Visual Outcomes And Satisfaction In Presbyopic Emmetropic Patients With Different Residual Accommodation After Uni Or Bilateral Trifocal Iol Implantation

To compare visual outcomes and satisfaction in emmetropic patients with presbyopia and greater or lesser residual accommodation who undergo unilateral or bilateral implantation of a trifocal diffractive intraocular lens (IOL).

Retrospective observational case series

We carried out a multicenter, multisurgeon study to evaluate outcomes in emmetropic presbyopes who underwent refractive lens exchange (RLE) followed by implantation of a FineVision trifocal IOL (PhysIOL). The inclusion criteria were as follows: emmetropia, sphere -0.25 to +0.50 diopters (D), cylinder < 0.75 D, and manifest refractive spherical equivalent (MRSE) -0.25 to +0.25 D. All patients also had to have an uncorrected distance visual acuity (UDVA) Snellen ≥ 0.9 in each eye. The sample was divided into different clusters based on 2 variables: eyes operated on (1 or 2); and age under or over 55 years. We assessed visual and refractive performance, patient satisfaction, and spectacle independence

690 eyes from 431 patients were evaluated. There was no difference in postoperative UDVA and corrected distance visual acuity (CDVA) between the groups. Binocular uncorrected near vision (UNVA) was better in patients who underwent bilateral surgery regardless of age (0.00 [0.00; 0.10] vs 0.10 [0.00; 0.10] p<0.001). Binocular uncorrected intermediate vision (UIVA) was better in patients who underwent bilateral surgery aged under 55 years than in those who underwent surgery in 1 eye aged over 55 years (0.18 [0.10; 0.18] vs 0.30 [0.18; 0.30] p<0.001). Visual dysphotopsia was worse in patients with both eyes operated on, although the differences were not statistically significant.

Our study shows that after RLE, presbyopic emmetropic patients with monocular or binocular trifocal IOL achieve good UNVA, UIVA, and UDVA. In near binocular visual acuity, results are better for patients who underwent surgery on both eyes than for those who underwent surgery on 1 eye. Regarding binocular intermediate visual acuity, patients aged under 55 years with both lenses replaced had better results than those over age 55 years with only 1 lens replaced. No significant differences were observed in UDVA or patient satisfaction.