in the Multi group (P = 1.000), and both groups demonstrated superiority to the Mono group after surgery (< 0.2 logMAR, < 0.2 logMAR and > 0.3 logMAR, respectively) (P < 0.001).

Table 2

Visual outcomes at 3 months after surgery
LogMAR	EDOF group (n = 33)	Multi group (n = 34)	Mono group (n = 33)	EDOF - Multi	Multi - Mono	EDOF - Mono
	Mean(SD)	Mean(SD)	Mean(SD)	P
1 d
UCDVA	0.13(0.21)	0.14(0.13)	0.15(0.11)		0.424
UCIVA	0.10(0.22)	0.21(0.11)	0.24(0.20)	< 0.001	1.000	< 0.001
UCNVA	0.24(0.23)	0.21(0.19)	0.40(0.20)	1.000	0.001	0.001
BCDVA	0.04(0.17)	0.05(0.09)	0.05(0.10)		0.172
1 w
UCDVA	0.10(0.10)	0.08(0.06)	0.09(0.12)	0.944
UCIVA	0.01(0.09)	0.14(0.11)	0.16(0.11)	< 0.001	1.000	< 0.001
UCNVA	0.13(0.10)	0.14(0.10)	0.34(0.14)	1.000	< 0.001	< 0.001
BCDVA	-0.02(0.05)	-0.01(0.05)	0.00(0.05)	0.190
1 m
UCDVA	0.08(0.12)	0.08(0.10)	0.08 (0.09)	0.692
UCIVA	-0.01(0.07)	0.12(0.11)	0.15(0.08)	< 0.001	0.558	< 0.001
UCNVA	0.12(0.10)	0.12(0.10)	0.32(0.11)	1.000	< 0.001	< 0.001
BCDVA	-0.03(0.05)	-0.02(0.07)	0.00(0.04)	1.000	0.091	0.014
3 m
UCDVA	0.04(0.09)	0.05(0.07)	0.08(0.09)	0.085
UCIVA	-0.01(0.09)	0.15(0.09)	0.17(0.09)	< 0.001	1.000	< 0.001
UCNVA	0.11(0.10)	0.12(0.10)	0.37(0.12)	1.000	< 0.001	< 0.001
BCDVA	-0.05(0.05)	-0.01(0.05)	0.00(0.05)	0.032	0.306	< 0.001
SD = standard deviation, EDOF = extended depth-of- focus, Multi = multifocal, Mono = monofocal, UCDVA = uncorrected distance visual acuity, UCIVA = uncorrected intermediate visual acuity, UCNVA = uncorrected near visual acuity, BCDVA = best corrected distance visual acuity, LogMAR = logarithm of the minimal angle of resolution, P value is statistically significant (P < 0.05)

Defocus curve

The defocus testing exhibited a smooth curve in the EDOF group, two peaks in the Multi group (at 0 D and − 3.0 D, respectively), and one peak in the Mono group (at 0 D) at month 3 after surgery (Fig. 1). The EDOF and Multi groups were significantly different from − 1.0 D to -4.0 D compared with the Mono group. Compared with the Multi group, the EDOF group surpassed the defocus curve from 0 D to − 2.0 D but lagged from − 2.5 D to − 4.0 D.

Comfortable near distance

Monocular subjective comfortable near distances in the three groups were collected preoperatively and 1 week, 1 month and 3 months postoperatively (Table 3). There was no clinical change in comfortable near distance between the preoperative and postoperative periods, although evident individual differences in the distribution of comfortable near distances among the recipients were demonstrated (P > 0.05). The comfortable near distance was 35.85 cm (range: 26 to 45 cm) in the EDOF group, 31.51 cm (range: 22 to 42 cm) in the Multi group, and 34.65 cm (range: 19.5 to 50 cm) in the Mono group at month 3 after surgery (Fig. 2).

Table 3

Comfortable near distance preoperative and postoperative
	pre	1 w	1 m	3 m	P
EDOF group	34.05\(\pm\)4.39	35.58\(\pm\)4.39	35.42\(\pm\)4.76	35.85\(\pm\)4.77	0.721
Multi group	32.39\(\pm\)4.61	30.85\(\pm\)5.35	31.18\(\pm\)4.15	31.51\(\pm\)5.42	0.467
Mono group	33.77\(\pm\)6.01	34.27\(\pm\)7.19	34.68\(\pm\)7.29	34.65\(\pm\)7.38	0.815

SD = standard deviation, EDOF = extended depth-of- focus, Multi = multifocal, Mono = monofocal, pre = preoperative, P value is statistically significant (P < 0.05).

