Management of Patient Dissatisfaction After Presbyopia-Correcting Intraocular Lens Implantation

Purpose: To evaluate the success rate of different treatments for dissatisfaction after presbyopia-correcting intraocular lens (PrC-IOL) surgery and propose a management decision tree to maximize patient satisfaction. Methods: This was a retrospective evaluation of patients who were dissatisfied following PrC-IOL implantation. Evaluated outcomes included nature of visual complaints, treatment modalities employed for each type of complaint, and treatment success for each intervention. Results: There were 140 eyes of 93 patients evaluated. PrCIOLs included trifocal (PanOptix), diffractive extended depth of focus (EDOF), and non-diffractive EDOF IOLs. Main drivers of dissatisfaction were blurred corrected vision (67.1%) and photic phenomena (48.6%). Interventions leading to the highest rates of improvement were IOL exchange (94%) and laser vision correction (LVC) (72%), whereas Nd:YAG capsulotomy (18.3%), spectacle correction (15.1%), and dry eye treatment (5.2%) were less successful interventions. Among the eyes that underwent IOL exchange, the cohort with intact posterior capsules had more eyes with ≥1 lines of CDVA gained (83.3% vs 0%, P < .001) and fewer eyes with ≥1 lines of CDVA lost (8.3% vs 55.6%, P = .04). Conclusions: The most effective treatments for patient dissatisfaction after PrC-IOL implantation were IOL exchange followed by laser vision correction, whereas glasses, Nd:YAG capsulotomy, and dry eye treatment alone were not effective. Although successful outcomes can be achieved following IOL exchange in eyes with open posterior capsules, eyes with intact capsules had better outcomes. Therefore, Nd:YAG capsulotomy should be delayed in the setting of PrC-IOL dissatisfaction until all other potential causes for dissatisfaction have been eliminated.