A survey of intraocular lens preferences of UK refractive surgeons for cataract surgery and refractive lens exchange

To explore intraocular lens (IOL) preferences of United Kingdom-based (UK) refractive surgeons in cataract and refractive lens exchange (RLE) surgery.

An online survey on IOL preferences (and reasons for their choice) in cataract and RLE surgery was distributed. It also enquired about implementing mini-monovision with extended depth of field (EDoF) IOLs, about utilising IOL mix-and-match (different IOL types in each eye), and at what level of corneal astigmatism they prefer toric lenses.

Following an 81.6% response rate, thirty responses were analysed; median years of refractive surgery experience was 12.5. The most popular IOL choices for cataract surgery were EDoF lenses (30%), monofocals (20%), and trifocals (20%). The most cited reason for each was better overall visual outcomes (88.9%), fewer unwanted symptoms (66.7%) and best spectacle independence (66.7%), respectively.

For RLE, EDoF remained most popular (36.7%), followed by trifocals (30%), and multifocals (16.7%) with the same reasons for choice cited above.

Mini-monovision with EDoF lenses was well-regarded (83% recommend for most/select patients), unlike utilising IOL mix-and-match (60% did not recommend). 40% prefer toric IOLs for astigmatism of 1 dioptre (D) or higher, whilst 30% opt for them at < 1D.

Experienced UK refractive surgeons prefer newer IOLs with enhanced optics; ≥50% of respondents favoured either EDoF or trifocals for a ‘typical’ cataract or RLE patient. Notably, respondents have a low corneal astigmatism threshold for toric lenses. Mini-monovision with EDoF IOLs was well-regarded, whilst mix-and-match of different IOL types was less recommended.