Comparison of binocular visual quality in six treatment protocols for bilateral cataract surgery with presbyopia correction: a prospective two-center single-blinded cohort study

Ann Med. 2023;55(2):2258894. doi: 10.1080/07853890.2023.2258894. Epub 2023 Sep 21.

Abstract

Objective: To compare the postoperative binocular visual quality in six treatment protocols for bilateral age-related cataract surgery with presbyopia correction for clinical decisions.

Materials and methods: In this prospective two-center single-blinded cohort study, participants from North or South China who underwent bilateral phacoemulsification and intraocular lens implantation were divided into six protocols: monovision, diffractive bifocal, mixed, refractive bifocal, trifocal, and micro-monovision extended range of vision (EROV). Binocular visual quality was evaluated at 3 months postoperatively, including binocular uncorrected full-range visual acuity, binocular defocus curves (depth of focus [DoF] and area under the curve [AUC]), binocular visual function (fusion function and stereopsis), binocular subjective spectacle independence rates, visual analog scale (VAS) of overall satisfaction, 25-item visual function questionnaire (VFQ-25), and binocular dysphotopsia symptoms.

Results: Of the 300 enrolled patients, 272 (90.7%; 544 eyes) were analyzed. The trifocal protocol showed excellent binocular full-range visual acuity and the best performance for most DoFs and AUCs. The monovision protocol presented the worst binocular visual quality in most perspectives, especially in convergence, distance, and near stereopsis (p < 0.001). The full-range subjective spectacle independence rates were sorted from highest to lowest as follows: trifocal (84.8%), refractive bifocal (80.9%), EROV (80.0%), mixed (73.3%), diffractive bifocal (65.2%), and monovision (32.6%) protocols, with no statistically significant differences between the former five protocols (p > 0.05). The EROV protocol achieved the highest VAS and VFQ-25 scores. The incidence of postoperative binocular dysphotopsia symptoms was comparable in all protocols.

Conclusions: The trifocal protocol showed the best performance, and the monovision protocol presented the worst performance in most perspectives of binocular visual quality for presbyopia correction. The refractive bifocal, mixed, or EROV protocols can provide an approximate performance as a trifocal protocol. Ophthalmologists can customize therapies using different protocols.

Keywords: Presbyopia correction; binocular visual quality; depth of focus; refractive cataract surgery; the area under the curve.

Publication types

  • Clinical Trial Protocol
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cataract* / complications
  • Clinical Protocols
  • Cohort Studies
  • Humans
  • Presbyopia* / surgery
  • Prospective Studies
  • Randomized Controlled Trials as Topic

Grants and funding

This study was supported by the Guangxi Medical Health Appropriate Technology Development and Application Project [S2020077], Science and Technology Plan Project of Qingxiu District in Nanning City [2020036], Natural Science Foundation of Guangxi Province [2021GXNSFBA075051], Guangxi Clinical Ophthalmic Research Center [AD19245193], National Natural Science Foundation of China [82171022, 81974128], and Capital Health Research and Development of Special Fund [2020-2-4097]. The funders had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation.