Custom Match Approach To Optimize Intraocular Lens Implantation In Cataract Surgery

Patient demand has increased, and surgeries are no longer focused merely on correcting refractive errors, but also on achieving a high-quality vision and spectacle-independent life.Several considerations, including visual outcome goals, profession, and hobbies should be taken into account before choosing personalized solution for each patient. Intraocular lens (IOL) selection process for custom-match of the multifocal and extended depth of focus (EDOF) lenses should follow a holistic approach to meet expectations. The current examination applies custom-match approach to correct refractive errors and evaluate visual outcomes and patient satisfaction after the implantation of an EDOF and a trifocal capsular bag IOL.

Tyger Valley Eye & Laser Centre, Cape Town, South Africa

A total of 56 eyes (19 female and9 male patients) were implanted according to the custom-match approach: the dominant eye was implanted with the extended depth of focus ELON IOL (877PEY by Medicontur), while the non-dominant eye was implanted with the diffractive, trifocal Liberty lens (677CMY by Medicontur).Postoperative monocular uncorrected and corrected distance visual acuities (UDVA, CDVA), and binocular uncorrected intermediate and near visual acuities (UIVA, UNVA) were measured up to 12 months. Binocular visual acuity defocus curves and contrast sensitivity curves were plotted using theMultifocal Lens Analyzer software (Qvision, Spain).

The refractive outcomes proved to be predictable: 82% and 86% of patients achieved postoperative S.E.  refraction of 0.50 D or less for both the ELON and Liberty Ienses. Efficient presbyopia correction is accomplished: the mean monocular UDVA was better than 20/25 postoperatively for both ELON and Liberty lenses. Binocular mean UIVA was 0.16 ± 0.13 and mean UNVA was 0.12 ± 0.09 logMAR. Corrected binocular visual acuity defocus curves were better than 0.00 logMAR for over 3.75 diopters, which proves that excellent vision could be achieved at all distances. Minimal reports of dysphotopsia could be registered. Patient satisfaction questionnaire, a wide range of daily activities could be performed without or with only minimal difficulties.

The custom-match approach ensures precise refractive predictability, stability and excellent restoration of vision throughout a wide range of focus. Complete spectacle-independence can be achieved in the majority of cases. Less halos and glares are experienced than with that observed with binocular implantation of a trifocal lens. This high-quality visual experience meets patient expectations for complete visual comfort during their daily lives.