Visual Performance Of A Non-Diffractive Extended Depth Of Focus Intraocular Lens In Patients With Early Age-Related Macular Degeneration

 To assess the visual and refractive outcomes of patients implanted with the non-diffractive extended depth of focus (EDOF) LuxSmart™ intraocular lens (IOL) (Bausch & Lomb GmbH, Berlin, Germany) following cataract surgery in patients with early-stage age-related macular degeneration (AMD) The control group is the monofocal plus Tecnis Eyhance™ IOL (ICB00, Johnson & Johnson Surgical Vision, Inc., Santa Ana, CA). The study analyzed monocular defocus curves with the best-corrected distance prescription to compare lens performance at different defocus distances to achieve this. Intraocular light scatter was quantified using halometry. Spherical equivalent and residual astigmatism were analyzed in both groups to evaluate refractive outcomes.

This prospective observational study included 22 eyes implanted with the monofocal plus Tecnis Eyhance™ intraocular lens (Lens A) and 19 eyes implanted with the non-diffractive extended depth of focus (EDOF) LuxSmart™ intraocular lens (Lens B) following femtosecond laser-assisted phacoemulsification. All procedures were performed by the same experienced cataract surgeon at Hospital Universitario de La Moraleja in Madrid, Spain. Patients were followed for 1 month postoperatively.

Patients were diagnosed with cataracts through slit-lamp biomicroscopy. Diagnosis of AMD was confirmed using optical coherence tomography (OCT) Retinography was used for AMD classification based on the Age-Related Eye Disease Study criteria. Biometry was performed with the IOLMaster 700 (Carl Zeiss Meditec, Jena, Germany) IOL power was calculated using the Barrett True-K. Inclusion criteria consisted of uncomplicated cataract surgery. Exclusion criteria any comorbidity that could compromise visual outcomes.

Statistical analysis was performed using SPSS (IBM).

Ethical considerations: This study adhered to the principles of the Declaration of Helsinki and was approved by the Ethics Committee of Hospital Clínico San Carlos in Madrid.

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The mean postoperative spherical equivalent for Lens A was -0.15 D ± 0.12 D, and for Lens B, it was -0.12 D ± 0.10 D, p = 0.705. Regarding the refractive cylinder, Lens A had a mean of 0.091 D ± 0.120 D, while Lens B had 0.075 D ± 0.115 D, p = 0.796

In halometry, the Light Distortion Index (LDI) was 0.82 ± 0.13 for Lens A and 0.83 ± 0.13 for Lens B (p = 0.48).

Regarding the monocular defocus curve with the best-corrected distance prescription, at distance (0 D) the the visual acuity (VA) for lens A was 0.017 and for lens B 0.027  (p = 0.273), at intermediate vision (-1.5 D),  VA for Lens A was 0.294, and for Lens B, it was 0.256 (p = 1). At near vision (-2.5 D), the VA for Lens A was 0.518, while for Lens B, it was 0.468 (p = 1).

Both intraocular lenses provided comparable postoperative refractive outcomes, with no statistically significant differences in spherical equivalent or residual astigmatism.

Light distortion showed no significant differences, indicating similar intraocular light scatter profiles for both IOLs.

In the defocus curve analysis, the two lenses offer comparable distance vision performance and, demonstrated intermediate and near vision capabilities, with Lens B (EDOF) showing a trend toward improved performance, although differences were not statistically significant.

These findings suggest that in patients with early-stage AMD undergoing cataract surgery, both IOLs are viable options.