Visual Acuity And Dysphotopsia Outcomes After Enhanced Monofocal Versus Edof Iol Implantation

To compare postoperative visual outcomes between enhanced monofocal and extended depth-of-focus (EDOF) intraocular lenses (IOLs) following cataract surgery, including distance, intermediate, and near visual acuity, as well as patient-reported photic phenomena, with an updated systematic review and meta-analysis.

Systematic review and meta-analysis of comparative clinical studies conducted in ophthalmology centers.

Six studies (772 eyes) were included following a systematic search of MEDLINE and the Cochrane Library comparing enhanced monofocal (non-diffractive lenses extending depth of focus) and EDOF IOLs in cataract surgery. Eligible studies performed head-to-head comparisons between the two IOL types and reported postoperative uncorrected and/or corrected distance visual acuity (UDVA/CDVA) with ≥3-month follow-up. Meta-analyses for UDVA and CDVA used a random-effects model with mean differences in logMAR acuity.  Intermediate visual acuity(IVA), near visual acuity(NVA), glare, and halo outcomes were summarized narratively due to heterogeneity.

Five studies contributed to the UDVA and six to the CDVA meta-analysis. Pooled analysis showed statistically significant differences favoring enhanced monofocal IOLs for UDVA (mean difference −0.01 [−0.02, 0.00], 95% CI; I²=0%) and CDVA (mean difference −0.01 [−0.01, −0.00], 95% CI; I²=0%), below the threshold for clinical significance. IVA and NVA outcomes varied; EDOF IOLs generally provided better intermediate and near vision, though clinically meaningful differences were inconsistent and dependent on optical design. Glare and halo outcomes were mostly comparable, with one study favoring enhanced monofocal IOLs. Quantitative pooling was not feasible due to heterogeneity.

Enhanced monofocal and EDOF IOLs both provide excellent postoperative distance visual acuity, with no clinically meaningful difference. Although EDOF IOLs tend to offer improved intermediate and near vision, this benefit is heterogeneous and not consistently clinically significant. Visual quality regarding glare and halos appears broadly comparable. These findings support individualized IOL selection rather than a universal recommendation.