A comparison of visual and subjective outcomes between two extended depth of focus intraocular lenses, with emphasis on mesopic performance

Purpose: To evaluate outcomes after implantation of two extended depth of focus IOLs, with emphasis on performance in dim light. Setting: Two clinical practices in the USA Design: Prospective, double masked, randomized clinical trial Methods: Subjects were randomized to receive Symfony Optiblue or Vivity IOLs. Objective optical quality, aberrations, and simulated visual disturbances were measured before and 3 months after surgery. Binocular visual acuity (VA), the defocus curve and low contrast VA were measured under mesopic lighting conditions. Patient questionnaires were administered and undirected patient comments were recorded. Results: Thirty-one subjects in each group completed the study. Refractive outcomes were not significantly different. The Symfony lens provided about a half line better monocular mesopic VA at distance when uncorrected and best corrected (p < 0.05). There were no differences in binocular visual function between lenses except for the mesopic defocus curve at -1.00 D and -1.50 D, with the Symfony lens providing better VA at those vergences (p < 0.02). Objective optical measures improved after surgery, with improvements not different by group. There were no differences in the size or intensity of simulated glare, but simulated halos and starburst size and intensity were significantly worse with the Symfony lens (p < 0.05). Satisfaction with distance and intermediate vision in both groups was high. Reported visual disturbances were not significantly different between groups. Conclusions: The two lenses provided similar visual performance in dim light, with the Symfony lens showing slightly better VA, but with more reports of halos and starbursts.