Prevalence of Presbyopia-Correcting Intraocular Lens Satisfaction, Dissatisfaction, and Intolerance

To evaluate the prevalence of satisfaction, dissatisfaction, and intolerance after presbyopia-correcting intraocular lens (PrC-IOL) implantation, identify primary causes of dissatisfaction, and assess the rate of spontaneous resolution of photic phenomena in a clinical setting.

This was a retrospective cross-sectional study of consecutive patients who had PrC-IOL implantation, including bifocal (ReSTOR; Alcon Laboratories, Inc), trifocal (Pan-Optix; Alcon Laboratories, Inc), diffractive extended depth-of-focus (EDOF) (Symfony; Tecnis), and non-diffractive EDOF (Vivity; Alcon Laboratories, Inc), at the Cole Eye Institute, Cleveland Clinic between January 2017 and December 2022. Evaluated variables included refractive outcomes, patient-reported satisfaction/dissatisfaction or intolerance, primary drivers of dissatisfaction, management strategies, IOL exchange rates, and spontaneous resolution of photic phenomena over time.

A total of 493 patients (970 eyes) were evaluated. Overall, 87.2% reported satisfaction with their IOL outcomes, with 38% experiencing photic phenomena in the early follow-up. Dissatisfaction occurred in 12.8% of patients, with 7.7% of the total cohort reporting IOL intolerance. Blurry corrected vision (73%) and photic phenomena (50.8%) were the most common causes of dissatisfaction. Compared to satisfied patients, dissatisfied and intolerant patients had worse refractive outcomes and higher rates of photic phenomena. Among patients reporting photic phenomena at their initial stability visit and completing 1 year of follow-up, 43% experienced spontaneous resolution, most between 6 and 12 months. IOL exchange was performed in 2.4% of patients.

Most patients were satisfied with PrC-IOLs; however, in this analysis 12.8% reported dissatisfaction and 7.7% were intolerant to the lenses. Blurry corrected vision and photic phenomena were the leading causes of dissatisfaction. Spontaneous resolution of photic phenomena occurred in approximately one-third of cases but is less frequent among dissatisfied patients. IOL exchange may be necessary to alleviate symptoms.