Patient Satisfaction, Visual Outcomes, and Regression Analysis in Post-LASIK Patients Implanted With Multifocal, EDOF, or Monofocal IOLs
Frank A. Bucci
Abstract
OBJECTIVE: To compare and contrast functional visual outcomes and levels of patient satisfaction in post-laser in situ keratomileusis (LASIK) cataract patients with multifocal, extended depth of focus (EDOF), or monofocal intraocular lens (IOLs). METHODS: Three cohorts of post-LASIK eyes with multifocal, EDOF, or monofocal IOLs were evaluated. Objective preoperative and postoperative clinical metrics, including higher-order aberration, contrast sensitivity, and visual acuities, plus subjective responses to a questionnaire about satisfaction, spectacle use, and ability to perform tasks were compared. Variables were regressed against "overall patient satisfaction" to identify predictors of satisfaction. RESULTS: Ninety-seven percent of patients were "very satisfied" or "satisfied." "Very satisfied" was significantly greater in multifocal (86.8%, 33 of 38) and EDOF (72.7%, 8 of 11) vs. monofocal (33.3%, 6 of 18) IOLs. However, EDOF IOLs outperformed monofocal IOLs for intermediate ( P =0.04). Contrast sensitivity was significantly worse at distance for multifocal vs. both EDOF ( P =0.05) and monofocal ( P =0.005) IOLs. Regression revealed that greater patient satisfaction in multifocal was explained by near visual function variables, including UNVA ( P =0.001) and UIVA ( P =0.04), reading acuity ( P =0.014), reading speed ( P =0.05), spectacle use at near ( P =0.0014), and ability to read moderate print ( P =0.002). CONCLUSIONS: Multifocals achieved high satisfaction levels in post-LASIK patients despite higher-order aberrations and lower contrast sensitivity scores; regression revealed that uncorrected near visual function variables explained high levels of satisfaction; dysphotopsias did not contribute significantly to scores for satisfaction; multifocal IOLs are a viable choice for cataract patients who have previously undergone LASIK.