Dissatisfaction after implantation of extended depth-of-focus intraocular lenses

Purpose: To evaluate the symptoms, etiology and treatment of patient dissatisfaction after extended depth-of-focus (EDOF) intraocular lens (IOL) implantation. Setting: University Eye Clinic, Maastricht University Medical Center, the Netherlands Design: Retrospective case series. Methods: For this study, all medical records of patients who received an EDOF IOL from July 2020 to July 2022 were reviewed. Patients were included if they had reported any dissatisfaction after surgery. The main outcome parameters were reasons for dissatisfaction (subjective complaints) and the presumed etiology of the complaints. Results: Out of 202 patients (354 eyes) who underwent EDOF IOL implantation, 83 eyes (22.8%) of 52 dissatisfied patients were included. Blurred vision was the predominant complaint, reported in 78 eyes (94%). Photic phenomena were reported in 21 eyes (25.3%), with 16 eyes (76.2%) experiencing coexisting blurred vision. The major etiologies for dissatisfaction in this cohort were residual ametropia (51.8%), dry eye disease (26.5%), and posterior capsular opacification (12.0%). Treatments were administered to 85.5% of the eyes, including interventions such as artificial tears, spectacles, or refractive surgery enhancement. A small number of patients (n=12; 5.9%) remained dissatisfied despite intervention. Conclusion: Based on this real-world data study, dissatisfaction following EDOF IOL implantation can be effectively identified and treated in most cases.