Extended depth of focus (EDOF) intraocular lenses
narrative review
DOI:
https://doi.org/10.70313/2718.7446.v18.n3.447Keywords:
intraocular lenses, EDOF, intermediate visión, cataract surgery, presbyopiaAbstract
Extended depth-of-focus (EDOF) intraocular lenses represent a significant advancement in cataract surgery. Unlike traditional multifocal lenses, EDOF designs provide a continuous range of vision from distance to intermediate without generating multiple simultaneous foci, thus reducing dysphotopsias and maintaining contrast sensitivity. This narrative review explores the historical development of EDOF technology, its optical principles, classification based on underlying mechanisms, and its differentiation from enhanced monofocal lenses. Current clinical outcomes and comparative studies are summarized, along with specific surgical considerations and real-world perceptions from both patients and surgeons. A comparative table of currently available EDOF lenses is included. This review aims to offer ophthalmologists a concise yet comprehensive overview of EDOF technology to inform clinical decision-making in modern lens surgery.
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References
1. Ben Yaish S, Zlotnik A, Raveh I, Yehezkel O, Belkin M, Zalevsky Z. Intraocular omni-focal lens with increased tolerance to decentration and astigmatism. J Refract Surg 2010 ; 26(1): 71-76. doi: 10.3928/1081597X-20101215-12.
2. Gallego AA, Bará S, Jaroszewicz Z, Kolodzie- jczyk A. Visual strehl performance of IOL de- signs with extended depth of focus. Optom Vis Sci 2012; 89(12): 1702-1707. doi: 10.1097/OPX. 0b013e3182775e1a.
3. Kanclerz P, Toto F, Grzybowski A, Alio JL. Extended depth-of-field intraocular lenses: an update. Asia Pac J Ophthalmol (Phila) 2020; 9(3): 194-202. doi: 10.1097/APO.0000000000000296.
4. Rampat R, Gatinel D. Multifocal and exten- ded depth-of-focus intraocular lenses in 2020. Ophthalmology 2021; 128(11): e164-e185. doi: 10.1016/j.ophtha.2020.09.026.
5. Megiddo-Barnir E, Alió JL. Latest deve- lopment in extended depth-of-focus intrao- cular lenses: an update. Asia Pac J Ophthal- mol (Phila) 2023; 12(1): 58-79. doi: 10.1097/ APO.0000000000000590.
6. Nanavaty MA. Evolving generation of new extended depth of focus intraocular lenses. Eye (Lond) 2024; 38(Suppl 1): 1-3. doi: 10.1038/ s41433-024-03045-w.
7. Kohnen T, Berdahl JP, Hong X, Bala C. The novel optical design and clinical classification of a wavefront-shaping presbyopia-correcting in- traocular lens. Clin Ophthalmol 2023; 17: 2449-2457. doi: 10.2147/OPTH.S400083.
8. Komatsu K, Masuda Y, Tachibana S, Sano K, Iida M, Ichihara K, Oki T, Fukai K, Tatemichi M, Nakano T. Postoperative visual function of extended depth-of-focus intraocular lenses ver sus monofocal lenses. J Refract Surg 2024; 40(7): e499-e505. doi: 10.3928/1081597X-20240522-01.
9. Garzón N, Gómez-Pedrero JA, Alba- rrán-Diego C, Fernández-Núñez S, Villanueva Gómez-Chacón S, García-Montero M. Optical power profiles and aberrations of a non-diffrac- tive wavefront-shaping extended depth of focus intraocular lens. Graefes Arch Clin Exp Oph- thalmol 2024; 262(9): 2897-2906. doi: 10.1007/ s00417-024-06469-y.
10. Vega F, Garzón N, García-Montero M, Millán MS. Power profile and optical per- formance of two extended range-of-vision intraocular lens designs. J Cataract Refract Surg 2024; 50(10): 1065-1073. doi: 10.1097/j. jcrs.0000000000001528.
11. Lyu J, Bang SP, Yoon G. Refractive extended depth-of-focus lens design based on periodic power profile for presbyopia correction. Oph- thalmic Physiol Opt 2024; 44(2): 301-310. doi: 10.1111/opo.13253.
12. Alfonso-Bartolozzi B, Martínez-Alber- quilla I, Fernández-Vega-Cueto L, Cuéllar F, Vega F, Millán MS, Madrid-Costa D, Alfonso JF. Optical and visual outcomes of a new re- fractive extended depth of focus intraocular lens. J Refract Surg 2025; 41(4): e333-e341. doi: 10.3928/1081597X-20250221-02.
13. Fernández J, Rocha-de-Lossada C, Zamo- rano-Martín F, Rodríguez-Calvo-de-Mora M, Rodríguez-Vallejo M. Positioning of enhanced monofocal intraocular lenses between conven- tional monofocal and extended depth of focus lenses: a scoping review. BMC Ophthalmol 2023; 23(1): 101. doi: 10.1186/s12886-023-02844-1.
14. Ribeiro F, Dick HB, Kohnen T, Findl O, Nui- jts R, Cochener B, Fernández J. Evidence-based functional classification of simultaneous vision intraocular lenses: seeking a global consensus by the ESCRS Functional Vision Working Group. J Cataract Refract Surg 2024; 50(8): 794-798. doi: 10.1097/j.jcrs.0000000000001502.
15. Tavassoli S, Ziaei H, Yadegarfar ME, Gokul A, Kernohan A, Evans JR, Ziaei M. Trifocal versus extended depth of focus (EDOF) intrao- cular lenses after cataract extraction. Cochrane Database Syst Rev 2024; 7(7): CD014891. doi: 10.1002/14651858.CD014891.
