Visual Performance Comparison Between Enhanced Monofocal and Extended Depth of Focus Intraocular Lenses: A Systematic...

Area of Science:

• Ophthalmology and Visual Sciences
• Biomedical Engineering
• Clinical Research Methodology

Background:

• Cataract surgery commonly involves intraocular lens (IOL) implantation to restore vision.
• Enhanced monofocal and extended depth of focus (EDOF) IOLs are advanced options offering improved visual outcomes.
• Direct comparison of these IOL types is crucial for guiding clinical decisions and patient selection.

Purpose of the Study:

• To systematically review and compare visual outcomes of enhanced monofocal versus EDOF intraocular lenses (IOLs) following cataract surgery.
• To assess differences in distance, intermediate, and near visual acuities, as well as subjective visual disturbances like glare and halo.

Main Methods:

• Systematic literature search of MEDLINE, CENTRAL, clinicaltrials.gov, and ICTRP up to April 1, 2025.
• Inclusion of five studies (672 eyes) directly comparing enhanced monofocal (Tecnis Eyhance) with EDOF IOLs (Tecnis Symfony, Tecnis PureSee, Acrysof IQ Vivity).
• Risk of bias assessment using RoB 2 and JBI tools; random-effects meta-analysis for distance visual acuity.

Main Results:

• Meta-analysis revealed no significant clinical difference in uncorrected or corrected distance visual acuity between enhanced monofocal and EDOF IOLs.
• Individual study results for intermediate and near visual acuity, and subjective glare/halo perception were presented but not quantitatively synthesized due to heterogeneity.
• Quantitative synthesis for intermediate visual acuity was not feasible due to substantial heterogeneity (I² > 50%) across studies.

Conclusions:

• Enhanced monofocal and EDOF intraocular lenses provide comparable distance visual acuity outcomes after cataract surgery.
• Heterogeneity in EDOF designs and study types limits quantitative synthesis of intermediate/near vision and visual quality outcomes.
• Further research is warranted to clarify differences in visual performance beyond distance acuity, particularly for intermediate vision.