Risk factors in self-reported dissatisfied patients implanted with various presbyopia-correcting intraocular lenses after cataract surgery

Abstract

BackgroundThis study aimed to investigate the self-reported dissatisfaction rates and associated risk factors among patients who underwent cataract surgery using different types of presbyopia-correcting intraocular lenses (IOLs).MethodsThis retrospective case-control study analyzed the medical records in 340 eyes from 211 cataract surgery patients with presbyopia-correcting IOLs. The analyzed IOL types included bifocal (ReSTOR (R)), trifocal (PanOptix (R)), and extended depth-of-focus (EDOF; Symfony (R)) IOLs. The rates of self-reported dissatisfaction related to vision or photic disturbances were compared between these IOLs. Various factors, including sex, age, preoperative visual acuity and refractive status, and biometric indices, were analyzed to identify potential risk factors for dissatisfaction.ResultsThe overall dissatisfaction rate was 18.5% (63/340). Among the IOL types, Symfony (R)-implanted eyes had the highest rate of near-vision dissatisfaction, while PanOptix (R)-implanted eyes showed similar proportions of photic disturbances and near-vision discomfort. The major risk factor identified for overall dissatisfaction, regardless of IOL type, was preoperative myopia, which aligns with the risk factor for near discomfort. Meanwhile, the risk factors for photic phenomena were revealed to be thinner corneal thickness and greater corneal astigmatism. By IOL types, preoperative myopia caused near-vision discomfort in Symfony (R) eyes, whereas greater corneal astigmatism and thinner corneas were linked to photic disturbances in PanOptix (R) eyes.ConclusionsIt suggests that near-vision discomfort is related to myopic factors, whereas photic disturbances are associated with ocular aberrations. The types of dissatisfaction vary depending on the designs of presbyopia-correcting IOLs.Trial RegistrationThis retrospective study adhered to the principles of the Declaration of Helsinki and was approved by the Institutional Review Board of the Seoul National University Hospital on March 13, 2023 (IRB No: 2303-025-1409).