The Role Of Neuroadaptation In Maintaining Visual Function In Elderly Patients After Diffractive Trifocal Iol Implantation

To evaluate age-related changes in visual function in patients who were satisfied with their vision immediately after surgery following implantation of a diffractive trifocal intraocular lens (IOL) (hydrophilic FineVision PodF). In particular, this study examines the role of neuroadaptation in preserving visual function in elderly patients.

Nishi Eye Hospital, Osaka, Japan

Patients who underwent FineVision PodF (BVI/PhysIOL) implantation (trifocal, hydrophilic, femtosecond laser-assisted cataract surgery) at our institution from Jan 2012 to Jan 2025 and achieved spectacle independence per a postoperative questionnaire were included. Patients were divided into two groups: under 60 years (7 cases, 14 eyes, mean age 54 ± 3.5 years) and over 75 years (8 cases, 16 eyes, mean age 78 ± 2.8 years). At 3 months, uncorrected binocular distant/intermediate (50 cm)/near (30 cm) visual acuities (VAs), monocular best-corrected distance/intermediate/near visual acuities, and near visual acuity under distance correction were assessed and compared.

Although the younger group exhibited better vision, the elderly group maintained good vision despite a trend of decline. At 3 months, uncorrected binocular distance visual acuity (LogMAR) was significantly better in the younger group (-0.051 ± 0.088) than in the elderly group (0.015 ± 0.053, p < 0.05). Best-corrected near and distance corrected near VAs were also better in the younger group (p<0.05). No significant differences were found in best-corrected distance, intermediate or binocular intermediate/near VAs. The younger group had lower cylindrical refractive error and larger preoperative pupil diameter (p < 0.05), while higher-order aberrations showed no difference. Posterior vitreous detachment was found at least in one elderly eye.

Visual function in the elderly group remained surprisingly well-preserved with spectacle independence. However, they exhibited a trend of decreased function, particularly in uncorrected binocular distance visual acuity, monocular best-corrected near visual acuity, and near visual acuity under distance correction. Nevertheless, good neuroadaptation appeared to compensate for some age-related visual decline, enabling elderly patients to maintain functional binocular vision and potentially enhancing postoperative satisfaction. Further research is needed to explore the interplay of neuroadaptation, vitreous opacity, and posterior vitreous detachment in shaping postoperative visual outcomes.