Peripheral vision in patients following intraocular lens implantation: a systematic review and meta-analysis: peripheral vision in patients following iol implantation

Purpose To revise the literature on peripheral optics and vision following intraocular lens (IOLs) implantation. Methods We investigated how current IOLs influence peripheral visual function, peripheral optical quality, and visual perception and performance, in patients following cataract surgery. Peripheral vision is described as vision outside the central foveal region of the eye (beyond 4-5° of eccentricity). We systematically searched PubMed, Cochrane Central Register of Controlled Trials, Embase, and grey literature for relevant references. Randomized controlled trials and observational studies were eligible for inclusion. Finally, 47 studies with a total of 5963 participants were eligible for this review, of which 15 were included in meta-analysis. Results Regarding visual fields, meta-analysis showed that the pooled estimate of mean deviation (MD) measured with perimetry tests (SAP, SWAP and FDT) appears to be lower than the mean of healthy age-matched controls, regardless of IOL design. Results for pooled estimate report localized defects (PSD) were higher than the healthy age matched controls for FDT. We also collected evidence demonstrating that pseudophakia increases peripheral astigmatism and a myopic shift from 20° onwards, leading to decreased peripheral image quality compared with phakic eyes. Patient-reported outcomes on peripheral vision showed a pooled score estimate of 95.19, indicating high satisfaction and for the Steps & Stairs” questions a pooled score estimate at 0.23 indicating no to little difficulty seeing steps and stairs. Conclusions Peripheral image quality is degraded in eyes after cataract surgery. Nevertheless, whether this degradation leads to impaired visual function in the periphery requires further investigations.