Implantation Of A Enhanced Monofocal Edof Iol In The Second Eye --Improve The Satisfaction Of First Eye With Implantation Of Diffractive Trifocal Iol

To evaluate post-operative visual acuity (VA) and subjective quality assessment after mix-and-match implantation of a enhanced monofocal EDOF IOL and a diffractive trifocal IOL versus bilateral implantation of trifocal lOL.

Retrospective Chart review

The Rayone trifocal IOL was implanted in the eye and the monofocal EDOF (Rayone EMV) IOL in the second eye if the patients were not satisfied with the visual quality. Otherwise, If no complaints in the first eye, then the second eye will also implant trifocal IOL. Postoperative outcome analysis included visual acuity at far, intermediate and near distances, binocular and monocular defocus curves, VF-7 questionnaire after first eye and second eye, wavefront analysis, and a halo and glare simulator

80 eyes of 40 subjects were enrolled. The bilateral trifocal IOL groups performed better at DCNVA(p < 0.05) and at defocus levels of -1.75D to -3.75D (p < 0.05), the mix-match with enhanced monofocal EDOF IOL group was better at -0.5D and -1.75D(p = 0.015). No differences in monocular BCDVA, DCIVA were observed(p > 0.05). The UDVA and CDVA were better in the EDOF group(0.08±0.05 and 0.05±0.03) than the trifocal group (0.16±0.06 and 0.11±0.08)( P <0.05). Monocular Defocus curves showed that VA was better with the EDOF IOL for vergences at 0.00 till -1.50 and better with the trifocal IOL for vergences at -1.50, -2.5, and -3.75. Low rates of dysphotopsia phenomenon and bettere satisfied results were obtained in mix-match group( P < 0.05). 

Better visual quality and high satisfaction rates of VF-7 questionnaire were obtained after mix-and-match implantation of the enhanced monofocal EDOF EMV IOL and the Rayone trifocal IOL. Trifocal IOL implantation in the first eye then give the option for the second eye to keep on using trifocal IOL or shift to monofocal EDOF IOL may decrease optical disturbing phenomena in the final visual outcome with good visual quality. Similar results were observed for monocular distant, and intermediate VA. The trifocal IOL provided better monocular and binocular uncorrected near VA. HOAs were low in small pupil size independent of IOL design. Enhanced monofocal EDOF IOL(EMV) could be an alternative for 2nd eye to increase the satisfaction rate.