A recent study published in BMC Ophthalmology investigated the efficacy of multiple varieties of intraocular lenses (IOLs) post-cataract surgery.
Give me some background first.
The current treatment norm for cataracts involves phacoemulsification combined with IOL implantation.
However, with a wide array of IOL options, selecting the correct lens for a patient may pose a challenge in the clinic.
Which brings us to …
Researchers here conducted a meta-analysis to comprehensively assess various high-quality IOLs, with a goal of establishing a reliable foundation for selection and enhancing patient care.
Now, talk about the study.
Investigators conducted a systematic search of past clinical trials by assessing data from 2018 to March 15, 2023, from the following databases:
This meta-analysis included a total of 28 randomized controlled trials (RCTs) that were composed of 2,465 participants.
What were the characteristics of past studies used?
Inclusion criteria of the RCT studies included:
- Participants over 40 who had cataract surgery in both eyes and the same IOL implanted in both eyes
- Control groups with standard monofocal IOLs and intervention groups with other various IOLs
- Primary outcome indicators of:
- Visual acuity (VA)
- Spectacle independence and optical quality
- Secondary outcome measures of contrast sensitivity (CS)
And the different IOL types?
The following IOL varieties were observed:
- Bifocal IOLs
- Trifocal IOLs
- AT LISAtri 839MP (Zeiss)
- FineVision POD F (BVI Medical)
- AcrySof IQ PanOptix (Alcon, Inc.)
- Other new trifocal IOLs
- Extended depth-of-focus (EDOF IOLs)
- Enhanced monofocal IOLs
Findings?
Statistical analysis was performed and interventions were ranked using Surface Under the Cumulative Ranking (SUCRA), which “ranks intervention efficacy based on cumulative probability, with higher values (closer to 1) signifying greater effectiveness.”
The investigators discovered that trifocal IOLs were significantly more effective than monofocal IOLs in uncorrected near VA (SUCRA 89.1%). They also had the best-corrected near visual acuity (BCVA) (SUCRA 81.2%).
Tell me more.
Based on the data, monofocal IOLs were found to provide better uncorrected-distant VA (UDVA) for patients (SUCRA 95.1%).
Go on…
The authors maintained that multifocal lenses, particularly the trifocal measures display enhancement of presbyopia treatment and spectacle independence. However, trifocal IOLs are associated with lower optical quality.
EDOF IOLs displayed comparable effectiveness in improving postoperative intermediate visual acuity, and lower CS than trifocals.
Limitations?
The study authors noted that the inclusion of various different studies may open the door to bias through possible discrepancies among RCTs.
They also reported that some of the studies had inconsistent definitions and relatively short follow-up times, which may have impacted the overall findings.
Expert opinion?
Per the authors of the study, “In pairwise comparison, all multifocal IOLs were more effective than monofocal IOLs in providing improved vision at intermediate and near distances.”
They added that the “findings underscore the advantages and potential of trifocal, EDOF, and enhanced monofocal IOLs in enhancing visual acuity for presbyopia-correcting cataract surgery.”
Anything else?
While the authors stated that the findings suggest trifocal lenses as the most effective, they also noted that neuroadaptation— the ability of the brain to adapt to changes in retinal image quality— with multifocal IOLs can be time consuming and difficult for patients.
Take home.
The study authors maintained that “more high-quality, large-sample, multicenter, randomized, double-blind trials are needed to confirm the reliability of the findings.”
They concluded: “The optimal treatment regimen should be determined on an individual patient basis, safety outcomes, and patient and caregiver decisions.”