Association of Ocular Comorbidities on Long-term Patient-Reported Outcome Measures After Multifocal Intraocular Lens Implantation.

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 3 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, nonproliferative 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 < .001), lower Strehl ratio (0.034±0.023 vs 0.042±0.027, P < .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 = .001) and mesopic conditions (1.01±0.20 vs 1.07±0.17 AULCSF, P < .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 < .001), with more glare reported (13.6±25.0 vs 8.6±19.7; P = .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 < .001). Dry eye disease (B = 18.0, 95% CI 8.4-27.6, P < .001) and vitreous opacities (B = 21.1, 95% CI 0.0-42.2, P = .050) were associated with higher dysphotopsia overall scores. Increasing comorbidity burden, shorter tear film break-up time (r = 0.207, P = .005), and bilateral macular disease (P < .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.