Comfortable near distance visual acuity

The mean CNDVA results for the EDOF and Multi groups compared with the Mono group established analogous differences to those for UCNVA (Fig 3). Compared with the Mono group, both the EDOF and Multi groups attained a mean monocular CNDVA less than 0.3 logMAR at month 3 (0.14 logMAR, 0.15 logMAR and 0.39 logMAR, respectively). However, the mean monocular CNDVA significantly differed in the EDOF and Multi groups versus the mean monocular UCNVA but showed noninferiority in the Mono group after surgery. Significant outcomes were observed in the EDOF group at 1 and 3 months and in the Multi group at every visit.

Visual comfort

When gazing at the identical size letter, the proportion of patients reporting visual clarity at a comfortable near distance at month 3 was improved among the EDOF, Multi and Mono groups compared with the standard near distance (51.5%, 58.8%, and 51.5%, respectively) (Fig. 4a). In addition, the incidence rated as no visual fatigue by patients at a comfortable near distance was significantly different from that at a standard near distance in the EDOF, Multi and Mono groups (78.8%, 84.2%, and 45.5% vs. 51.5%, 47.1%, and 27.3%, respectively) (Fig. 4b-c). Only one recipient in the Multi group rated this experience as severely fatigue-inducing and was unable to tolerate it.

The current study indicated the effectiveness of the EDOF and Multi IOLs in providing a continuous range of vision in comparison with the Mono IOL^14–16. However, some patients in the three groups who presented with corneal epithelial and stromal edema demonstrated a low level of distance, intermediate, and near vision at 1 day after surgery, which especially affected the function of vision for recipients with EDOF and Multi IOLs and significantly reduced their expected visual acuity. Therefore, it is important for IOLs to maximize the best visual outcomes that preserve the normal anatomy of the eye. In addition, the present study results reported the well-known benefits and limitations of premium IOLs versus monofocal IOLs^17–19. The three groups demonstrated excellent visual acuity at far. Regarding the UCIVA, the EDOF group was superior, while the Multi and Mono groups showed no differences. Compared with the Multi group, the EDOF group displayed comparable monocular UCNVA and spectacle independence at near. This could be explained by the fact that when choosing the IOL power for EDOF IOLs, we aim for − 1.0D, whereas for the Multi group, we aim for emmetropia. Previous studies have also highlighted that slight myopia can achieve better near vision for recipients with EDOF IOLs after surgery^[14]. Interestingly, the current study also indicated that 18.2% of recipients with Mono IOLs achieved a UCNVA of less than 0.2 logMAR and engaged in activities with a range of visual acuity while being spectacle free at near distances, which was confirmed by the result of the defocus curve. A probable explanation is pseudoaccommodation without regard to the cultural background and occupation factors of the patients in the Mono group, which adjusted the anterior chamber depth and increased the range of vision through forward and backward movement of the lens capsule driven by the relaxation and contraction of the ciliary muscle²⁰. Therefore, this finding demonstrated that even if the lens was replaced, a small accommodation still existed to effectively expand the depth of vision.

At present, the designs of premium IOLs focus on achieving good full visual acuity based on an addition-specific diopter^{3, 8}. We hypothesize that recipients with premium IOLs achieved 0.0 logMAR at a standard near distance, but a great difference was in their comfortable near working distance, which would lead to changes in the CNDVA and affect visual comfort. However, few relevant studies have investigated the comfortable near-distance vision and visual comfort of premium IOLs. Previous studies have demonstrated that the visual comfort can remain efficient in near-range tasks and can become stronger to resist fatigue during high-intensity and long-duration near work^[5]. The present study measured the distribution of the comfortable near distance preoperatively and postoperatively among the three groups. The results of the distribution of comfortable near distances in the three groups were relatively stable after surgery, and there was no clinical significance in comparison with the distribution before surgery. The study also evaluated the difference in CNDVA compared with UCNVA. The CNDVA outcomes agreed with the UCNVA outcomes, demonstrating a high level in the EDOF and Multi groups compared with the Mono group. However, the CNDVA was lower than the UCNVA in the EDOF and Multi groups after surgery. Therefore, there is a significant correlation with the near-focus design of MIOL.

