Toric Aberrometric Extended Depth of Focus Intraocular Lens: Visual Outcomes, Rotational Stability, Patients' Satisfaction, and Spectacle Independence.

Abstract

Objective: To evaluate visual outcomes, rotational stability, patients' satisfaction, and spectacle independence after bilateral Toric extended depth of focus intraocular lens (EDOF IOL) implantation. Methods: Prospective observational study including cataract patients with bilateral corneal astigmatism between 0.75 and 3.00 D implanted with Toric EDOF IOLs. After three months distance corrected and uncorrected visual acuity at 4 m (DCVA and UDVA), 80 cm (DCI80VA and UI80VA), 67 cm (DCI67VA and UI67VA), and 40 cm (DCNVA and UNVA), IOL stability by Toric IOL Assistant tool (Osiris T, CSO, Florence, Italy), binocular defocus curves, contrast sensitivity (CS), halometry, reading performance, and subjective and objective (Root mean square-RMS, modulation transfer function-MTF, cut-off and point-spread-function-PSF-Strehl ratio) visual quality were evaluated. Results: Forty eyes from 20 astigmatic patients were enrolled. Mean refractive spherical equivalent and residual cylinder were -0.21 ± 0.74 D and 0.29 ± 0.31 D, respectively. No patients needed additional surgery due to IOL rotation. Binocular UDVA, UI80VA, UI67VA, and UNVA ≤ 0.2 logMAR was found in 90%, 95%, 85%, and 80%. Distance-corrected visual outcomes have overall shown higher performances. All visual acuities at defocus curves were ≤0.125 logMAR between +0.50 D and -2.00 D. PSF-Strehl ratio, MTF cut-off, RMS were 0.26 ± 0.28, 19.82 ± 12.35, 0.31 ± 0.17. Reading analysis reached 125.42 ± 27.21 words/minute, 92.56 ± 7.82, 0.17 ± 0.15 logMAR and 0.50 ± 0.11 logRAD for mean reading speed, visual acuity score, reading acuity, and critical print size, respectively. CS was higher in photopic conditions. Subjective spectacle independence was achieved in 80% of patients. Conclusions: Toric EDOF IOL showed rotational stability and reliable astigmatic correction. It provided spectacle independence and good performance from distance to near distance, reaching high patient satisfaction without undermining binocular quality of vision.