Journal of Refractive Surgery

Original Article Supplemental Data

Visual Outcomes and Patient Satisfaction for Trifocal, Extended Depth of Focus and Monofocal Intraocular Lenses

Luba Rodov, MD; Olga Reitblat, MD; Adi Levy, MHA; Ehud I. Assia, MD; Guy Kleinmann, MD

Abstract

PURPOSE:

To assess visual outcomes and patient satisfaction for trifocal and extended depth of focus (EDOF) intraocular lenses (IOLs) compared to monofocal IOLs with and without monovision.

METHODS:

Consecutive patients underwent bilateral cataract extraction surgery and implantation of either monofocal IOLs, monofocal IOLs using monovision, EDOF IOLs, or trifocal IOLs. Patients with preoperative biometric data, postoperative refraction, and visual acuity who completed a questionnaire regarding satisfaction and side effects were included. Visual outcome, spectacle independence, patient satisfaction, and subjective photic phenomena were assessed.

RESULTS:

Each group comprised 50 patients (100 eyes). The mean postoperative uncorrected distance, intermediate, and near visual acuities (logMAR) were: 0.17 ± 0.14 (Snellen 20/30), not applicable, and not applicable for monofocal; 0.08 ± 0.12 (Snellen 20/24), not applicable, and 0.07 ± 0.12 (Snellen 20/23) for monovision; 0.03 ± 0.08 (Snellen 20/21), 0.08 ± 0.12 (Snellen 20/24), and 0.23 ± 0.17 (Snellen 20/34) for EDOF; 0.07 ± 0.09 (Snellen 20/23), 0.08 ± 0.11 (Snellen 20/24), and 0.02 ± 0.06 (Snellen 20/21) for trifocal. Spectacle independence was reported by 36%, 70%, 74%, and 92% of patients, respectively. Postoperative halos and/or glare were experienced by 2%, 6%, 14%, and 38%, respectively, of which 2%, 0%, 6%, and 10%, respectively, were functionally disturbing. A total of 64%, 72%, 78%, and 76%, respectively, would choose the same IOL again.

CONCLUSIONS:

Patient satisfaction rates were high in all groups. Trifocal IOLs were more effective in improving unaided whole range of vision, but were associated with a higher rate of photic phenomena. The EDOF IOL and monovision provided partial spectacle independence with less photic phenomena.

[J Refract Surg. 2019;35(7):434–440.]

Abstract

PURPOSE:

To assess visual outcomes and patient satisfaction for trifocal and extended depth of focus (EDOF) intraocular lenses (IOLs) compared to monofocal IOLs with and without monovision.

METHODS:

Consecutive patients underwent bilateral cataract extraction surgery and implantation of either monofocal IOLs, monofocal IOLs using monovision, EDOF IOLs, or trifocal IOLs. Patients with preoperative biometric data, postoperative refraction, and visual acuity who completed a questionnaire regarding satisfaction and side effects were included. Visual outcome, spectacle independence, patient satisfaction, and subjective photic phenomena were assessed.

RESULTS:

Each group comprised 50 patients (100 eyes). The mean postoperative uncorrected distance, intermediate, and near visual acuities (logMAR) were: 0.17 ± 0.14 (Snellen 20/30), not applicable, and not applicable for monofocal; 0.08 ± 0.12 (Snellen 20/24), not applicable, and 0.07 ± 0.12 (Snellen 20/23) for monovision; 0.03 ± 0.08 (Snellen 20/21), 0.08 ± 0.12 (Snellen 20/24), and 0.23 ± 0.17 (Snellen 20/34) for EDOF; 0.07 ± 0.09 (Snellen 20/23), 0.08 ± 0.11 (Snellen 20/24), and 0.02 ± 0.06 (Snellen 20/21) for trifocal. Spectacle independence was reported by 36%, 70%, 74%, and 92% of patients, respectively. Postoperative halos and/or glare were experienced by 2%, 6%, 14%, and 38%, respectively, of which 2%, 0%, 6%, and 10%, respectively, were functionally disturbing. A total of 64%, 72%, 78%, and 76%, respectively, would choose the same IOL again.

