Cataract surgery has evolved into a procedure that generally yields the best postoperative refractive result attainable. Patients with multifocal intraocular lenses (IOLs) present higher rates of spectacle independence, although reduced intermediate vision, dysphotopsias, and a loss of image quality might also be experienced. The aim of the study was to review the methods for assessing quality of life and vision in patients undergoing lens refractive surgery in randomized controlled trials.
We reviewed the PubMed web platform to identify relevant studies using the following keywords: quality of life, quality of vision, lens surgery, lens exchange, refractive lens exchange, cataract, cataract surgery, intraocular lens, IOL, multifocal, and monovision.
An increasing number of studies have focused on patient-reported outcomes (PROs). Only a few of the available visual function questionnaires can be regarded as useful in lens refractive surgery with multifocal IOL implantation. Many self-developed questionnaires have emerged that have not been adequately validated or found to feature properly evaluated repeatability, hampering the possibility of comparing outcomes.
This review describes the existing PROs instruments and informs the choice of an appropriate measure in lens refractive surgery. Rasch-developed tools should be utilized for measuring quality of life and vision in patients undergoing lens refractive surgery and there is a number of highly robust tools available.
Cataract surgery has evolved from being primarily considered a method for opaque lens removal to a procedure capable of yielding high-quality postoperative refractive result. As the incidence of complications has significantly decreased, the use of lens removal as a refractive procedure has emerged. Small-incision techniques have led to minimizing surgically induced astigmatism, while toric intraocular lenses (IOLs) are available for management of higher grades of astigmatism. In order to accurately evaluate the outcomes of presbyopia-correcting IOLs, several measurements must be considered. Objective measures include uncorrected binocular acuity under multiple conditions and distances, residual refractive error, contrast sensitivity, glare disability, straylight levels, and halometry. Notably, two individuals may have the same objective visual function but perceive their quality of vision (QoV) differently. Thus, subjective measures should also be employed in order to assess patient-reported outcomes (PROs). These are numerous questionnaires evaluating spectacle independence, visual function across a range of distances and circumstances, and overall satisfaction with vision including preoperative expectations.
The aim of this study was to review the methods for assessing quality of life (QoL) and vision in patients undergoing lens refractive surgery based on the currently available literature.
PubMed and Medline were the main resources reviewed for medical literature, with an extensive search performed in order to identify relevant articles concerning QoL and vision in patients undergoing lens refractive surgery up to October 31, 2018. The following keywords were used in various combinations: quality of life, quality of vision, lens surgery, lens exchange, refractive lens exchange, cataract, cataract surgery, intraocular lens, IOL, multifocal, and monovision. The search identified 243 unique articles, but only articles written in the English language articles were ultimately selected. Randomized controlled trials (RCTs) analyzing PROs in people undergoing cataract surgery or refractive lens exchange and who received a multifocal intraocular lens were included. If a study on multifocal IOLs assessed PROs, but was not a RCT, the applied method was also investigated. Studies describing PROs instruments used in other conditions such as keratoconus or corneal refractive surgery were excluded. Other articles cited in the reference lists of identified publications were additionally considered as a potential source of information. No attempts to discover unpublished data were made.
Methods for evaluating QoL and vision
Vision impairment has a considerable impact on the length of life  and QoL . A long tradition in ophthalmology with respect to using objective psychophysical measures to evaluate outcomes has served the field well. With the current level of perfection objective measures possibly no longer be considered sufficient, more studies are focusing increasingly on PRO. The visual function questionnaires employed in current studies are presented in Table 1.
