Title : Extended Depth of Focus versus Trifocal for Intraocular Lens Implantation: An Updated Systematic Review and Meta Analysis
Abstract:
Objective
To compare the outcomes of extended depth of focus (EDOF) versus trifocal intraocular lenses (IOLs) in patients undergoing cataract surgery.
Methods
A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines and a search of electronic information was conducted to identify all comparative studies of EDOF versus trifocal lenses were included. Postoperative refraction and visual acuity were primary outcome measures. Secondary outcome measures included postoperative defocus curves, intraocular aberrations, contrast sensitivity (CS), quality of vision (QoV) questionnaire score, haloes and glare, spectacle independence and patient satisfaction. Fixed and random effects models were used for the analysis.
Results
A total of 28 studies enrolling 3065 eyes from 1766 patients were identified. Trifocal IOL showed a significant improvement in postoperative refraction, particularly sphere (Mean difference [MD] = -0.17; P = 0.01) and spherical equivalence (MD = -0.11, P = 0.0001) compared to EDOF IOL. However, no statistically significant difference was observed in postoperative cylinder (MD = -0.02, P = 0.36) or postoperative astigmatism. Trifocal IOL reported significantly superior postoperative visual acuity only at near vision outcomes, namely uncorrected near visual acuity (UNVA) (MD = 0.12, P <0.00001) and distance-corrected near visual acuity (DCNVA) (MD = 0.12, P = 0.002). Distant visual acuity was statistically significantly improved for the EDOF group, particularly in postoperative corrected distance visual acuity (CDVA) (MD = -0.01, P = 0.002), although no significant difference was noted in postoperative uncorrected distance visual acuity (MD = -0.00, P = 0.97). Intermediate visual outcomes were not statistically significant between the two groups, namely uncorrected intermediate visual acuity (UIVA) (MD = 0.00, P = 0.89) or distance-corrected intermediate visual acuity (DCIVA) (MD = -0.01, P = 0.39). For secondary outcomes, defocus curve demonstrated favourable results for trifocal IOLs at near vision and EDOF IOL at intermediate vision. Ocular aberration and CS were not statistically significant between the groups. Haloes (Odds ratio [OR] = 0.66, P = 12), glare and patient satisfaction were comparable in both groups. Finally, trifocal IOL group had a statistically favourable QoV questionnaire score (MD = 1.24, P = 0.03) and spectacle independence (OR = 0.26, P = 0.02) over the EDOF IOL group.
Conclusions
Overall, outcomes of EDOF IOLs are comparable to trifocal IOLs. The latter group yields improved near visual acuity as well as postoperative refraction, particularly sphere and spherical equivalence. Overall, the use of trifocal versus EDOF IOLs should be based on individual basis and the clinician’s judgement.
