Prevalence And Management Of Presbyopia-Correcting Intraocular Lens Dissatisfaction
Published 2026 - 44th Congress of the ESCRS
Reference: PP24.03 | Type: Free paper | DOI: 10.82333/z4z8-8695
Authors: Claudia Perez-Straziota* 1
1Ophthalmology ,Cole Eye Institute ,Cleveland,United States
Purpose
To evaluate patient satisfaction, dissatisfaction, and intolerance following implantation of presbyopia-correcting intraocular lenses (PrC-IOLs) in eyes with and without prior laser vision correction (LVC) and propose a management decision tree to maximize patient satisfaction.
Setting
Methods
Retrospective cross-sectional study including consecutive patients who had PrC-IOL implantation with bifocal, trifocal, diffractive extended depth-of-focus, or non-diffractive EDOF IOLs at the Cleveland Clinic Cole Eye Institute. There were 493 patients (970 eyes) with no prior surgery and 59 eyes from 32 patients with prior LASIK or PRK. Evaluated variables included refractive outcomes, patient-reported satisfaction/dissatisfaction or intolerance, primary drivers of dissatisfaction, management strategies, spontaneous resolution of photic phenomena, and IOL exchange rates.
Results
In patients without prior LVC, 87.2% reported satisfaction postoperatively, 12.8% of patients were dissatisfied, and 7.7% were ultimately intolerant to symptoms. In patients with prior LVC dissatisfaction increased to 46.8%, with 31.3% being intolerant. Blurry corrected vision and photic phenomena were the most common causes of dissatisfaction in both groups. Dissatisfied patients had significantly worse UDVA and refractice error. Most effective interventions were IOL exchange (94%), laser vision correction (LVC) (72%), while ND:YAG laser capsulotomy (18.3%), spectacle correction (15.1%) and dry-eye treatment (5.2%) were ineffexctive. Ultimately, 2.5% of eyes without prior surgery and 12.5% of eyes with prior LVC underwent IOL exchange.
Conclusions
Most patients were satisfied with presbyopia-correcting IOLs; however, a significant portion of patients were dissatisfied postoperatively. Blurred corrected vision and photic phenomena were the leading causes of dissatisfaction. Symptoms and satisfaction were worse in eyes with prior LVC. Postoperatively, ND:YAG capsulotomy, and dry eye treatment alone were not effective, while LVC frequently improved satisfaction. IOL exchange may be necessary to alleviate symptoms.