In addition, patient satisfaction after surgery is an important measure of the success of surgery. Prior studies have focused on patient satisfaction with distance vision and visual quality after surgery, but few have evaluated and studied the visual comfort level at near^{15, 21–23}. In this study, the patients' close range visual comfort level was evaluated by a subjective quantitative score based on the VICO index¹³. Patient near visual comfort is an important template for judging the close-range vision achieved with premium IOLs. The present study demonstrated that the EDOF, Multi and Mono groups had clearer and easier vision at comfortable near distances versus standard near distances (51.5%, 58.8%, and 51.5%, respectively). Few recipients were severely fatigued and unable to tolerate their present experience at comfortable near distances (0.0% of EDOF recipients, 2.9% of Multi recipients and 0.0% of Mono recipients). These outcomes confirmed that the comfortable near distance was better than the standard near distance in increasing the visual comfort.

Limitations of this study are that the research on visual function at near is still relatively single, and a more detailed exploration is needed in conjunction with various visual disturbances caused by close range vision. In addition, this study only discussed the close range visual function of three types of IOLs, and further research is needed on the comfortable intermediate distance visual acuity (CIDVA) of IOLs.

In summary, the EDOF and Multi groups exhibited better distance, intermediate, and near vision and spectacle independence than the Mono group. However, the CNDVA was significantly lower than the UCNVA in the EDOF and Multi recipients. Near visual comfort effectively resulted in better visual clarity and less visual fatigue at comfortable near distances in the three groups. These observed distinctions were at clinical significance levels. Thus, we guessed that when choosing the IOL diopter, the residual diopter can be more appropriately reserved to guarantee that the close focus is placed at the patient's comfortable distance, which may help the patient achieve higher near vision and a better visual experience.

EDOF: Extended depth of focus; Multi: Multifocal; Mono: Monofocal; IOL: Intraocular lens; UCDVA: Uncorrected distance visual acuity; UCIVA: Uncorrected intermediate visual acuity; UCNVA: Uncorrected near visual acuity; BCDVA: Best corrected distance visual acuity; CNDVA: Comfortable near distance visual acuity; D: Diopter; LogMAR: Logarithm of the minimal angle of resolution; VICO: Visual health and comfort

Acknowledgements

No applicable.

Author contributors

JHW and MJ were responsible for the design of this study. JHW, JXL, RXR and YX took part in the original investigation and data collection. JHW, WYY and JWL implemented data management, analyses and interpretation. JHW wrote manuscript composition. MJ is guarantor.

Funding

This work was supported by the National Natural Science Foundation of China (No. 82171038 and 81974129), Jiangsu Provincial Health Commission Project (No. M2021084), and Nantong Municipal Science and Technology Project (No. MS22022020).

Availability of date and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Ethics approval

Human subjects were included in this study. The study was conducted in accordance with the tenets of the Declaration of Helsinki. This study was approved by the Ethics Committees of the Affiliated Hospital of Nantong University (approval ID: 2019-K068). All patients signed a written informed consent.

Consent for publication

Not applicable.

Competing interests

None.