First-generation surveys include questions about difficulties in performing particular tasks and do not differentiate the importance of certain tasks based on the patient’s lifestyle. This is consistent with the classical test theory for psychometric testing, using a simple summary scoring system. The National Eye Institute Visual Function Questionnaire (NEI-VFQ) was developed in order to test the level of visual impairment related to eye diseases including the following: age-related cataracts, age-related macular degeneration, diabetic retinopathy, primary open-angle glaucoma, cytomegalovirus retinitis, and/or low vision from any cause . The questionnaire consists of 51 items that assess general vision problems and specific conditions, e.g., reading, work-related duties, and driving during the daytime and at night. The newer version features 25-items and may be more feasible in busy clinical settings . Although some NEI-VFQ subscales have been found to not be psychometrically sound , the questionnaire overall was established as a reliable measure in patients with visual impairment related to age-related macular degeneration  and geographic atrophy . Several questions regarding the QoV are strongly associated with objective measures .
The National Eye Institute Refractive Error Quality of Life Instrument-42 (NEI RQL-42) is a self-administered assessment tool designed specifically for use in those who through correction of refractive error have normal visual acuity but who may still be experiencing problems in vision-related functioning and well-being . This 42-item questionnaire measures patients’ satisfaction with distance vision, clarity of vision, and severity and frequency of glare symptoms along with the need for spectacles. Higher scores indicate better QoL and less dependence on corrective wear. Psychometric evaluation of the NEI RQL-42 showed that it has deficiencies in all of its tested aspects .
The Functional Assessment of Visual Tasks (VISTAS) questionnaire was created to assess the difficulties in near, intermediate, and distance tasks [31, 32]. The VISTAS test has sections relating to experiences when performing tasks at different distances, regarding using corrective wear, and an assessment of satisfaction for daytime and nighttime vision.
The Visual Function Index (VF-14) is a brief questionnaire that evaluates visual impairment owing to cataract and contains 18 questions covering 14 aspects regarding visual function . The tasks most correlated with patient satisfaction, from best to worst, are nighttime driving; reading small print; watching television; seeing steps, stairs or curbs; reading traffic, street or store signs; cooking; and doing fine handwork . Only the seven most important items were selected for inclusion in a new seven-item index (VF-7).
The second-generation tests involve Rasch analysis, consistent with item response theory. Analyzing data according to the Rasch model—that is conducting a Rasch analysis—supplies a range of details for checking whether or not adding the scores is justified in the data. Item values are calibrated and person abilities are measured on a shared continuum. This overcomes the drawbacks of summary scoring in classical test theory, which suffers from unknown spacing between scores. An example of a second-generation PROs instrument is the Catquest questionnaire, which was designed for determining the benefits of cataract surgery . The questions cover four areas: frequency of performing activities, perceived difficulties in performing daily-life activities, global questions about difficulties in general, and satisfaction with vision as well as cataract symptoms. After collection, the preoperative and postoperative data undergo Rasch analysis. A revised nine-item short-form version (Catquest-9SF) was also shown to be highly valid in measuring visual disability outcomes of cataract surgery . In addition, the Cat-PROM5 questionnaire is a short, five-item measure suitable for use in high-volume surgical environments. As of the case of all questionnaires conducted regarding visual impairment due to cataract, the patients are instructed to describe their vision while wearing their best glasses. One should remember that none of these questionnaires evaluating vision impairment due to cataract are meant for use in evaluating the outcomes of multifocal IOLs.
The third-generation questionnaires use item banking, employing purposeful creation of an item database as a part of an intent to measure a predetermined set of constructs. This methodology results in significantly reduced administrative time for maintaining content and producing tests. Currently, however, item banking has not been implemented in any visual function questionnaires.
Methods for evaluating near vision and spectacle independence
The ultimate goal for presbyopic patients receiving premium IOLs is to achieve spectacle-free clear vision at all focal distances. The Near Activity Visual Questionnaire (NAVQ) is designed specifically to assess the near visual function and benefits of presbyopia-correcting IOLs. It was introduced and standardized for English speakers by Gupta et al.  and developed further by Buckhurst et al.  The NAVQ requires patients to indicate their level of difficulty in performing common near-vision and intermediate-vision tasks without the use of spectacles and to rate their overall satisfaction with their near vision. The preliminary version of the questionnaire included 19-items, while the modified one includes 26-items; both versions incorporate Rasch analysis. At this time, the NAVQ questionnaire is frequently employed and has been assessed as a superior quality measure [33,34,35].
