Effectiveness of intraocular lenses designed to correct presbyopia after cataract surgery: an overview of systematic reviews

This is an overview of systematic reviews to evaluate the visual outcomes of different presbyopia correcting intraocular lens (IOL), spectacle independence (SI), adverse visual effects and cost-effectiveness. Reviews were included if they compared presbyopia-correcting IOLs-such as multifocal (bifocal and trifocal), extended-depth-of-focus (EDOF), and accommodative and monofocal IOLs. The AMSTAR-2 tool was used. Primary outcomes were uncorrected distance visual acuity (UDVA), intermediate visual acuity (UIVA) and near visual acuity (UNVA). Secondary outcomes were SI, halos and glare, and cost-effectiveness. Prospero registration CRD42023425283. Eight systematic reviews were included. None scored 'Yes' in all AMSTAR-2 tool 16 items. Primary outcomes were as follows: all IOLs reported similar UDVA. EDOF and trifocal IOLs reported better UCIVA. Trifocal diffractive, EDOF, accommodative and bifocals were better than monofocal IOL for UNVA and of these trifocal and biofocal reported better UNVA. Secondary outcomes: SI was better with trifocal, bifocals and EDOF compared with monofocal IOLs. Trifocals and bifocals reported more glare and halos. No review reported cost-effectiveness. The findings indicate that while multifocal and EDOF IOLs show comparable performance in UDVA and UIVA, multifocal performs better in UNVA but at the cost of glare and halos. EDOFs may offer superior spectacle independence but may not consistently match multifocal in near vision.