Exchanging A Trifocal Lens With An Extended Depth-Of-Focus Intraocular Lens In A Dissatisfied 20/20 Patient

To report the case and managment of a 53-year-old hyperopic presbyopic unhappy after refractive lens exchange with trifocal intraocular (IOL) lenses.

Clínica CEMO. Private practice in Vilanova i la Geltrú, Barcelona, Spain

A 53-year-old hyperopic presbyopic patient underwent refractive surgery for spectacle independence. Refractive lens exchange with trifocal lenses (Rayner RayOne Trifocal) implantation was performed without complications. Postoperatively, 20/20 visual acuity was achieved for distance and near, but the patient experienced decreased visual acuity, excessive glare, and halos at night. Despite a 6-month neuro-adaptation period, these issues persisted. Replacement with monofocal lenses was proposed.

After discussing the patient's goal of achieving spectacle independence at all distances, the plan was to replace the lens with Extended Depth of Focus (EDOF IOL) lenses (AST Asqelio EDOF, refractive IOL) in the dominant eye and assess binocular visual quality. The surgery was uneventful.

At the one-week follow-up, the patient subjectively reported excellent vision with a visual acuity of 20/16 for distance and 20/20 for near vision, with no significant halos or glare at night. No further intervention was performed in the non-dominant eye due to the favorable outcome and patient satisfaction.

Combining a refractive EDOF IOL in the dominant eye with a trifocal IOL in the non-dominant eye appears to be a reasonable approach in dissatisfied patients who are unwilling to compromise on spectacle independence at all distances but seek improvement in night vision disturbances.