A new tool, the Patient-reported Spectacle Independence Questionnaire (PRSIQ), was generated based on a literature review, expert clinical interviews, and patient interviews . The need for glasses or contact lenses for various distances and the assessment of their frequency of use within the previous 7 days are surveyed. Three concepts of spectacle independence are employed: need, wear, and function. It could be considered as a valid tool for spectacle independence.
The Freedom from Glasses Value Scale (FGVS©) was released in 2010 in French and Spanish [18, 19]. Primarily it was applied to rank patients’ experiences with multifocal ReSTOR IOLs (Alcon, Fort Worth, TX, USA) via a telephone interview . It contains 21 items and a five-point Likert response scale is used. The questionnaire was subsequently linguistically validated in British English and Danish. Nevertheless, it was not evaluated psychometrically and has minimal content quality, as a consultation with patients is not performed .
Finally, self-developed questionnaires are commonly applied, with questions regarding the level of patient satisfaction with surgical outcome, level of spectacle independence, and difficulties performing vision-related activities after surgery [37,38,39]. For example, the Spectacle Independence Lens Vision Evaluation and Repurchase (SILVER) questionnaire is one example that was developed by a sponsor, but which cannot be determined as a valid assessment of “spectacle independence” . All PROs instruments require validation and repeatability evaluation; thus, the utility of self-developed questionnaires is limited.
Methods for evaluating dysphotopsia
Dysphotopsias are a well-known problem with multifocal IOLs. Such visual phenomena are more common and troublesome in participants with multifocal IOLs versus those with monofocals . Although pseudophakic dysphotopsias are considered to be an annoyance with little functional significance, they have been identified as an important factor correlating with patient satisfaction after cataract surgery .
The perception of dysphotopsias, as a subjective phenomenon, is difficult to measure and older questionnaires have not addressed these symptoms at all. In 2010, an instrument for assessing subjective QoV was developed . The questionnaire features 10 items regarding the patient’s perception of glare, halos, starburst, hazy vision, distortion, multiple images, fluctuation, focusing difficulties, and depth. Each item is scored for frequency and level of disturbance. The questionnaire involves Rasch analysis and is claimed to be suitable for all types of refractive correction, eye surgery, and eye diseases causing QoV problems.
The Assessment of Photic Phenomena and Lens Effects (APPLES) questionnaire is a 21-item self-rated tool aimed at addressing the frequency and severity of phenomena, including glare, halos, starbursts, hazy vision, blurred vision, distortion in which straight lines look tilted, distortion in which flat surfaces look curved, double vision, color distortion, and feeling sick to one’s stomach based on visual distortions . However, the APPLES questionnaire to date has not undergone psychometric evaluation, so its results should be interpreted with caution.
Apart from questionnaires using formal descriptions, the perceptions of halo and glare can be reported and adjusted by patients with computer software (Halo&Glare Simulator; Eyeland-Design Network GmbH, Vreden, Germany). This simulator utilizes a scale for intensity, size of the halo, and glare that ranges from zero (none) to 100 (extremely disturbing). It also allows for classifying the halos into three types, as follows: T1 (diffuse halo ring), T2 (starburst type), and T3 (distinct halo ring) . Another psychophysical test to measure halos is the MonCv3 vision monitor (Metrovision, Perencies, France) .
