Impact Of Ocular Comorbidities On The Long-Term Proms After Multifocal Intraocular Lens Implantation

To evaluate the long-term impact of ocular comorbidities on clinical outcomes and patient-reported outcome measures (PROMs) in patients bilaterally implanted with diffractive MFIOLs.

Single private ophthalmic surgical clinic.

Participants comprised 260 emmetropic patients who underwent bilateral implantation of either the Zeiss AT LISA tri (n=89) or the AcrySof IQ PanOptix (n=171) with postoperative follow-up exceeding three years. Ocular comorbidities were identified with multimodal imaging and included dry eye disease (DED), prior corneal refractive surgery, vitreous opacities, macular disease, nonproliferative diabetic retinopathy, and glaucoma. Objective outcomes included uncorrected visual acuity at distance, intermediate, and near, contrast sensitivity, and optical quality. Subjective outcomes included VF-14 scores and dysphotopsia grading. Associations between comorbidities and postoperative outcomes were analyzed using multivariable regression.

Of 260 patients, 109 had no comorbidities, 21 had unilateral, and 130 had bilateral comorbidities. Eyes with comorbidities showed worse uncorrected visual acuities at all distances (all P<.001) and reduced contrast sensitivity under photopic (P=.001) and mesopic conditions (P<.001). On multivariable analysis, DED (B=-12.2; P<.001), prior refractive surgery (B=-13.9; P<.001), vitreous opacities (B=-9.91; P<.001), and macular disease (B=-7.22; P<.001) were associated with lower VF-14. DED (B=18.0; P<.001) and vitreous opacities (B=21.1; P=.050) were associated with higher dysphotopsia. Greater comorbidity burden, shorter tear break-up time (P=.005), and bilateral macular disease (P<.001) were linked to worse PROMs.

A substantial proportion of patients had multiple coexisting ocular comorbidities, with both the number and severity showing significant associations with PROMs. Fluctuating conditions such as DED and vitreous opacities had a greater impact on dysphotopsia, highlighting the importance of considering comorbidity patterns in patient selection and perioperative care for MFIOL implantation.