Patient Satisfaction, Visual Outcomes, and Regression Analysis in Post-LASIK Patients Implanted With Multifocal, EDOF, or Monofocal IOLs

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.