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. 2025 Jun 13:12:1505401.
doi: 10.3389/fmed.2025.1505401. eCollection 2025.

Visual outcomes with a non-diffractive enhanced depth-of-focus IOL in patients with age-related macular degeneration

Affiliations

Visual outcomes with a non-diffractive enhanced depth-of-focus IOL in patients with age-related macular degeneration

Juan Carlos Elvira et al. Front Med (Lausanne). .

Abstract

Purpose: To evaluate visual function in eyes with age-related macular degeneration (AMD) implanted with a non-diffractive enhanced depth-of-focus (EDOF) intraocular lens (IOL) after cataract surgery.

Design: Prospective, observational, non-randomized clinical study.

Methods: Twenty-two eyes from 22 patients diagnosed with AMD and cataracts were submitted to standard cataract surgery with a non-diffractive EDOF IOL implantation (AcrySof IQ Vivity). We measured monocular uncorrected and best-corrected-distance visual acuity (UDVA and CDVA), uncorrected- and distance-corrected-intermediate visual acuity (UIVA and DCIVA), uncorrected- and distance-corrected-near visual acuity (UNVA and DCNVA), manifest refractive spherical equivalent (MRSE) and cylinder, monocular defocus curve and patient-reported outcome questionnaires (Catquest-9SF and NEI VFQ-25). Follow-up visits were carried out at 1, 3 and 6 months post-surgery.

Results: At 6 months post-surgery all eyes were within ± 0.50 D with a mean MRSE of -0.19 ± 0.20 D, 95.45% had a refractive cylinder of ≤ 0.50 D with a mean cylinder of -0.24 ± 0.27 D. The mean values of postoperative monocular CDVA, DCIVA, and DCNVA were 0.02 ± 0.08, 0.16 ± 0.11, and 0.26 ± 0.15 logMAR, respectively. The defocus curve showed good visual acuity at distance and intermediate with a depth-of-focus of about 1.60 D. A total of 81.82% of patients did not report any difficulty with their vision in their everyday-life and 86.36% reported being quite satisfied to very satisfied with their current vision. The NEI VFQ-25 showed that all values improved significantly (p < 0.05) after the surgery in the different parameters analyzed except for ocular pain (p = 0.390) and color vision (p = 0.333).

Conclusion: The use of a non-diffractive EDOF IOL in AMD eyes with cataracts is a safe and effective surgical approach for visually correcting aphakia, providing good visual acuity at far and intermediate distances. Our outcomes support the use of non-diffractive EDOF IOLs in patients with AMD diagnosed with cataracts aiming to obtain spectacle-independence at far and intermediate distances.

Keywords: age-related macular degeneration; cataracts; enhanced depth-of-focus; intraocular lens; patient satisfaction.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Distribution of spherical equivalent refraction (A) and refractive cylinder (B) 6 months post-surgery, and double-angle plots for preoperative corneal astigmatism (C) and postoperative refractive astigmatism (D) 6 months post-surgery applying the double-angle tool. Centroids, mean absolute values with standard deviations, and 95% confidence ellipses of the centroid and dataset are also shown.
FIGURE 2
FIGURE 2
Cumulative percentage of eyes at 6 months post-surgery with different degrees of uncorrected and best-corrected distance visual acuity (UDVA and CDVA) (A), and uncorrected and distance-corrected intermediate visual acuity at 66 cm (UIVA and DCIVA) and uncorrected and distance-corrected near visual acuity at 40 cm (UNVA and DCNVA) (B).
FIGURE 3
FIGURE 3
Mean monocular logMAR visual acuity with best correction for distance based on the vergence chart for AcrySof IQ Vivity) intraocular lens (IOL) at 6 months post-surgery. The error bars show the standard deviation. The right y-axis shows the Snellen visual acuity in feet and the top x-axis is the distance (cm). Depth-of-focus was defined as the range of lens powers that achieved a mean acuity of 20/32 or better (from 0 D of vergence).
FIGURE 4
FIGURE 4
Distribution of the answers (percentage) for the different questions in the Catquest-9SF questionnaire before and after the surgery.
FIGURE 5
FIGURE 5
Mean and standard deviation NEI VFQ-25 score (percentage) for different vision-targeted sub-scales and a single general health rating question before and after the surgery. Note that the scores represent the achieved percentage of the total possible score, with 100% being the best and 0% the worst possible score. The Student’s t-test was conducted to evaluate the significance of the differences between before and after the surgery. The asterisk * indicates a statistically significant difference (p < 0.05).

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