Comparative evaluation of the clinical performance of conventional and extended depth of focus monofocal intraocular lenses (systematic review)

A systematic review was performed in PubMed using the following keywords “monofocal IOLs”, “monofocal IOLs with extended depth of focus (sharpness)”, “EDOF”, “cataract phacoemulsification”, “visual acuity”, and “quality of life”. Studies were selected in accordance with the criteria for prospective or retrospective studies. In a comparative analysis of clinical efficacy, the results of binocular IOL implantation and lens material from the same manufacturer were analyzed as the main sources. In total, 234 studies were analyzed using systematic review filters and authors’ knowledge of the topic. The duration of the retrospective analysis was 8 years (2017–2023). A total of 234 papers were analyzed over the last 8 years (2017–2023), further using systematic review filters and the authors’ knowledge of the topic.

Data obtained indicated that traditional monofocal IOLs acted like bifocal lenses because they formed two main focal points for far and near vision, which did not provide the required level of visual acuity at an intermediate distance. The basic optical principle of EDOF (extended depth of focus) was to create a focal point for distance vision and an elongated focal point to increase the depth of field near and at intermediate distances. The results of the literature analysis indicated that the use of EDOF (compared with monofocal IOL) was associated with a higher level of visual acuity at intermediate and near distances and comparable distance visual acuity and increased depth of field, which generally provides a more natural range of vision and less use of glasses. Light phenomena, spectacle independence, and patient satisfaction were comparable among EDOF types.

Given the above advantages, EDOF implantation can be considered a variant of an individual approach to the selection of IOLs, taking into account the possibility of using it in patients whose professional activity is associated with long-term visual work at intermediate distances (e.g., users of personal computers). In the context of the role and place of EDOF in the general system of aphakia correction following cataract phacoemulsification, further accumulation of clinical material is necessary, taking into account the IOL model and patient’s professional visual activity level.