The relationship between patient satisfaction and visual and optical outcome after bilateral implantation of an extended depth of focus multifocal intraocular lens

Purpose:To evaluate patient satisfaction after implantation of the Tecnis Symfony multifocal intraocular lens(MIOL).Methods:120 eyes of 60 subjects with senile cataract were bilaterally implanted with the Tecnis Symfony IOL.Follow-up examination was performed 6 months postoperatively.Main outcome measures included uncorrected and corrected distance and near visual acuity,manifest refraction,and visual quality metrics.According to their subjective symptoms patient were divided in two groups:satisfied and unsatisfied.Results:Uncorrected intermediate(0.15±0.11 vs 0.18±0.01,P=0.04)and near(0.26±0.12 vs 0.31±0.11,P=0.04)(UIVA,UNVA)log MAR visual acuity was significantly better,cylindrical error less(0.31±0.36 vs 0.67±0.29,P=0.05),axial length(AL)smaller(23.68±1.3 vs 24.22±1.6,P=0.05),Strehl ratio higher(0.08±0.08 vs 0.05±0.04,P=0.03)and mesopic pupil larger(4.3±1.1 vs 3.7±1.05,P=0.01)among satisfied patients.Residual cylinder,Strehl ratio,halos,mesopic pupil diameter and UNVA were significant predictors of patient satisfaction.Uncorrected distance visual acuity,higher order Strehl ratio and pupil diameter were significant predictors of halos.Near visual acuity significantly correlated(P=0.018,R=0.22)with axial length.Conclusions:Uncorrected cylindrical error,poor reading quality,larger pupil and halos seem to be the most disturbing factors for patients implanted with the Tecnis Symfony IOL.