CONCLUSIONS:

Patient satisfaction rates were high in all groups. Trifocal IOLs were more effective in improving unaided whole range of vision, but were associated with a higher rate of photic phenomena. The EDOF IOL and monovision provided partial spectacle independence with less photic phenomena.

[J Refract Surg. 2019;35(7):434–440.]

Currently, there are several options for achieving relative spectacle independence in cataract surgery. One is the monovision method, in which monofocal intraocular lenses (IOLs) are implanted in both eyes, one aiming for distance and the other for intermediate/near vision. Previous studies have shown that monovision reduces spectacle dependence for both distance and near while retaining good stereopsis and contrast sensitivity. However, only 25% of the patients were completely spectacle independent.1 Another solution is multifocal IOLs, which simultaneously provide several images in each eye. Bifocal lenses approved by the U.S. Food and Drug Administration in 2005 (AcrySof ReSTOR; Alcon Laboratories, Inc., Fort Worth, TX) provide good distance and near, but often not intermediate, uncorrected vision.2 Modern lifestyles raise the importance of intermediate distance vision, mainly due to the extensive use of computers and small hand-held devices (cellphones, digital tablets, etc.).3 Trifocal lenses were designed to provide good uncorrected visual acuity for intermediate distance in addition to near and far distances. Prospective studies that analyzed visual acuity, patient satisfaction, and spectacle dependence following trifocal IOL implantation showed good results with high patient satisfaction, but with some complaints of photic phenomena.4–7 Most complaints of blurred vision and photic phenomena after multifocal IOL implantation can be effectively managed, with few eyes requiring IOL exchange.8

Extended depth of focus (EDOF) IOLs are a new family of IOLs that aim to provide continuous restoration of visual acuity from intermediate to far distance with less photic phenomena.9 The Tecnis Symfony IOL (Johnson and Johnson, New Brunswick, NJ) is one representative of this new IOL family. Its diffractive echelette profile induces an increase in the range of focus and achromatic properties that enhance contrast sensitivity.10

The goal of this study was to compare the clinical outcomes and patient satisfaction for four IOL options: monofocal for distance (MFD), monovision, trifocal, and EDOF.

Patients and Methods

This was a retrospective review of medical records of patients who underwent bilateral cataract surgery with implantation of the same type of IOL in both eyes at Ein Tal Eye Center, performed by one of two expert surgeons (EIA and GK) between January 2014 and October 2017. The study adhered to the tenets of the Declaration of Helsinki, and institutional review board/ethics committee approval was obtained.

Inclusion criteria were: (1) availability of preoperative biometric data (IOLMaster-500; Carl Zeiss Meditec AG, Jena, Germany), (2) postoperative data including refraction and visual acuity at least 1 month postoperatively, and (3) compliance with a questionnaire regarding patient satisfaction and side effects at least 1 month postoperatively. Exclusion criteria were: (1) patients with significant ophthalmic pathology, such as corneal or macular scars and amblyopia, (2) previous refractive surgery, and (3) complications during or following the cataract surgery.

The IOL power was selected based on third-generation formula calculations (SRK/T, Holladay 1, and Hoffer Q) together with newer fourth-generation formulas (Haigis, Olsen, and Barrett Universal II). The IOL power was selected to target emmetropia or minimal myopia, except in eyes chosen for near vision in the monovision method. The Barrett online toric calculator was used in cases that warranted a toric IOL implantation, as indicated by keratometry and corneal topography. Additional adjustments were taken under consideration according to the surgeon's experience and preferences (eg, surgical incision site, posterior corneal astigmatism, and astigmatism orientation). All procedures were done by phacoemulsification through a 2.2- to 2.4-mm clear corneal incision. Customization of the refractive solution proposed to each patient was based on several factors, including the eyes' characteristics (eg, refractive status, higher order aberrations, and biometry) and the patients' desires and needs.

The patients were divided into four groups according to the implanted IOL type and intended focus: (1) monofocal group: Acrysof SN60WF/SA60AT (Alcon Laboratories, Inc., Fort Worth, TX) targeted for distance in both eyes (MFD), (2) monovision group: Acrysof SN60WF/SA60AT IOLs targeted for distance vision in one eye and for near vision in the other eye (between −1.50 and −2.00 diopters [D]), (3) EDOF group: Tecnis Symfony IOL (Johnson and Johnson), and (4) trifocal group: FineVision Micro F/POD F (PhysIOL Inc., Liège, Belgium). Toric IOLs were included in all four groups with a similar percentage.

