Inducing cylindrical and spherical defocus after implantation with new generation intraocular lenses improves intermediate and near visual acuity

An induced cylinder and spherical power after implantation with an extended depth of focus (EDOF) and enhanced monofocal intraocular lens (IOL) could improve distance, intermediate (60 cm) and near (40 cm) visual acuity (VA). In this prospective study, forty eyes with Eyhance EDOF IOL (Johnson and Johnson, USA) and 40 eyes with Vivity EDOF IOL (Alcon Laboratories Inc. USA) were included. Induced cylinder (applied to non-dominant eye) in steps of + 0.25D were used and then VA was measured monocularly (only non-dominant eye). Similarly, induced sphere (applied to non-dominant eye) in steps of + 0.25D were used and then VA was measured monocularly (only non-dominant eye). The above methods were repeated for the dominant eye as well. Then, binocular defocus curve for each patient was obtained by inducing optimal sphere and cylinder (one at a time in front of the non-dominant eye only). In both IOL groups, induced cylinder and sphere independently led to significant improvement in near and distance vision (p < 0.05). Induced sphere binocularly caused a greater decrease (~ 0.1 LogMAR) in distance VA compared to induced cylinder but this was not clinically significant. Most patients accepted an induced cylinder of +1.0 to +1.5D in both IOL groups. Induced cylinder and sphere caused a favourable improvement in near and intermediate VA after surgery in both IOL groups without a significant drop in distance VA.