Concepts to achieve multifocality
Multifocal IOLs can be divided into the following categories according to the number of focal points: bifocals (which incorporate a far and a near focus), trifocal IOLs (which include an additional intermediate distance point), and extended depth of focus IOLs (which boast an extended far focus area that reaches intermediate distances). According to the optical design and physical principles applied, multifocal IOLs employ diffractive optics, offer zones of differing refractive power, or induce spherical aberration . A diffractive IOL generates multifocality based on light interference. It incorporates a pattern consisting of a series of annular concentric grooves less than one micron in depth, which are engraved around the optical axis on either the front or the back surface of a lens (the echelette technology). With this refractive design, multifocality is achieved with light refraction on the IOL surfaces based on Snell’s law; specifically, the optical power decreases continuously from the center to the periphery of the lens, creating an infinite number of focal points and which is derived from the smooth hyperbolic shape of its optics. The performance of refractive design IOLs is dependent on pupil size and IOL centration, while those of a diffractive design operate independently of pupil size. Importantly, the IOL design might influence the PROs and, when analyzing outcomes, this factor should be taken into account. Diffractive designs are known to induce more dysphotopsia than refractive designs  With that, improving the diffractive pattern in newer IOL designs (Johnson & Johnson Vision Tecnis ZM900) influences the severity of dysphotopsia in comparison with in the case of older-generation multifocal IOLs (Johnson & Johnson Array SA40N and ReZoom) .
Some other optical concepts might also be utilized. A small-aperture design uses the pinhole effect in order to increase depth of focus. The IC-8 IOL (AcuFocus, Inc., Irvine, CA, USA) creates an extended and continuous range of functional vision, similar to as done by the KAMRA corneal inlay (AcuFocus, Inc., Irvine, CA, USA). An accommodative IOL attempts to adjust the focus for different distances by way of an axial shift of a fixed-power lens, change of lens curvature, or variable-focus optics with two optical elements . An alternative to multifocal and accommodative IOLs for reducing spectacle dependence is monovision, where the distant eye is targeted for emmetropia, and the non-dominant eye for myopia. Historically, monovision is usually referred to as anisometropia of − 1.75 diopters (D) or greater . However, with the large number of intermediate tasks, and the fact that most patients are unable to tolerate such a large refractive difference, a mini-monovision approach (with induced myopia ranging from − 0.75 to − 1.25 D) might be beneficial. Monovision provides complete spectacle independence in 25.8% to 31.4% of patients versus in 65.7% to 71.3% as in the case with multifocal IOLs [47, 48]. Patients with multifocal IOLs report more shadows, glare, or dazzle, than what is seen with monovision [47, 48]. With that, although IOL explantation is uncommon, most of the IOL exchanges performed in patients with multifocal IOLs was a result of dissatisfaction about the image quality; in comparison, no IOL exchanges were performed in the monovision arm of the study . Nevertheless, when analyzing general outcomes of surgery (the VF-14 index), patients largely reported similar degrees of satisfaction with multifocal IOLs and monovision .
Importance of PROs
A Cochrane review revealed that patients receiving multifocal IOLs are less likely to be spectacle-dependent than those with monofocal IOLs with better near vision . Near-distance spectacle independence might range from 38.4 to 86% in multifocal groups in comparison with between 9.8 and 32% in individuals with monofocal IOLs [49, 50]. Although postoperative patient satisfaction after MIOL implantation is correlated with better visual performance, spectacle independence, and less photic phenomena, personality characteristics also have an impact on subjective disturbances provoked by photic phenomena . Specifically, the personality characteristics of compulsive checking, orderliness, competence, and dutifulness were statistically significantly correlated with subjective disturbance by glare and halos. This underlines the usefulness of PRO questionnaires. Another aspect to consider for multifocal IOLs is the process of neuroadaptation, with visual acuity tending to improve over time. With the formerly mentioned disadvantages, a patient’s determination is an unmeasured factor of postoperative QoL and vision.
Currently, much stress is put on photopic phenomena in studies investigating multifocal IOLs. Although up to 80.0% of individuals with multifocal IOLs perceived some level of halos at 3 months after surgery, for most of the participants (77/82) they were not significantly bothersome . One recent investigation suggested that there is no correlation between the optical properties of an IOL (including total or high-order aberrations) and QoV scores . Patients reporting dysphotic symptoms had increased activity in several regions of the frontoparietal circuits of the brain, including the cingulate gyrus and caudate nucleus [53, 54]. Thus, particularly in the field of presbyopia correction, PROs might be of exceptional importantance. Another issue to consider in the influence of multifocal IOL on contrast sensitivity. The Cochrane review  presented that there is little evidence of any important difference in contrast sensitivity between monofocal and multifocal IOLs , while in the review by Wang et al., a disadvantage for multifocal IOLs was found under at least certain conditions . To date, no study has reported a correlation between contrast sensitivity and patient satisfaction after surgery.
