Factors Affecting Postoperative Satisfaction After Presbyopia-Correcting Intraocular Lens

Abstract

Presbyopia-correcting IOLs have revolutionized cataract surgery by enabling functional vision across multiple focal distances, thereby reducing dependence on spectacles. These lenses—ranging from multifocal to extended depth-of-focus (EDOF) and hybrid designs—incorporate advanced optical technologies to address the limitations of traditional monofocal IOLs. Despite their clinical promise, patient satisfaction remains variable, with a substantial subset experiencing postoperative visual discomfort. This review provides a comprehensive overview of presbyopia-correcting IOL technologies, detailing their optical principles, design evolution, and clinical performance. It further analyzes the multifactorial causes of postoperative dissatisfaction, which include optical phenomena such as glare, halos, and reduced contrast sensitivity; ocular comorbidities like dry eye disease, corneal irregular astigmatism, glaucoma, and macular pathology; and surgical variables including IOL centration, pupil size, and biometry accuracy. Additionally, non-physiological factors—such as patient expectations, lifestyle demands, and psychological disposition—play a critical role in perceived outcomes. To address these challenges, the review explores evidence-based strategies for improving satisfaction. These include rigorous preoperative screening for ocular surface disease and aberrations, personalized lens selection based on anatomical and functional criteria, and thorough patient counseling to align expectations with achievable results. Emerging IOL designs that blend multifocal and EDOF features offer promising avenues for minimizing visual disturbances while preserving range of vision. By integrating optical innovation with individualized clinical care, ophthalmologists can enhance postoperative outcomes and optimize real-world satisfaction with presbyopia-correcting IOLs.