Comparing postoperative reading performance and visual outcomes of a non-diffractive EDOF-IOL versus a monofocal IOL: a randomized controlled eye movement study.

BACKGROUND: To compare oculomotor behavior and reading performance along with conventional visual outcomes in patients following implantation of an enhanced depth of focus (EDOF) intraocular lens (IOL) versus a monofocal IOL. METHODS: In this prospective, exploratory, randomized, clinical trial patients underwent either bilateral implantation with a non-diffractive EDOF IOL DFT015 (Acrysof IQ Vivity, Alcon, USA) or an aspheric monofocal IOL SN60WF (Acrysof IQ, Alcon, USA). 106 eyes of 53 patients with bilateral age-related cataract were evaluated (EDOF IOL group: n = 25; Monofocal IOL group n = 28). At 3 months after surgery, along with visual acuity at various distances, halometry, and patient-reported quality of vision, silent reading performance and oculomotor behavior were assessed at 66 cm with an infrared eye tracker under photopic and mesopic light levels. Data analysis included computation of reading speed and a range of oculomotor indices. RESULTS: Median mesopic silent reading speed in words per minute (wpm) and fixation duration in milliseconds (ms) were 205 wpm and 277 ms for the EDOF group and 168 wpm (p = 0.04) and 301 ms (p = 0.02) for the monofocal control IOL group, respectively. No significant differences were observed under photopic conditions. Binocular means expressed in logarithm of the minimum angle of resolution for postoperative corrected distance, uncorrected distance, uncorrected intermediate, and uncorrected near visual acuities were - 0.04 ± 0.07, 0.00 ± 0.07, 0.12 ± 0.09, and 0.27 ± 0.13 for the EDOF group and - 0.08 ± 0.06 (p = 0.08), -0.04 ± 0.07 (p = 0.10), 0.19 ± 0.13 (p = 0.01), and 0.41 ± 0.14 (p = < 0.001) for the control group, respectively. Postoperative halo size and visual disturbances were similar in both groups. CONCLUSIONS: Silent reading speed at 66 cm distance is found improved with EDOF compared to monofocal IOLs only at mesopic light levels, mainly due to the improvement in average fixation duration. Further studies are needed to confirm these preliminary findings. TRIAL REGISTRATION: Jan 4, 2022: NCT05194657 ( https://clinicaltrials.gov/study/NCT05194657 ).