Association of Ocular Comorbidities on Long-term Patient-Reported Outcome Measures After Multifocal Intraocular Lens Implantation.

OBJECTIVE

To evaluate the association of ocular comorbidities on long-term patient-reported outcome measures (PROMs) in patients bilaterally implanted with diffractive multifocal intraocular lenses (MFIOLs).

DESIGN

Retrospective clinical cohort study.

SUBJECTS

A total of 260 patients who underwent bilateral implantation of MFIOLs with postoperative emmetropia and follow-up exceeding 3 years.

METHODS

Uncorrected visual acuities at near, intermediate and distance, contrast sensitivities, optical quality, spectacle-independent Visual Function Index (VF-14) questionnaire scores and dysphotopsia (graded 0-100 for glare, halos, and starburst) were measured. Ocular comorbidities included dry eye disease, prior corneal refractive surgery, vitreous opacities, macular disease, nonproliferative diabetic retinopathy, and glaucoma.

MAIN OUTCOME MEASURES

VF-14 scores at 3 years.

RESULTS

Eyes with comorbidities showed significantly worse uncorrected visual acuities at all distances (all P < .001), lower Strehl ratio (0.034±0.023 vs 0.042±0.027, P < .001), and reduced contrast sensitivity under both photopic (1.33±0.21 vs 1.40±0.18 area under the log contrast sensitivity function [AULCSF], P = .001) and mesopic conditions (1.01±0.20 vs 1.07±0.17 AULCSF, P < .001) compared with eyes without comorbidities. VF-14 scores were significantly lower in eyes with comorbidities (87.1±13.8 vs 95.6±5.1; P < .001), with more glare reported (13.6±25.0 vs 8.6±19.7; P = .015). On multivariable analysis with age, sex, concomitant ocular comorbidities, and MFIOL type adjustment, dry eye disease, prior refractive surgery, vitreous opacities, and macular disease were independently associated with lower VF-14 scores (all P < .001). Dry eye disease (B = 18.0, 95% CI 8.4-27.6, P < .001) and vitreous opacities (B = 21.1, 95% CI 0.0-42.2, P = .050) were associated with higher dysphotopsia overall scores. Increasing comorbidity burden, shorter tear film break-up time (r = 0.207, P = .005), and bilateral macular disease (P < .001) were further associated with worse VF-14 scores.

CONCLUSIONS

Ocular comorbidities, particularly dry eye disease and vitreous opacities, which cause fluctuating visual disturbances, were associated with greater impairment in PROMs following diffractive MFIOL implantation.