Multivariate Regression Analysis Identifying Predictors of Patient Satisfaction with Multifocal IOLs: +4.00/+4.00 vs +3.25/+3.25 vs +3.25/EDOF

PURPOSE: To detect and compare the predictors of “overall patient satisfaction” with an EDOF/+3.25 versus +3.25/+3.25 versus +4.00/+4.00 diffractive multifocal IOLs. SETTING: Bucci Laser Vision Institute, Wilkes-Barre, PA, USA. DESIGN: Non-interventional, observational, retrospective-prospective. PATIENTS AND METHODS: A total of 55 (EDOF/+3.25) “best case patients” with 1) 4 months neuroadaptation 2) corrected residual refractive error 3) necessary YAGs performed and 4) aggressive ocular surface management underwent regression analysis to identify predictors of “overall patient satisfaction”. Satisfaction was regressed against 40 independent variables – 31 clinical metrics such as reading speed and acuity, angle kappa, aberrations, mesopic pupil size, residual spherical equivalent and astigmatism, near, intermediate vision at fixed and preferred focal distances, etc., and 9 responses from a questionnaire evaluating the performance of everyday tasks. Results were compared to two prior cohorts (67 bilateral +3.25 and 55 bilateral +4.00) with identical methods. RESULTS: Eighty percent (44/55) of the EDOF/+3.25 patients were “very satisfied” and 20% (11/55) were “satisfied” compared to 82% “very satisfied”/18% “satisfied” (+3.25/+3.25) and 64% “very satisfied”/36% “satisfied” (+4.00/+4.00). Subjective scores for near VA (p=0.02) were in favor of the +3.25/+3.25 (1.92/2.00) vs EDOF/3.25 (1.76/2.00). However, EDOF/+3.25 scores for intermediate VA (4.65/5.00 vs 4.32/5.00; p=0.02) and distance VA (4.76/5.00 vs 4.53/5.00; p=0.047) were significantly better than bilateral +3.25 and bilateral +4.00. In the bilateral +3.25 cohort, regression revealed that variables related to intermediate vision were responsible for outperforming the bilateral +4.00 cohort, and it also showed that smaller mesopic pupils (p=0.005) again predicted better intermediate vision as was observed in the bilateral +4.00 patients. CONCLUSION: The EDOF/+3.25 patients had equal patient satisfaction vs the bilateral +3.25, and greater satisfaction vs the bilateral +4.00 patients because of significantly better intermediate and distance vision, despite scoring less for near vision with fine print and no difference with moderate print. Regression predicted better intermediate vision with smaller mesopic pupils with the +3.25 and +4.00 IOLs.