Expanding visual horizons: comparative outcomes of bilateral implantation of an extended depth-of-focus versus enhanced and standard monofocal intraocular lenses

Abstract

Patients undergoing cataract surgery have different postoperative visual priorities. Some primarily seek excellent uncorrected distance vision and accept the need for near spectacles, whereas others aim for greater spectacle independence across distance, intermediate, and near activities. This study compared visual and patient-reported outcomes after bilateral implantation of an extended depth-of-focus (EDOF) intraocular lens (IOL), an enhanced monofocal (EM) IOL and a standard monofocal IOL. This retrospective consecutive comparative case series included patients who underwent bilateral phacoemulsification with implantation of the same IOL model in both eyes. The evaluated IOLs were Tecnis ZCB00 (standard monofocal), Tecnis Eyhance ICB00 (EM), and Asqelio ETLIO130C (EDOF). At 6 months postoperatively, monocular and binocular uncorrected visual acuity were assessed at distance (6 m), intermediate (66 cm), and near (40 cm). Additional outcome measures included manifest refraction, binocular defocus curves, patient-reported halo and glare symptoms, spectacle independence, and patient satisfaction. A total of 197 patients were included (78 monofocal, 65 EM, and 54 EDOF). Baseline demographic and preoperative ocular characteristics were comparable across groups. Postoperative uncorrected distance visual acuity was similar among groups. Intermediate visual acuity was better in the EM and EDOF groups than in the monofocal group, with the best intermediate performance observed in the EDOF group. Near visual acuity remained limited in all groups but was better in the EDOF group than in the other groups. Defocus-curve findings were consistent with these results. Patient reported halo and glare scores were low and comparable across groups, whereas spectacle independence was highest in the extended depth-of-focus group. In this retrospective comparative case series, bilateral implantation of the Asqelio EDOF IOL was associated with better intermediate visual acuity and modestly better near visual acuity than implantation of the enhanced and standard monofocal IOLs, without compromising distance visual acuity or increasing patient-reported halo and glare at 6 months.