Diffractive Optic IOL Exchange: Indications and Outcomes.

PURPOSE To assess indications for and outcomes of surgical exchange of diffractive optic multifocal and extended depth of focus IOLs in favor of monofocal IOLs. SETTING Private Practice, Los Angeles, CA. DESIGN Retrospective chart review. METHODS All cases of diffractive optic IOL exchange between June 2007 and October 2020 for diffractive optic dysphotopsia (DOD) (light induced concentric circles, spider web patterns, etc.), poor visual quality, or night vision symptoms were evaluated retrospectively regarding surgical indications, comorbidities, surgical methods, surgical complications and visual outcomes. Ocular surface disease and ametropia were managed prior to consideration of IOL exchange. RESULTS The charts of 64 eyes of 46 patients were included. 53/64 (83%) had DOD, 50/64 (78%) experienced reduced quality of vision and 12/64 (19%) complained of night vision difficulties. 27/64 (42%) of eyes had no ocular comorbidities; 15/64 (23%) of eyes had more than one comorbid condition and 12/64 (19%) were post laser refractive surgery. Laser posterior capsulotomy had been performed in 15/64 (23%) of eyes. There were a variety of inciting diffractive optic IOLs and various monofocal exchange lenses and fixation techniques were used based on symptoms, comorbidities, and status of the posterior capsule. Following IOL exchange all eyes were relieved of DOD and all eyes had improved or unchanged CDVA. CONCLUSIONS Diffractive Optic IOLS may induce unsatisfactory visual outcomes. However, in this large series of IOL exchanges, diffractive optic dysphotopsia and reduced visual function can be overcome with exchange for a monofocal IOL, despite comorbidities or an open posterior capsule.