Long-Term Refractive Outcomes And Visual Quality Of Multifocal Intraocular Lens Implantation In High Myopic Patients: Multimodal Evaluation

To perform a multimodal assessment of refractive outcomes and quality of vision (QoV) in patients with high myopia submitted to multifocal intraocular lens (IOL) implantation with at least 3 years of follow-up.

Refractive Surgery Unit, Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal

Retrospective study that included consecutive eyes with high myopia (axial length [AL] >26.00mm) submitted to multifocal IOL implantation, between January 2014 and February 2020. Minimum follow-up time was 3 years. AL was measured with IOL master 500/700®, according to the preoperative device used. Uncorrected distance visual acuity (UCVA – logMAR scale) and near visual acuity (NVA - Jaeger scale) were evaluated. QoV was evaluated with the Objective Scatter Index (OSI) and the Modular Transfer Function (MTF) by HD Analyzer®. Two QoV questionnaires were applied to patients in which both eyes were included: the McAlinden and the Catquest-9 SF. 

We included 49 eyes (28 patients). Mean follow-up time was 5.4±1.0 years. The AL increased from 27.0 mm before surgery to 27.1 mm at last follow-up (p=0.031). At the last follow-up visit, UCVA was 0.14±0.13 logMAR (vs 0.08±0.08 one month after surgery (p=0.003)) and 55% of eyes had a NVA of J1, 13% of J1.5, 20% of J2 and 12% inferior to J3. The mean OSI was 5.1±1.8 and the mean MTF was 17.5±10.6. Posterior capsulotomy had been performed in 41% of eyes and 14% had slight posterior capsule opacification. The mean Catquest-9 SF score was -1.99±1.47, with 84% of patients being at least fairly satisfied with their vision. Some degree of near vision difficulty was reported by 89% of patients, glare by 72%, halos by 63% and starbursts by 56%.

Despite statistically significant,  mean UCVA change was inferior to 1 logMAR line after a mean time of 5 years, and 88% had an uncorrected NVA of at least J2. Most patients experienced visual symptoms, such as glare and halos, however QoV questionnaires showed that, globally, patients were satisfied with their current vision.