Success and Failure Rates with Increased-Range-of-Focus IOLs

Overview

A retrospective study compared four increased range of focus (IRoF) intraocular lenses (IOLs) in cataract patients, showing similar overall visual acuity outcomes but differences in patient satisfaction and dysphotopsia rates. The TECNIS PureSee lens demonstrated the highest proportion of very satisfied patients and the lowest failure rates related to spectacle dependence and visual disturbances.

Background

Traditional monofocal IOLs are being replaced by enhanced monofocal and presbyopia-correcting lenses in cataract surgery. Patients with mild ocular pathology or concerns about night vision symptoms are often recommended IRoF lenses, while others may receive full range of focus (FRoF) lenses. Understanding the real-world performance and patient satisfaction with different IRoF IOLs helps guide clinical decision-making and patient counseling.

Data Highlights

Key Findings

• All four IRoF IOLs provided excellent uncorrected binocular visual acuity of at least 0.1 LogMAR (20/25) at distance (400 cm) and intermediate (60 cm), and at least 0.2 LogMAR (20/32) at near (45 cm).
• The AT-Lara lens showed a slightly trifocal-like defocus curve, but overall differences among the lenses were minimal.
• High percentages of patients reported never needing spectacles for distance vision, with low spectacle use also at intermediate and near distances.
• Rates of never experiencing night vision disturbances (halos, light rings, starbursts) were highest with TECNIS PureSee (88%) and lowest with TECNIS Symfony and AT-Lara (72%).
• Patients implanted bilaterally with TECNIS PureSee were significantly more likely to be in the “Never-Never-Never-Never Club” (no glasses, no dysphotopsias) and less likely to be in the “Always-Always-Always-Always Gang” (always glasses, always symptoms) compared to other lenses (p<0.05).
• The study was retrospective and conducted in a real-world setting, limiting the level of evidence but providing practical insights for patient counseling.

Clinical Implications

Clinicians should consider IRoF IOLs as a safe and effective option for presbyopia correction in cataract patients, especially those with mild ocular pathology or concerns about night vision symptoms. Among IRoF lenses, TECNIS PureSee may offer superior patient satisfaction and lower rates of dysphotopsia, which can guide lens selection and preoperative counseling. Setting realistic expectations using binocular defocus curves and discussing potential visual phenomena remain essential.

Conclusion

Increased range of focus IOLs provide excellent visual outcomes and high patient satisfaction, with TECNIS PureSee demonstrating the best balance of spectacle independence and minimal dysphotopsia in this retrospective study. These findings support the use of IRoF lenses as a preferred option for presbyopia correction in cataract surgery.

Related Resources & Content

1. Author/Source/2024 -- Success and Failure Rates with Increased-Range-of-Focus IOLs