The utility of current methods
Current PRO tools are generally designed for patients with significant cataract with the primary goals of evaluating visual impairment prior to lens surgery and the outcomes after receiving a monofocal IOL, respectively. Examples of RCTs comparing PROs of multifocal and monofocal IOLs are presented in Table 2. After analyzing the information in this table, it might be concluded that within different studies completely different questionnaires were employed for reporting PROs. To date, none of the societies focused on refractive surgery, i.e., International Society of Refractive Surgery, European, American, or Asia-Pacific Societies of Cataract and Refractive Surgeons, has issued guidelines on methods of reporting PROs in patients with multifocal IOL.
This review describes the existing PROs instruments and informs the choice of an appropriate measure in lens refractive surgery. Rasch-developed tools should be utilized for measuring QoL and vision in lens refractive surgery, and a number of highly robust tools is already available for this purpose.
Taylor HR, McCarty CA, Nanjan MB (2000) Vision impairment predicts five-year mortality. Trans Am Ophthalmol Soc 98:91–96 discussion 96–9
Weih LM, Hassell JB, Keeffe J (2002) Assessment of the impact of vision impairment. Invest Ophthalmol Vis Sci 43:927–935
Maxwell A, Holland E, Cibik L et al (2017) Clinical and patient-reported outcomes of bilateral implantation of a 2.5 diopter multifocal intraocular lens. J Cataract Refract Surg 43:29–41
Mangione CM, Lee PP, Pitts J, Gutierrez P, Berry S, Hays RD (1998) Psychometric properties of the National Eye Institute Visual Function Questionnaire (NEI-VFQ). NEI-VFQ Field Test Investigators. Arch Ophthalmol 116:1496–1504
Mangione CM, Lee PP, Gutierrez PR, Spritzer K, Berry S, Hays RD, National Eye Institute Visual Function Questionnaire Field Test Investigators (2001) Development of the 25-item National Eye Institute Visual Function Questionnaire. Arch Ophthalmol 119:1050–1058
(2001) NEI Refractive Error Quality of Life Instrument-42 (NEI RQL-42). https://nei.nih.gov/catalog/nei-refractive-error-quality-life-instrument-42-nei-rql-42. Accessed 30 Nov 2017
Pesudovs K, Garamendi E, Elliott DB (2004) The Quality of Life Impact of Refractive Correction (QIRC) questionnaire: development and validation. Optom Vis Sci 81:769–777
Lundström M, Roos P, Jensen S, Fregell G (1997) Catquest questionnaire for use in cataract surgery care: description, validity, and reliability. J Cataract Refract Surg 23:1226–1236
Lundström M, Pesudovs K (2009) Catquest-9SF patient outcomes questionnaire: nine-item short-form Rasch-scaled revision of the Catquest questionnaire. J Cataract Refract Surg 35:504–513
Steinberg EP, Tielsch JM, Schein OD, Javitt JC, Sharkey P, Cassard SD, Legro MW, Diener-West M, Bass EB, Damiano AM (1994) The VF-14. An index of functional impairment in patients with cataract. Arch Ophthalmol 112:630–638
Uusitalo RJ, Brans T, Pessi T, Tarkkanen A (1999) Evaluating cataract surgery gains by assessing patients’ quality of life using the VF-7. J Cataract Refract Surg 25:989–994
Frost NA, Sparrow JM, Durant JS, Donovan JL, Peters TJ, Brookes ST (1998) Development of a questionnaire for measurement of vision-related quality of life. Ophthalmic Epidemiol 5:185–210
