Attitudes And Understanding Of Premium Intraocular Lenses In Cataract Surgery: A Patient Survey

As varieties of intraocular lens (IOL) proliferate, the choice for cataract surgery (CS) patients becomes more complex. This study investigated patient understanding of, and attitudes to premium (toric, extended depth of focus and multifocal) IOLs to establish what the baseline of knowledge is in public health sector patients in the UK.

Patients attending a cataract clinic at Guy’s and St. Thomas’ NHS Foundation Trust, a central London University National Health Service (NHS) Hospital, between August 2021 and January 2022.

An anonymised 12 question survey was designed, with Likert scale questions to assess attitudes to post-operative spectacle dependence, post-operative refractive target and desirability of spectacle independence when considering possible complications of premium IOLs (PIOLs), namely dysphotopsia (halos and starburst phenomena) and need for IOL exchange.

162 surveys were collected. Mean age was 71.3 years (19-96). Pre-operatively 29% used distance and reading glasses, 22% reading glasses only, 26% varifocals/bifocals and 5% contact lenses. 69 patients (42%) were drivers. 86% reported not minding wearing glasses after CS with 77% preferring reading glasses.  64% were unfamiliar with PIOLs. Only 17% would consider PIOL implantation when considering a 2% chance of dysphotopsias. 27% would consider PIOL implantation despite a 1:20 risk of requiring an IOL exchange. There was a positive correlation between those who were happy to wear distance glasses after CS, and those who would be willing to have PIOLs surgery despite a risk of requiring lens exchange (r 0.56, p<0.001).

Our results demonstrate a lack of familiarity in the existence of premium IOLs in our NHS patients, as well as a reluctance to risk dysphotopsia and a need for a second operation for spectacle independence. Most of our patients would at present be willing to wear reading glasses after CS.