Refractive Lens Exchange In Patients With High Hyperopia: Long-Term Functional And Patient-Reported Outcomes

The aim of this study was to assess the long-term subjective and objective outcomes, efficacy and safety of high-power intraocular lenses (IOLs) of ≥ +30.0 dioptres (D) in eyes undergoing refractive lens exchange (RLE) with implantation of monofocal and multifocal IOLs.

The David J Apple Center for Vision Research, Department of Ophthalmology, Heidelberg University Hospital, Heidelberg, Germany

Between 2009 and 2023, 42 eyes of 21 patients undergoing RLE with the implantation of a ≥ +30.0 D IOL were included in the study. The study cohort was divided into a monofocal (n=24 eyes, 12 patients) and a multifocal (n=18 eyes, 9 patients) group and invited for a prospective follow-up visit at least 12 months after surgery (mean: 7.2 years). Long-term data collection included assessment of subjective refraction, corrected and uncorrected distance, intermediate and near visual acuity (VA) using ETDRS-charts, a binocular defocus curve from +1 D to -3.5 D, with 0.5 D increments, patient-reported-outcome using validated questionnaires (including the Heidelberg Daily Task Evaluation – DATE - questionnaire) and complications.

Uncorrected distance VA improved in both groups (from 0.99 ± 0.44 logMAR in the monofocal and 0.93 ± 0.42 logMAR in the multifocal group to 0.26 ± 0.21 logMAR and 0.15 ± 0.16 logMAR, respectively). Target refraction was within ±1.0 D in 88.9% in the multifocal and 95.8% in monofocal group. The mean spherical equivalent was reduced from 6.53 ± 2.48 D preoperatively to 0.01 ± 0.53 D postoperatively, with a mean prediction error of 0.13 ± 0.87 D. Despite the morphological abnormalities, all calculation formulae showed low prediction errors. Multifocal lenses provided superior intermediate and near vision but were associated with more photic phenomena. Patient satisfaction was high in both cohorts as spectacle dependence was majorly reduced.

Refractive lens exchange with implantation of high-power IOLs is an effective and safe procedure for patients with high hyperopia, although accurate IOL calculation remains a challenge. In particular, the use of multifocal lenses has proven to be a safe option for greater spectacle independence but requires individual consideration of photic disturbances.