Sparrow JM, Grzeda MT, Frost NA, Johnston RL, Liu CSC, Edwards L, Loose A, Donovan JL (2018) Cat-PROM5: a brief psychometrically robust self-report questionnaire instrument for cataract surgery. Eye 32:796–805
Gupta N, Wolffsohn JS, Naroo SA, Davies LN, Gibson GA, Shah S (2007) Development of a near activity visual questionnaire to assess accommodating intraocular lenses. Cont Lens Anterior Eye 30:134–143
Buckhurst PJ, Wolffsohn JS, Gupta N, Naroo SA, Davies LN, Shah S (2012) Development of a questionnaire to assess the relative subjective benefits of presbyopia correction. J Cataract Refract Surg 38:74–79
Morlock R, Wirth RJ, Tally SR, Garufis C, Heichel CWD (2017) Patient-Reported Spectacle Independence questionnaire (PRSIQ): development and validation. Am J Ophthalmol 178:101–114
(2017) Clinical Investigation of AcrySof® IQ ReSTOR® +2.5 D Multifocal Intraocular Lens (IOL) Model SN6AD2 [SV25T0]. https://clinicaltrials.gov/ct2/show/NCT01510717. Accessed 31 Aug
Lévy P, Elies D, Dithmer O, Gil-Campos I, Benmedjahed K, Berdeaux G, Arnould B (2010) Development of a new subjective questionnaire: the Freedom from Glasses Value Scale (FGVS). J Refract Surg 26:438–446
Berdeaux G, Meunier J, Arnould B, Viala-Danten M (2010) Measuring benefits and patients’ satisfaction when glasses are not needed after cataract and presbyopia surgery: scoring and psychometric validation of the Freedom from Glasses Value Scale (FGVS). BMC Ophthalmol 10:15
McAlinden C, Pesudovs K, Moore JE (2010) The development of an instrument to measure quality of vision: the Quality of Vision (QoV) questionnaire. Invest Ophthalmol Vis Sci 51:5537–5545
Kinard K, Jarstad A, Olson RJ (2013) Correlation of visual quality with satisfaction and function in a normal cohort of pseudophakic patients. J Cataract Refract Surg 39:590–597
Sloane ME, Ball K, Owsley C, Bruni JR, Roenker DL (1992) The Visual Activities Questionnaire: developing an instrument for assessing problems in everyday visual tasks. www.uab.edu/medicine/ophthalmology/images/research/VisualActivities.pdf. Accessed 21 Dec 2017
Javitt JC, Jacobson G, Schiffman RM (2003) Validity and reliability of the Cataract TyPE Spec: an instrument for measuring outcomes of cataract extraction. Am J Ophthalmol 136:285–290
Pesudovs K, Coster DJ (1998) An instrument for assessment of subjective visual disability in cataract patients. Br J Ophthalmol 82:617–624
Donovan JL, Brookes ST, Laidlaw DAH, Hopper CD, Sparrow JM, Peters TJ (2003) The development and validation of a questionnaire to assess visual symptoms/dysfunction and impact on quality of life in cataract patients: the Visual Symptoms and Quality of life (VSQ) Questionnaire. Ophthalmic Epidemiol 10:49–65
Pesudovs K, Gothwal VK, Wright T, Lamoureux EL (2010) Remediating serious flaws in the National Eye Institute Visual Function Questionnaire. J Cataract Refract Surg 36:718–732
Revicki DA, Rentz AM, Harnam N, Thomas VS, Lanzetta P (2010) Reliability and validity of the National Eye Institute Visual Function Questionnaire-25 in patients with age-related macular degeneration. Invest Ophthalmol Vis Sci 51:712–717
Sivaprasad S, Tschosik E, Kapre A, Varma R, Bressler NM, Kimel M, Dolan C, Silverman D (2018) Reliability and construct validity of the NEI VFQ-25 in a subset of patients with geographic atrophy from the phase 2 Mahalo study. Am J Ophthalmol 190:1–8
