THE IMPACT OF DECERTATION OF WAVEFRONT-CORRECTING EDOF LENS IN ITS OPTICAL PERFORMANCE, A CASE REPORT

to show the relevance of proper centration of the central 2.2 mm optical part of the Vivity EDOF lens in order to achieve a satisfactory vision for both intermediate and near.

Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain 

A 77-year-old man presented to our clinic for refractive lens exchange surgery in his right eye (CDVA of 20/40, UNVA and UIVA  of 20/200) and 20/20 in his left eye.Wavefront-correcting EDOF (X-Wave Technology) was selected to be implanted to achieve acceptable intermediate and near depth of focus. Four weeks postoperatively patient satisfaction was remarkably low for intermediate and near vision although he gained a good UCDVA (UCDVA of 20/25 but UIVA of 20/100, and UNVA (40 cm) of 20/125).

4 mm decentration of central 2.2 mm optical zone shifted to the upper nasal part of the capsular bag was confirmed by the camera of Osiris aberrometer (Osiris, Italy).IOL exchange was planned with aspheric multifocal diffractive IOL (Rayone , Rayner, USA). One week postoperativelythe patient gained acceptable intermediate and near vision (UDVA, UIVA (66 cm), and UNVA (40 cm) were 20/25, 20/32, and 20/32).

In our patient, IOL decentration confirmed by the ocular wavefront camera was apparently the reason for the unsatisfactory outcome at intermediate and near vision, being this issue was solved after exchanging the Vivity by another multifocal IOL. We hypothesize that the Vivity IOL decentration (4mm) was the reason for the suboptimal intermediate and near visual functions, being this issue fixed after IOL exchange with ATC implantation. 

In conclusion, although EDOF IOLs are supposed to be more immune to optical quality degradation caused by IOL decentration compared to multifocal IOLs, in the current case we show the relevance of proper centration of the optical part of the Vivity EDOF lens in order to achieve a satisfactory vision for both intermediate and near. We recommend the use of CTR at the moment of IOL implantation for the prevention of a postoperative decentration that could lead to unsatisfactory visual outcome.