A follow-up questionnaire survey was conducted at least 1 month following the surgery on the second eye to evaluate the frequency of spectacle use, photic phenomena, and patient satisfaction. The answers were categorized and graded from 1 to 5. For analysis purposes, the answers “never” and “rarely” were grouped together as positive outcomes and the answers “often” and “all the time” were regarded as negative outcomes. For questions regarding quality of vision, the answers “good” and “excellent” were considered as high patient satisfaction and the answers “very poor” and “poor” were considered as low patient satisfaction.

Statistical Analysis

Continuous variables were compared using a oneway analysis of variance or the Kruskal–Wallis test, followed by post-hoc tests, as indicated by a normality test (Shapiro–Wilk). Categorical variables were compared using Pearson's chi-square tests. Patient feedback from the survey was expressed as proportions and assessed as categorical variables. Statistical analyses were performed using SPSS software (version 21.0; SPSS, Inc., Chicago, IL). A P value of less than .05 was considered statistically significant.

Results

Each group included 50 consecutive patients (100 eyes) that met the inclusion criteria. The patients' demographic and biometric data are presented in Table 1. The patients in the MFD group were older compared to the other groups (P < .001). The trifocal group consisted of more women compared to the other groups (P = .03). Axial length was longer in the monovision group compared to the MFD group (P = .001). There was no difference in keratometric readings. Higher order aberrations were significantly higher in the MFD group compared to all other groups (P < .001). The preoperative astigmatism was highest in the MFD group, followed by the monovision group, with significantly lower astigmatism in the trifocal group (P = .001).

Patient Demographic and Biometric Data

Table 1:

Patient Demographic and Biometric Data

The mean implanted IOL power was 20.11 ± 4.61 D for the MFD group, 18.49 ± 5.55 D for the monovision group, 19.19 ± 5.35 D for the EDOF group, and 18.38 ± 4.15 D for the trifocal group (P = .052). All groups included toric IOLs: 27% in the MFD group, 32% in the monovision group, 41% in the EDOF group, and 32% in the trifocal group (P = .202).

Postoperative results at least 1 month after the surgery are presented in Figure 1. The spherical equivalent (SE) results at the postoperative manifest refraction examination were similar between the four groups (−0.302, −0.37, −0.363, and −0.226 D for the MFD, monovision, EDOF, and trifocal groups, respectively). The mean SE for near in the monovision group was −1.82 D, as planned. The threshold for astigmatic correction with the toric IOL was generally higher in the monofocal and monovision versus the multifocal and EDOF groups. Accordingly, mean absolute residual postoperative astigmatism was significantly higher in the MFD group compared to all other groups and in the monovision group compared to the multifocal and EDOF groups (0.92 ± 0.63, 0.67 ± 0.52, 0.40 ± 0.34, and 0.45 ± 0.39 D for the MFD, monovision, EDOF, and trifocal groups, respectively; P < .001). Postoperative astigmatism (D) centroid values were 0.53 ± 0.64 @ 6.55, 0.32 ± 0.54 @ 14.21, 0.04 ± 0.37 @ 4.43, and 0.26 ± 0.37 @ 9.97 respectively (X < .001, Y = .059).

Postoperative spherical equivalent refraction for the (A) monofocal intraocular lens (IOL) targeted for distance (MFD) group, (B) monovision group–distance and near eye, (C) extended depth of focus (EDOF) IOL group, and (D) trifocal IOL group. Postoperative refractive cylinder in the (E) MFD group, (F) monovision group, (G) EDOF IOL group, and (H) trifocal IOL group. D = diopters

Figure 1.