Sarwar H, Modi N. Sir Harold Ridley: innovator of cataract surgery. J Perioper Pract. Sep 2014;24(9):210-212.
Nijkamp MD, Dolders MG, de Brabander J, van den Borne B, Hendrikse F, Nuijts RM. Effectiveness of multifocal intraocular lenses to correct presbyopia after cataract surgery: a randomized controlled trial. Ophthalmology. Oct 2004;111(10):1832-1839.
Salerno LC, Tiveron MC, Jr., Alió JL. Multifocal intraocular lenses: Types, outcomes, complications and how to solve them. Taiwan J Ophthalmol. Oct-Dec 2017;7(4):179-184.
Terwee T, Weeber H, van der Mooren M, Piers P. Visualization of the retinal image in an eye model with spherical and aspheric, diffractive, and refractive multifocal intraocular lenses. J Refract Surg. Mar 2008;24(3):223-232.
Anshel JR. Visual ergonomics in the workplace. Aaohn j. Oct 2007;55(10):414-420; quiz 421-412.
Shen J, Cai L, Zhuo B, et al. Binocular Visual Outcomes Comparison of Two Trifocal Intraocular Lenses in High-Myopic Cataract Patients: A 1-Year Multicenter Study. Am J Ophthalmol. Oct 2023;254:1-10.
Sudhir RR, Dey A, Bhattacharrya S, Bahulayan A. AcrySof IQ PanOptix Intraocular Lens Versus Extended Depth of Focus Intraocular Lens and Trifocal Intraocular Lens: A Clinical Overview. Asia Pac J Ophthalmol (Phila). Jul-Aug 2019;8(4):335-349.
Pedrotti E, Carones F, Aiello F, et al. Comparative analysis of visual outcomes with 4 intraocular lenses: Monofocal, multifocal, and extended range of vision. J Cataract Refract Surg. Feb 2018;44(2):156-167.
Breyer DRH, Kaymak H, Ax T, Kretz FTA, Auffarth GU, Hagen PR. Multifocal Intraocular Lenses and Extended Depth of Focus Intraocular Lenses. Asia Pac J Ophthalmol (Phila). Jul-Aug 2017;6(4):339-349.
Kanclerz P, Toto F, Grzybowski A, Alio JL. Extended Depth-of-Field Intraocular Lenses: An Update. Asia Pac J Ophthalmol (Phila). May-Jun 2020;9(3):194-202.
Friedrich R. Intraocular lens multifocality combined with the compensation for corneal spherical aberration: a new concept of presbyopia-correcting intraocular lens. Case Rep Ophthalmol. Sep 2012;3(3):375-383.
Cai JQ, Wang W, Shao GD. Research of Visual Health Comfort by Watching 3D LED TV. Vid Eengineering. 2014;38(24):47-49+54.
Tabuchi H, Tanabe H, Shirakami T, Takase K, Shojo T, Yamauchi T. Comparison of visual performance between bifocal and extended-depth-of-focus intraocular lenses. PLoS One. 2023;18(7):e0288602.
Schmickler S, Bautista CP, Goes F, Shah S, Wolffsohn JS. Clinical evaluation of a multifocal aspheric diffractive intraocular lens. Br J Ophthalmol. Dec 2013;97(12):1560-1564.
Hogarty DT, Russell DJ, Ward BM, Dewhurst N, Burt P. Comparing visual acuity, range of vision and spectacle independence in the extended range of vision and monofocal intraocular lens. Clin Exp Ophthalmol. Nov 2018;46(8):854-860.
Alio JL, Plaza-Puche AB, Férnandez-Buenaga R, Pikkel J, Maldonado M. Multifocal intraocular lenses: An overview. Surv Ophthalmol. Sep-Oct 2017;62(5):611-634.
Lian H, Ma W, Wei Q, Yuan X. A comparative study on early vision quality after implantation of refractive segmental and diffractive multifocal intraocular lens. Pak J Med Sci. Nov-Dec 2020;36(7):1607-1612.
Woodward MA, Randleman JB, Stulting RD. Dissatisfaction after multifocal intraocular lens implantation. J Cataract Refract Surg. Jun 2009;35(6):992-997.
Wu XW, He W. Advanced research on pseudophakic accommodation of eyes with artificial lens. Int J Ophthalmol. 2008(07):1423-1425.
Liu MR, Peng ZX, Wu ZZ, Yang W, Wan L. Comparative analysis of visual acuity, visual quality and satisfaction after exteded depth, bifocal and monofocal intraocular lens implantation. Rec Adv Ophthalmol. 2023;43(02):127-130.
Sevik MO, Akkaya Turhan S, Toker E. Clinical outcomes with a low add multifocal and an extended depth of focus intraocular lenses both implanted with mini-monovision. Eye (Lond). Jun 2022;36(6):1168-1177.
Masket S, Lum F, MacRae S, et al. Symptoms and Satisfaction Levels Associated with Intraocular Lens Implants in the Monofocal and Premium IOL Patient-Reported Outcome Measure Study. Ophthalmology. Jul 2023;130(7):726-734.
Rodov L, Reitblat O, Levy A, Assia EI, Kleinmann G. Visual Outcomes and Patient Satisfaction for Trifocal, Extended Depth of Focus and Monofocal Intraocular Lenses. J Refract Surg. Jul 1 2019;35(7):434-440.

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You are reading this latest preprint version

The effect and comfortable after extended depth of focus, multifocal and monofocal intraocular lenses implantation

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Abstract

Figures

Introduction

Methods

Statistical analysis

Results

Visual acuity

Defocus curve

Comfortable near distance

Comfortable near distance visual acuity

Visual comfort

Discussion

Abbreviations

Declarations

References

Additional Declarations

Status:

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