16. Zeilinger J, Kronschläger M, Schlatter A, Georgiev S, Ruiss M, Pilwachs C, Findl O. Com- paring an advanced monofocal with a non-di- ffractive extended depth of focus intraocular lens using a mini-monovision approach. Am J Ophthalmol 2025; 271: 86-95. doi: 10.1016/j. ajo.2024.10.014.
17. Alió JL, Martínez-Abad A, Ruiz-Mesa R, Kim HM, Mendicute J, Ribeiro FJ, Holzer MP, Cantó-Cerdán M. Visual and patient reported outcomes provided by a refractive multifocal intraocular lens based on continuous transitio- nal focus. Eye Vis (Lond) 2024; 11(1): 41. doi: 10.1186/s40662-024-00408-y.
18. Zhong Y, Wang K, Yu X, Liu X, Yao K. Com- parison of trifocal or hybrid multifocal-exten- ded depth of focus intraocular lenses: a syste- matic review and meta-analysis. Sci Rep 2021; 11(1): 6699. doi: 10.1038/s41598-021-86222-1.
19. Karam M, Alkhowaiter N, Alkhabbaz A, Aldubaikhi A, Alsaif A, Shareef E, Alazaz R, Alotaibi A, Koaik M, Jabbour S. extended depth of focus versus trifocal for intraocular lens im- plantation: an updated systematic review and meta-analysis. Am J Ophthalmol 2023; 251:52-
70. doi: 10.1016/j.ajo.2023.01.024.
20. Li J, Sun B, Zhang Y, Hao Y, Wang Z, Liu C, Jiang S. Comparative efficacy and safety of all kinds of intraocular lenses in presbyopia-co- rrecting cataract surgery: a systematic review and meta-analysis. BMC Ophthalmol 2024; 24(1): 172. doi: 10.1186/s12886-024-03446-1.
21. Pedrotti E, Chierego C, Talli PM, Selvi F, Galzignato A, Neri E, Barosco G, Montresor A, Rodella A, Marchini G. Extended depth of focus versus monofocal IOLs: objective and subjective visual outcomes. J Refract Surg 2020; 36(4): 214-222. doi: 10.3928/1081597X-20200212-01.
22. Cochener B, Boutillier G, Lamard M, Au- berger-Zagnoli C. A comparative evaluation of a new generation of diffractive trifocal and extended depth of focus intraocular len- ses. J Refract Surg 2018; 34(8): 507-514. doi: 10.3928/1081597X-20180530-02.
23. Zhang Y, Zhang J, Liang C, Xu Y, Wu J, Wu J, Zhang Y, Jin A, Tan X, Luo L. Effect of crystalline lens decentration and tilt on visual performance in eyes implanted with bifocal or extended depth of focus intraocular lenses. BMC Ophthalmol 2025; 25(1): 58. doi: 10.1186/ s12886-025-03884-5.
24. Pantanelli SM, O’Rourke T, Bolognia O, Scru- ggs K, Longenecker A, Lehman E. Vision and patient-reported outcomes with nondiffractive EDOF or neutral aspheric monofocal intraocu- lar lenses. J Cataract Refract Surg 2023; 49(4): 360-366. doi: 10.1097/j.jcrs.0000000000001123.
25. Waring GO 4th, van den Berg AB, van den Berg RM, Rocha KM. Prospective evaluation of clinical andpatient-reportedoutcomes following contralateral implantation of an extended depth of focus (EDOF) and hybrid EDOF-multifocal IOL. J Refract Surg 2024; 40(10): e699-e705. doi: 10.3928/1081597X-20240805-02.
26. Zhu D, Dhariwal M, Zhang J, Smith A, Mar- tin P. Patient perception and self-reported out- comes with presbyopia-correcting intraocular lenses (PCIOLs): a social media listening study. Ophthalmol Ther 2024; 13(1): 287-303. doi: 10.1007/s40123-023-00840-8.
27. Yeu E, Cuozzo S. Matching the patient to the intraocular lens: preoperative considerations to optimize surgical outcomes. Ophthalmology 2021; 128(11): e132-e141. doi: 10.1016/j.oph- tha.2020.08.025.
28. Wanten JC, Bauer NJC, Berendschot TTJM, van den Biggelaar FJHM, Nuijts RMMA. Dis- satisfaction after implantation of EDOF intrao- cular lenses. J Cataract Refract Surg 2025; 51(5): 399-405. doi: 10.1097/j.jcrs.0000000000001615.
29. Alió JL, Radner W, Plaza-Puche AB, Ortiz D, Neipp MC, Quiles MJ, Rodríguez-Marín J. Design of short Spanish sentences for measu- ring reading performance: Radner-Vissum test. J Cataract Refract Surg 2008; 34(4): 638-642. doi: 10.1016/j.jcrs.2007.11.046.
30. Torres RM, River J, Daponte P. Cartillas de lectura en escala logarítmica: ¿por qué el test de Jaeger es obsoleto en el presente? Of- talmol Clin Exp 2023; 16(4): e320-e331. doi: 10.70313/2718.7446.v16.n04.255
31. Torres RM, Botta MJ, Rivero JS et al. Which is our true nearvision? It depends on how and with what instrument we measure it: relevance of logarithmic reading charts. Invest Ophthal- mol Vis Sci 2025; 66(8): 5044. Disponible en: https://iovs.arvojournals.org/article.aspx?articleid=2804283
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