Optical Determinants Of Patient Dissatisfaction Following Implantation Of Presbyopia-Correcting Intraocular Lenses
Published 2026 - 44th Congress of the ESCRS
Reference: PP17.06 | Type: Poster | DOI: 10.82333/bw69-6s09
Authors: Dr Seth Michel Pantanelli* 1 , Dr Seungpil Bang 2 , Mr Karanpreet Multani 3 , Dr Deanna Dang 3 , Dr Kamran Riaz 3 , Dr David Cooke 4
1Ophthalmology,Penn State College of Medicine,Hershey,United States, 2Ophthalmology,Keimyung University Dongsan Medical Center,Daegu,Korea, Republic Of, 3Dean McGee Eye Institute,Oklahoma City,United States, 4Great Lakes Eye Care,St. Joseph,United States
Purpose
To investigate causes of dissatisfaction and identify associated optical factors in eyes implanted with presbyopia-correcting intraocular lenses (IOLs).
Setting
One private and one university based practice
Methods
This retrospective non-consecutive case series reviewed medical records of 70 eyes implanted with presbyopia-correcting IOLs that required subsequent IOL exchange due to patient dissatisfaction. IOL categories included bifocal, trifocal, and extended depth-of-focus (EDoF) designs. The prevalence and type of dissatisfaction related to visual quality and photic phenomena were compared among IOL groups. Optical assessments included postoperative visual acuity, refractive outcomes, biometric parameters, and higher-order corneal aberrations. Additionally, optical simulations were performed to explore potential relationships between measured optical metrics and subjective symptoms.
Results
Overall, patient dissatisfaction stemmed from blurred vision in 39/70 (56%) and photic phenomena in 31/70 (44%) eyes. Bifocal IOLs demonstrated a higher incidence of photic phenomena (4/6 = 67%), whereas trifocal and EDoF IOLs were more commonly associated with blurred vision (37/64 = 58%). Although residual refractive error contributed to dissatisfaction, increased corneal spherical aberration and coma emerged as the principal optical factor across IOL types. Optical simulations showed partial discordance between predicted and observed visual outcomes, suggesting that other factors such as angle-kappa, IOL tilt/decentration, and failed neuroadaptation may influence perceived visual quality beyond conventional topography measurements.
Conclusions
Patient dissatisfaction following presbyopia-correcting IOL implantation is multifactorial and influenced by both IOL design and individual optical characteristics. Photic disturbances were generally associated with point spread function alterations, whereas blurred vision correlated with contrast reduction reflected by modulation transfer function metrics. However, incomplete agreement between simulated and clinical outcomes highlights the additional roles of ocular surface status, intraocular scatter, and neural adaptation. Comprehensive optical evaluation—including assessment of higher-order aberrations and ocular surface quality—may improve preoperative counseling and postoperative management of dissatisfied patients.