Sensorimotor Disturbances After Extended Depth of Focus Intraocular Lens Implantation

Cataracts are the leading cause of reversible blindness in the world. Their prevalence is expected to dramatically increase with the anticipated global population growth by 2050, consequently increasing the need for cataract surgery. As cataract surgery evolves, novel types of intraocular lenses (IOLs) are also emerging. Extended depth of focus (EDOF) lenses are a recently introduced lens technology that was approved for commercial use in 2016. The lens optics create a focal zone with an overlap for near and far images, enabling an enhanced depth of focus for intermediate vision with little impact on distance vision. Reports of sensorimotor decompensation, such as ocular misalignment and diplopia, following cataract surgery have been described in the literature, particularly in patients with a history of strabismus or diplopia. However, there is very limited literature to determine if newer multifocal IOLs, such as EDOF lenses, carry the same risk of sensorimotor decompensation. The purpose of this report is to describe two cases with sensorimotor disturbances after uncomplicated bilateral EDOF IOL implantation, the first being decompensation of stereopsis in a patient with previously well-controlled accommodative esotropia, and the second involving the development of vertical diplopia post-operatively.