Extended depth-of-focus (EDOF) IOLs are an exciting new option for presbyopic patients.
Though these lenses tend to be more forgiving of residual refractive error and mild decentration than other presbyopia-correcting IOLs, it is still important to select patients carefully and follow good preoperative protocols to maximize the chance of a successful outcome.
Patient selection and counseling
When introducing EDOF lenses to the surgical regimen, I recommend selecting uncomplicated cases (e.g., no concomitant ocular disease or prior surgery) at first, with the aim of building confidence in the lens. Choose patients with bilateral cataracts so that you can give them the same optics in both eyes. Certainly, EDOF lenses can still be a good option for a patient with unilateral cataract or for a post-LASIK eye—but save those cases for later, if possible.
EDOF lenses provide a very functional range of vision for patients who still have active lives and want to be less dependent on spectacles for their daily activities. However, it is important not to mislead patients that their vision will be perfect.
I tell patients to expect they will still need glasses for some tasks, such as small print or prolonged reading.
I also talk about glare, halo, and starbursts. I explain that the incidence is lower and the symptoms seem to be less bothersome than with multifocal IOLs, but they may still experience some night-vision symptoms. Patients who seem like they will not be able to tolerate any night-vision symptoms at all might be better served with a monofocal IOL.
Early on, I implanted an EDOF lens (Symfony, Johnson & Johnson Vision) in a hyperopic attorney who I later realized would have benefited from a more in-depth preoperative conversation about the potential for starbursts while driving at night.
Ultimately, he was satisfied with his vision and did not want to give up the spectacle independence that he enjoyed, but it would have been easier on both of us if I had confirmed what he understood about the possibility of having night-time starbursts.