Effectiveness Of Multifocal Intraocular Lenses (Iols) Designed To Correct Presbyopia After Cataract Surgery Compared To Monofocal Iols - An Overview Of Reviews

Cataract surgery is the most commonly performed eye surgery. In the developed world, the procedure has a refractive aspect aiming for avoidance of spectacle dependence, while ophthalmic surgeons are overwhelmed by the influx of the different intraocular lens (IOL) types designed to correct presbyopia. There are many published randomised controlled trials (RCTs) on the outcomes of the IOL types designed to correct presbyopia, still the evidence is difficult to interpret due to conflicting results between studies.

In this ESCRS funded systematic review project we performed an overview of systematic reviews of RCTs and non-RCTS comparative that followed the PRIOR and PRISMA reporting guidelines as well as Cochrane Handbook for Systematic Reviews. We summarize data on the performance of IOLs to correct presbyopia that underwent bilateral cataract surgery.

Ovid MEDLINE, Ovid EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus were searched for the reviews published in the last 10 years that assessed IOL types according to the PICO parameters described below: (P)Adults ≥ 40 years of age who underwent bilateral phacoemulsification with IOL implantation, (I, C) different IOLs, (O) uncorrected distance, intermediate and near visual acuity, and spectacle independence (SI).  Evaluation of the systematic review methodology was done using AMSTAR-2 tool. Data were extracted, complied into tables, and synthesized.

Seven systematic reviews, published between 2014-2023, were included. None scored with “Yes” in all AMSTAR-2 tool 16 items. Trifocal diffractive, EDOF, accommodative and bifocals were better than monofocal IOL for UNVA. Trifocal diffractive showed the largest difference to monofocal IOLs MD –0.32 [95% CI: –0.46 to –0.19]. EDOF was better than monofocal for UIVA –0.17 [ –0.33 to –0.01]. Comparison between multifocal (refractive and diffractive IOL) and monofocal IOLs revealed UDVA - 0.0 [ − 0.02 to 0.02], UNVA - 0.26 [− 0.37 to -0.15], and SI RR: 0.27 [95% CI: 0.20 to 0.38]. When trifocals were compared to bifocal IOLs UDVA MD: 0.00 [95% CI −0.04 to 0.04]), UIVA -0.16 [ −0.22 to -0.10] and UNVA MD: 0,01 [−0.04 to 0.06] at one year.

No statistical difference between lenses for UDVA but monofocal ranked the highest for UDVA.  However, some evidence indicated that EDOF and mIOL demonstrated superior outcomes for UIVA and UNVA relative to monofocal lenses. EDOF lenses ranked highest for UIVA and trifocal diffractive ranked highest for UNVA. Trifocal diffractive was better than bifocal for UIVA. Additionally, spectacle independence was more frequently achieved with multifocal and EDOF lenses than with monofocal options. Therefore, individual patient factors and their unique preferences should be carefully evaluated to inform the selection of an appropriate IOL for the correction of presbyopia.