Association of ocular comorbidities on long-term patient-reported outcome measures after multifocal intraocular lens implantation.

Abstract

OBJECTIVE To evaluate the association of ocular comorbidities on long-term patient-reported outcome measures (PROMs) in patients bilaterally implanted with diffractive multifocal intraocular lenses (MFIOLs). DESIGN Retrospective clinical cohort study. SUBJECTS A total of 260 patients who underwent bilateral implantation of MFIOLs with postoperative emmetropia and follow-up exceeding three years. METHODS Uncorrected visual acuities at near, intermediate and distance, contrast sensitivities, optical quality, spectacle-independent Visual Function Index (VF-14) questionnaire scores and dysphotopsia (graded 0-100 for glare, halos, and starburst) were measured. Ocular comorbidities included dry eye disease, prior corneal refractive surgery, vitreous opacities, macular disease, non-proliferative diabetic retinopathy, and glaucoma. MAIN OUTCOME MEASURES VF-14 scores at 3 years. RESULTS Eyes with comorbidities showed significantly worse uncorrected visual acuities at all distances (all P<0.001), lower Strehl ratio (0.034±0.023 vs. 0.042±0.027, P<0.001), and reduced contrast sensitivity under both photopic (1.33±0.21 vs. 1.40±0.18 area under the log contrast sensitivity function [AULCSF], P=0.001) and mesopic conditions (1.01±0.20 vs. 1.07±0.17 AULCSF, P<0.001) compared with eyes without comorbidities. VF-14 scores were significantly lower in eyes with comorbidities (87.1±13.8 vs. 95.6±5.1; P<0.001), with more glare reported (13.6±25.0 vs. 8.6±19.7; P=0.015). On multivariable analysis with age-, sex-, concomitant ocular comorbidities and MFIOL-type adjustment, dry eye disease, prior refractive surgery, vitreous opacities, and macular disease were independently associated with lower VF-14 scores (all P<0.001). Dry eye disease (B=18.0; 95%CI 8.4-27.6, P<0.001) and vitreous opacities (B=21.1; 95%CI 0.0-42.2, P=0.050) were associated with higher dysphotopsia overall scores. Increasing comorbidity burden, shorter tear-fluid break-up-time (r=0.207, P=0.005), and bilateral macular disease (P<0.001) were further associated with worse VF-14 scores. CONCLUSIONS Ocular comorbidities, particularly dry eye disease and vitreous opacities, which cause fluctuating visual disturbances, were associated with greater impairment in PROMs following diffractive MFIOL implantation.