Postoperative spherical equivalent refraction for the (A) monofocal intraocular lens (IOL) targeted for distance (MFD) group, (B) monovision group–distance and near eye, (C) extended depth of focus (EDOF) IOL group, and (D) trifocal IOL group. Postoperative refractive cylinder in the (E) MFD group, (F) monovision group, (G) EDOF IOL group, and (H) trifocal IOL group. D = diopters

The uncorrected distance visual acuity (UDVA) results for all groups are presented in Table 2. The UDVA was similar in the trifocal, EDOF, and monovision groups, whereas the MFD group showed slightly but significantly worse UDVA results compared with the other groups (P < .001). There was no difference between the trifocal and EDOF uncorrected intermediate visual acuity (UIVA). The uncorrected near visual acuity (UNVA) was significantly better in the trifocal and monovision groups compared with the EDOF group (P < .001).

Postoperative Uncorrected Visual Acuity (logMAR) Results

Table 2:

Postoperative Uncorrected Visual Acuity (logMAR) Results

Patient satisfaction was evaluated using a questionnaire. The mean surgery-to-questionnaire completion time was shorter in the EDOF group (mean: 6.5 ± 4.7 months) compared to the other groups: 11.9 ± 15.1 months in the MFD, 11.0 ± 7.8 months in the monovision, and 14.5 ± 7.5 months in the trifocal group (P < .001).

The patients' perception of their subjective UNVA was statistically significantly different between the IOL groups. The highest percentage of patients reporting “good” or “excellent” UNVA was in the trifocal group, with the lowest percentage in the MFD group (P < .001). The differences in subjective uncorrected far and intermediate visual acuity were not statistically significant (Figure 2). The reported subjective spectacle independence, defined as “never” or “rarely” using spectacles, was found to be significantly different between the groups for intermediate, near, and whole range of vision. For intermediate vision, patients in the trifocal and EDOF groups reported the best results, followed by the monovision and MFD groups (P < .001). For near and whole range of vision, patients in the trifocal group reported the best results, followed by the EDOF and monovision groups and then the MFD group (P < .001 and P = .001; respectively) (Figure 3). The patients' satisfaction questionnaire scores are presented in Table A (available in the online version of this article).

The percentage of patients in each intraocular lens (IOL) group who rated their uncorrected visual acuity as “excellent” or “good” for distance, intermediate distance, and near. * P < .001. VA = visual acuity; MFD = monofocal IOL targeted for distance; EDOF = extended depth of focus IOL

Figure 2.

The percentage of patients in each intraocular lens (IOL) group who rated their uncorrected visual acuity as “excellent” or “good” for distance, intermediate distance, and near. * P < .001. VA = visual acuity; MFD = monofocal IOL targeted for distance; EDOF = extended depth of focus IOL

The percentage of patients in each intraocular lens (IOL) group who reported to never or rarely use spectacles for distance, intermediate distance, near, and whole range of vision. *P < .001, ** P = .001. MFD = monofocal IOL targeted for distance; EDOF = extended depth of focus IOL

Figure 3.

The percentage of patients in each intraocular lens (IOL) group who reported to never or rarely use spectacles for distance, intermediate distance, near, and whole range of vision. *P < .001, ** P = .001. MFD = monofocal IOL targeted for distance; EDOF = extended depth of focus IOL

Results of the Postoperative Patient Satisfaction Questionnaire

Table A:

Results of the Postoperative Patient Satisfaction Questionnaire

Postoperative halos or glare were experienced often or all the time by 2%, 6%, 14%, and 38% of the patients in the MFD, monovision, EDOF, and trifocal groups, respectively (P < .001). However, only 2%, 0%, 6% and 10%, respectively, reported functionally disturbing halos or glare often or all of the time. None of the patients required IOL exchange. A total of 64%, 72%, 78%, and 76%, respectively, reported that they would choose the same IOL again.

Discussion

Patients in the MFD group were older than patients in the other groups. We hypothesize that although people now have active lifestyles late into their 90s, it is possible that older patients tend to choose multifocal IOLs less often compared to younger adults. Most of the patients in the trifocal group were women (72%), indicating that it may be more important to women to be free of reading spectacles. Bilbao-Calabuig et al.6 also found more women in their trifocal IOL group, whereas Monaco et al.11 did not. Therefore, the significance of this finding is questionable. Higher order aberrations were higher in the MFD group. A possible explanation is that patients with a high value of higher order aberrations were advised against implantation of multifocal IOLs due to an increased risk of photic phenomena.