Owen CG, Rudnicka AR, Smeeth L, Evans JR, Wormald RPL, Fletcher AE (2006) Is the NEI-VFQ-25 a useful tool in identifying visual impairment in an elderly population? BMC Ophthalmol. https://doi.org/10.1186/1471-2415-6-24
McAlinden C, Skiadaresi E, Moore J, Pesudovs K (2011) Subscale assessment of the NEI-RQL-42 questionnaire with Rasch analysis. Invest Ophthalmol Vis Sci 52:5685–5694
Atkinson MJ, Tally S, Heichel CW, Kozak I (2011) PSS34 qualitative grounding for a new patient assessment measure in ophthalmology: the functional assessment of visual tasks (Vistas). Value Health 14:A508
Atkinson MJ, Tally S, Kozak I, Heichel CW, Kulischak J (2011) PSS35 validation of the eighteen item functional assessment of visual tasks (Vistas-18) using a new lens prescription methodology. Value Health 14:A508
Sheppard AL, Shah S, Bhatt U, Bhogal G, Wolffsohn JS (2013) Visual outcomes and subjective experience after bilateral implantation of a new diffractive trifocal intraocular lens. J Cataract Refract Surg 39:343–349
Berrow EJ, Wolffsohn JS, Bilkhu PS, Dhallu S (2014) Visual performance of a new bi-aspheric, segmented, asymmetric multifocal IOL. J Refract Surg 30:584–588
Kandel H, Khadka J, Goggin M, Pesudovs K (2017) Patient-reported outcomes for assessment of quality of life in refractive error: a systematic review. Optom Vis Sci 94:1102–1119
Cochener B, Fernández-Vega L, Alfonso JF, Maurel F, Meunier J, Berdeaux G (2010) Spectacle independence and subjective satisfaction of ReSTOR multifocal intraocular lens after cataract or presbyopia surgery in two European countries. Clin Ophthalmol 4:81–89
Kretz FTA, Choi CY, Müller M, Gerl M, Gerl RH, Auffarth GU (2016) Visual outcomes, patient satisfaction and spectacle Independence with a trifocal diffractive intraocular lens. Korean J Ophthalmol 30:180–191
Chang DH (2016) Visual acuity and patient satisfaction at varied distances and lighting conditions after implantation of an aspheric diffractive multifocal one-piece intraocular lens. Clin Ophthalmol 10:1471–1477
Schallhorn SC, Schallhorn JM, Pelouskova M, Venter JA, Hettinger KA, Hannan SJ, Teenan D (2017) Refractive lens exchange in younger and older presbyopes: comparison of complication rates, 3 months clinical and patient-reported outcomes. Clin Ophthalmol 11:1569–1581
de Silva SR, Evans JR, Kirthi V, Ziaei M, Leyland M (2016) Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003169.pub4
Kretz FTA, Breyer D, Klabe K, Hagen P, Kaymak H, Koss MJ, Gerl M, Mueller M, Gerl RH, Auffarth GU (2015) Clinical outcomes after implantation of a trifocal toric intraocular lens. J Refract Surg 31:504–510
Puell MC, Pérez-Carrasco MJ, Hurtado-Ceña FJ, Álvarez-Rementería L (2015) Disk halo size measured in individuals with monofocal versus diffractive multifocal intraocular lenses. J Cataract Refract Surg 41:2417–2423
Alio JL, Simonov A, Plaza-Puche AB, Angelov A, Angelov Y, van Lawick W, Rombach M (2016) Visual outcomes and accommodative response of the lumina accommodative intraocular lens. Am J Ophthalmol 164:37–48
Savini G, Schiano-Lomoriello D, Balducci N, Barboni P (2018) Visual performance of a new extended depth-of-focus intraocular lens compared to a distance-dominant diffractive multifocal intraocular lens. J Refract Surg 34:228–235
Cillino S, Casuccio A, Di Pace F, Morreale R, Pillitteri F, Cillino G, Lodato G (2008) One-year outcomes with new-generation multifocal intraocular lenses. Ophthalmology 115:1508–1516
