Outcomes of Extended Monofocal and Extended Depth of Focus Intraocular Lens Implantation by a Trainee Surgeon in an Australian Tertiary Public Hospital

Abstract

Purpose To compare the visual and patient reported outcomes of an enhanced monofocal (EM) and refractive extended depth of focus (rEDOF) intraocular lenses (IOL) implanted by a senior trainee in a tertiary referral hospital. Patients and Methods A prospective case-series with a retrospective comparison group was conducted at Westmead Hospital Eye Clinic, Sydney, NSW, Australia. Patients had monocular implantation of an EM (Tecnis Eyhance ICB00) or rEDOF (Lentis Comfort LS-313 MF15 or Acunex Vario Toric AN6VT) IOL. Phacoemulsification was performed by a single trainee surgeon and data was entered into the Cataract & Lens Exchange Analysis & Register log. Primary outcomes were unaided distance (UDVA), intermediate (UIVA) and near visual acuity (UNVA), visual disturbance (glare, halo, starburst) and satisfaction with vision. Results EM was used in 25 eyes, rEDOF was used in 33 eyes, and a monofocal group of 20 eyes was established retrospectively. Mean monocular UDVA was lowest in the EM and rEDOF groups (UDVA: mono 0.13 ± 0.12 logMAR, EM 0.02 ± 0.13 logMAR, rEDOF 0.05 ± 0.13 logMAR). The UIVA and UNVA were superior in the rEDOF group compared with the monofocal group (UIVA: rEDOF 0.19 ± 0.12 vs mono 0.36 ± 0.22 logMAR, p = 0.011; UNVA: rEDOF 0.45 ± 0.17 vs mono 0.66 ± 0.15 logMAR, p = 0.002). Glare was prevalent in the EM and monofocal groups, and starburst and halos were greatest in the rEDOF group. Satisfaction with vision was high in all groups. Conclusions Both EM and rEDOF IOLs were successfully implanted by a trainee surgeon, with the benefits of improved refractive outcomes over monofocal IOLs and high satisfaction scores. Dysphotopsias were similar between the EM and monofocal IOLs. This study shows that rEDOF and EM IOLs are an ideal premium IOL choice for training centres who wish to expand their IOL options.