The postoperative SE in the trifocal group was the closest to emmetropia compared to the other groups (P = .08). This could be explained by the fact that when choosing IOL power for trifocal IOLs, we aim for emmetropia, whereas for other IOLs we aim for a slight myopia.

UDVA was good in all groups, with no significant difference between the monovision, trifocal, and EDOF groups. This is in agreement with previous studies.11–14 In our study, mean UDVA in the MFD group was 20/30, which is slightly but statistically significantly inferior compared to the other groups. Because it is important to correct even low magnitudes of astigmatism to fully benefit from the trifocal and EDOF IOLs, we corrected lower amounts of astigmatism with the toric version of these IOLs, as demonstrated by the lower astigmatism correction threshold for toric IOL implantations in these groups compared with the MFD group. This can explain the higher residual astigmatism and lower UDVA in the MFD group. In the monovision group, the astigmatism correction threshold for a toric IOL was also higher than in the multifocal and EDOF groups because astigmatic correction was of greater importance in the eye targeted for distance and less so in the eye targeted for near distance vision.

Our results are in contrast to several previous studies that found no difference between the groups for distance vision.9,11 However, Pedrotti et al.15 compared clinical results of bilateral monofocal to EDOF IOL implantations, and also found that the EDOF IOL provides better UDVA. Analysis of reported spectacle dependence showed that more patients in the trifocal and EDOF groups were spectacle independent for distance (96%) compared to the MFD and monovision groups (80%). However, probably due to sample size, this difference was not statistically significant. Interestingly, these differences did not affect the patients' subjective ratings of their UDVA, which were similar in all four groups. The discrepancies between objective visual acuity measurements and reported subjective evaluation of acuity and spectacle independence reflect the problem of subjective questionnaires and subjective measures, which are affected by factors such as cultural background, personality, and occupation.

Regarding the UIVA, no differences were found between the trifocal and EDOF groups. This is in concordance with the findings of Ruiz-Mesa et al.,16 who reported comparable UIVA of 20 patients implanted with the trifocal PanOptix IOL and 14 patients implanted with the Symfony IOL. This is in contrast with the report by Monaco et al.,11 who compared 40 eyes of 20 patients in three groups (PanOptix IOL, Symfony IOL, and monofocal SN60WF IOL). They showed that, at 4 months postoperatively, the trifocal IOL had better intermediate performance using a defocus curve than the EDOF IOLs, and both multifocal IOLs performed better than monofocal IOLs.

There was a tendency toward higher satisfaction rates with intermediate distance vision in the trifocal group (88%) than in the EDOF and monovision groups (74%), although this difference was not statistically significant. Reported spectacle independence for intermediate distance was similar in the trifocal and EDOF groups: 96% and 90% of the patients, respectively, reported they never or rarely used spectacles for intermediate vision.

The UNVA in the trifocal and monovision groups was similar and significantly superior compared to the EDOF group. This finding is in agreement with previous studies reporting that patients implanted with tri-focal IOLs achieved better UNVA than those implanted with EDOF IOLs.11,16,17 The mean UNVA in our EDOF group, although not as good as in the trifocal group, was fair (Snellen 20/34), and 34% of the EDOF patients rated their near vision as good or excellent. This result was better than expected because the EDOF IOL is not targeted for unaided near vision. These findings were reflected in the patients' estimation of their UNVA and spectacle independence, which were significantly better in the trifocal group compared to the EDOF and monovision groups. Nearly all patients in the MFD group were spectacle dependent for near vision.

The highest rate of spectacle independence for all distances was reported by the patients in the trifocal group (92%). There were similar rates in the monovision and EDOF groups (70% and 74%, respectively), and the lowest rate of total spectacle independence was reported by the MFD group (36%). Monaco et al.11 used the Quality of Vision questionnaire to evaluate spectacle use in different IOL groups. In their study, patients in the EDOF and trifocal IOL groups had similar and better results than patients in the monofocal group in terms of spectacle independence for any distance. These results differ slightly from ours, which could be due to using different questionnaires.