Olson RJ, Braga-Mele R, Chen SH, Miller KM, Pineda R 2nd, Tweeten JP, Musch DC (2017) Cataract in the adult eye preferred practice pattern®. Ophthalmology 124:P1–P119
Wilkins MR, Allan BD, Rubin GS, Findl O, Hollick EJ, Bunce C, Xing W, Moorfields IOL Study Group (2013) Randomized trial of multifocal intraocular lenses versus monovision after bilateral cataract surgery. Ophthalmology 120:2449–2455.e1
Labiris G, Giarmoukakis A, Patsiamanidi M, Papadopoulos Z, Kozobolis VP (2015) Mini-monovision versus multifocal intraocular lens implantation. J Cataract Refract Surg 41:53–57
Gimbel HV, Sanders DR, Raanan MG (1991) Visual and refractive results of multifocal intraocular lenses. Ophthalmology 98:881–887 discussion 888
Javitt JC, Wang F, Trentacost DJ, Rowe M, Tarantino N (1997) Outcomes of cataract extraction with multifocal intraocular lens implantation: functional status and quality of life. Ophthalmology 104:589–599
Mester U, Vaterrodt T, Goes F, Huetz W, Neuhann I, Schmickler S, Szurman P, Gekeler K (2014) Impact of personality characteristics on patient satisfaction after multifocal intraocular lens implantation: results from the “happy patient study”. J Refract Surg 30:674–678
Mendicute J, Kapp A, Lévy P, Krommes G, Arias-Puente A, Tomalla M, Barraquer E, Rozot P, Bouchut P (2016) Evaluation of visual outcomes and patient satisfaction after implantation of a diffractive trifocal intraocular lens. J Cataract Refract Surg 42:203–210
Rosa AM, Miranda ÂC, Patrício M, McAlinden C, Silva FL, Murta JN, Castelo-Branco M (2017) Functional magnetic resonance imaging to assess the neurobehavioral impact of dysphotopsia with multifocal intraocular lenses. Ophthalmology 124:1280–1289
Rosa AM, Miranda ÂC, Patrício MM, McAlinden C, Silva FL, Castelo-Branco M, Murta JN (2017) Functional magnetic resonance imaging to assess neuroadaptation to multifocal intraocular lenses. J Cataract Refract Surg 43:1287–1296
Wang SY, Stem MS, Oren G, Shtein R, Lichter PR (2017) Patient-centered and visual quality outcomes of premium cataract surgery: a systematic review. Eur J Ophthalmol 27:387–401
Zhao G, Zhang J, Zhou Y, Hu L, Che C, Jiang N (2010) Visual function after monocular implantation of apodized diffractive multifocal or single-piece monofocal intraocular lens randomized prospective comparison. J Cataract Refract Surg 36:282–285
Peng C, Zhao J, Ma L, Qu B, Sun Q, Zhang J (2012) Optical performance after bilateral implantation of apodized aspheric diffractive multifocal intraocular lenses with +3.00-D addition power. Acta Ophthalmol 90:e586–e593
Shah S, Peris-Martinez C, Reinhard T, Vinciguerra P (2015) Visual outcomes after cataract surgery: multifocal versus monofocal intraocular lenses. J Refract Surg 31:658–666
Monaco G, Gari M, Di Censo F, Poscia A, Ruggi G, Scialdone A (2017) Visual performance after bilateral implantation of 2 new presbyopia-correcting intraocular lenses: trifocal versus extended range of vision. J Cataract Refract Surg 43:737–747
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Grzybowski, A., Kanclerz, P. & Muzyka-Woźniak, M. Methods for evaluating quality of life and vision in patients undergoing lens refractive surgery. Graefes Arch Clin Exp Ophthalmol 257, 1091–1099 (2019). https://doi.org/10.1007/s00417-019-04270-w
- Cataract surgery
- Intraocular lens
- Lens refractive surgery
- Patient-reported outcomes
- Quality of life
- Visual function