Increase In Intraocular Lens Explantation And Replacement Coincides With Introduction Of Multifocal And Extended Depth Of Focus Lenses In Australia

To evaluate trends in intraocular lens (IOL) replacement over the last two decades in Australia.

Cross-sectional study using routinely collected government healthcare data from the Australian Institute of Health and Welfare (AIHW) National Hospital Morbidity Database (NHMD).

IOL replacement procedures stratified by age and sex were identified using The Australian Classification of Health Interventions (ACHI) codes 42707 and 42710 from the NHMD. The population incidence for IOL replacement per 100 000 persons was calculated for each year from 2000 to 2020, starting in June of each year. Furthermore, the incidence of IOL replacement was calculated per 10 000 cataract extraction and IOL insertion procedures. 

The number of IOL replacement procedures increased from 2.83 to 6.49 per 100 000 persons from 2000 to 2020 respectively. Similarly, when compared to IOL insertions in the same year, the incidence of IOL replacement increased from 40.2 per 10 000 IOL insertions in 2000 to 55.2 per 10 000 insertions in 2020. Overall, there was a sharp increase in the incidence of IOL replacement from 2013 to 2020. These dates coincide with the introduction of multiple trifocal and extended depth of focus lenses in Australia.

There has been a sharp incidence in IOL replacement in Australia since 2013. We hypothesise this increased incidence may coincide with complications arising from the use of multifocal and extended depth of focus lenses. Appropriate counselling of patients regarding aberrations with these lenses to reduce explantation rates is a critical aspect of their use.