A major reported problem of multifocal IOLs is photic phenomena. More than one-third of patients in the trifocal IOL group reported experiencing postoperative halos or glare often or all the time. This was significantly more than in the EDOF (14%), monovision (6%), and MFD (2%) groups. However, the rate of functionally bothersome photic phenomena was lower, with no significant difference between the four groups (10% for trifocal, 7% EDOF, 0% monovision, and 2% MFD). Monaco et al.11 found no differences in reported photic phenomena between the trifocal and EDOF groups using the Quality of Vision questionnaire. However, photic phenomena were significantly higher than in their monofocal IOL group. Interestingly, most of the patients in the monovision group reported they never experienced halos or glare. In this group, the myopization of the non-dominant eye inevitably induces the perception of a large halo of defocus. Thus, it must be “neutralized” by the brain, indicating that neuroadaptation plays an important role in the success of current methods aimed to reduce spectacle dependence.

The method of assessing photic phenomena in IOL studies is not standardized, and different types of questions might influence the percentage of reported symptoms. Direct questioning as used in our study may have been suggestive, triggering the patients' answers. An indirect question as used by Cochener et al.18 (Do you experience any problems with your vision?) may result in lower reported incidence of photic phenomena.

The mean time from surgery to questionnaire completion was shorter in the EDOF group compared to other groups (P < .010). This is because the EDOF is a relatively new IOL. However, it was still more than 6 months, which is considered long enough for neuroadaptation.19

The overall satisfaction was high and similar in all four groups. This may reflect the overall satisfaction from the cataract surgery itself. Although high, it is slightly lower than in some other reports.13,18 Patient satisfaction is a highly subjective variable. Patients who chose the trifocal IOLs and were willing to pay a higher cost were probably more motivated to achieve spectacle independence and have higher expectations regarding uncorrected vison postoperatively. Patients in the EDOF group were advised that this IOL provides good far and intermediate but not near distance uncorrected vision. Therefore, they had no expectations for good uncorrected near vision and were not disappointed with such a result. Moreover, 34% of the patients in the EDOF group reported good near vision and 58% never or rarely required spectacles for near vision activities, which is a better result than they expected and contributed to their satisfaction. Similarly, patients in the MFD group did not expect to be spectacle independent for intermediate or near distance, and were pleased to achieve good uncorrected vision for far distance.

This study's strength is that it was performed in the same population, so expectations and satisfaction rates were less biased by cultural differences. Therefore, it is a good platform to compare different IOL solutions and to help in patient consultation on what to expect from each option in comparison to the others.

The limitations of this study are that it was retrospective and not randomized. Patients chose the implanted IOL type according to their individual preferences after being advised of all options.

There are currently several options for IOL type implantation after cataract extraction. We have shown that the trifocal IOL is best for achieving a full range of good uncorrected vision, but it also has the highest rate of photic phenomena. The EDOF IOL and monovision provide partial unaided range of vision with less photic phenomena. A larger prospective study is needed to confirm our results.

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Patient Demographic and Biometric Data

ParameterMFDMonovisionEDOF IOLTrifocal IOLP
Patients, n50505050
Age (y), mean ± SD72.18 ± 7.8766.79 ± 9.8667.21 ± 9.8367.01 ± 6.73< .001
Female, n (%)26 (52)26 (52)24 (48)36 (72).003
AL (mm), mean ± SD23.9 ± 1.3424.81 ± 1.9224.34 ± 1.6224.4 ± 1.35.001
K (D), mean ± SD43.73 ± 1.6643.70 ± 1.5443.60 ± 1.5543.60 ± 1.46.904
RMS, mean ± SD0.83 ± 0.430.6 ± 0.280.53 ± 0.150.53 ± 0.14< .001
Preoperative astigmatism (D)
  Absolute, mean ± SD − whole group / only toric IOLs1.41 ± 0.92 / 2.48 ± 0.591.29 ± 0.91 / 2.24 ± 0.891.11 ± 0.83 / 1.58 ± 1.030.94 ± 0.76 / 1.66 ± 0.88.001
  Centroid, mean ± SD @ axis − whole group / only toric IOLs0.17 ± 1.12 @ 11.89 / 0.17 ± 1.62 @ 15.470.26 ±0.95 @ 81.24 / 0.51 ± 1.37 @ 77.580.28 ± 0.86 @ 79.97 / 0.26 ± 1.18 @ 76.880.21 ± 0.79 @ 82.66 / 0.10 ± 1.25 @ 34.27X = .720; Y = .978

Postoperative Uncorrected Visual Acuity (logMAR) Results

Visual AcuityMFDMonovisionEDOF IOLTrifocal IOLP
Distance, mean ± SD0.17 ± 0.140.08 ± 0.120.03 ± 0.080.07 ± 0.09< .001
Intermediate, mean ± SDNANA0.08 ± 0.120.08 ± 0.11.843
Near, mean ± SDNA0.07 ± 0.120.23 ± 0.170.02 ± 0.06< .001

Results of the Postoperative Patient Satisfaction Questionnaire

QuestionMFDMonovisionEDOF IOLTrifocal IOLP
Q1 – How would you rate your far distance vision?
  Very poor (%)2400NA
  Poor (%)2400
  Fair (%)108122
  Good (%)38423634
  Excellent (%)48425264
Q2 – How would you rate your intermediate distance vision?
  Very poor (%)4222NA
  Poor (%)18240
  Fair (%)26222010
  Good (%)34323220
  Excellent (%)18424268
Q3 – How would you rate your near distance vision?
  Very poor (%)462240< .001
  Poor (%)3816184
  Fair (%)14322422
  Good (%)2261628
  Excellent (%)0241846
Q4 – How frequently do you use spectacles for far distance vision?
  All the time (%)12842NA
  Often (%)4800
  Sometimes (%)4402
  Rarely (%)183022
Never (%)62509494
Q5 – How frequently do you use spectacles for intermediate distance vision?
  All the time (%)18442< .001
  Often (%)16620
  Sometimes (%)181042
  Rarely (%)14842
  Never (%)34728694
Q6 – How frequently do you use spectacles for near distance vision?
  All the time (%)648242< .001
  Often (%)2218106
  Sometimes (%)102286
  Rarely (%)420148
  Never (%)0324478
Q7 – How frequently do you use spectacles for any distance?
  All the time (%)12442.001
  Often (%)101262
  Sometimes (%)4214164
  Rarely (%)36482610
  Never (%)0224882
Q8 – Do you experience halos or glare in your vision?
  All the time (%)02220< .001
  Often (%)241218
  Sometimes (%)8162418
  Rarely (%)1883422
  Never (%)72702822
Q9 – Do the halos and glare disturb your daily life activities?
  All the time (%)0002NA
  Often (%)2068
  Sometimes (%)412618
  Rarely (%)021610
  Never (%)94866662
Q10 – If you could, would you choose to receive the same IOL again?
  No (%)4204NA
  Probably not (%)101424
  I don't know (%)22122016
  Probably (%)610162
  Yes (%)58626274
Authors

From Ein-Tal Eye Center, Tel-Aviv, Israel (LR, OR, AL, EIA, GK); Kaplan Medical Center, Rehovot, Israel, affiliated with The Hebrew University, Jerusalem, Israel (LR, GK); and Meir Medical Center, Kfar-Saba, Israel, affiliated with Tel-Aviv University, Ramat Aviv, Israel (EIA).

Drs. Rodov and Reitblat contributed equally to this work and should be considered as equal first authors.

Dr. Assia is a consultant for Hanita Lenses and Biotechnology General (Israel) Ltd., receives research fees from and holds options in Vision Care Technologies, is Founder and CMO of APX Ophthalmology and VisiDome, and is a shareholder in IOPtima and CorNeat. Dr. Kleinmann is a consultant for Hanita Lenses, Vision 6, and S.I.S Shulov Innovative Science Ltd. The remaining authors have no financial or proprietary interest in the materials presented herein.

AUTHOR CONTRIBUTIONS

Study concept and design (LR, OR, AL, EIA, GK); data collection (LR); analysis and interpretation of data (LR, OR, AL, EIA, GK); writing the manuscript (LR, OR); critical revision of the manuscript (LR, OR, AL, EIA, GK); statistical expertise (OR); administrative, technical, or material support (AL); supervision (EIA, GK)

Correspondence: Luba Rodov, MD, Habarzel 15, Tel Aviv, Israel. E-mail: lubadi@gmail.com

Received: February 14, 2019
Accepted: June 18, 2019

10.3928/1081597X-20190618-01

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