# Autorefraction Pitfalls in Extended Depth-of-Focus Pseudophakia: A Case Report

## TL;DR

This case report highlights how autorefraction can mislead after EDOF IOL implantation, causing incorrect prescriptions and patient discomfort.

## Contribution

The paper introduces a novel case series showing how EDOF IOLs can cause misleading autorefraction results and emphasizes the need for subjective refraction.

## Key findings

- Three patients with EDOF IOLs showed myopia on autorefraction but had excellent uncorrected vision.
- Incorrect spectacle prescriptions led to asthenopic symptoms, resolved upon discontinuation.
- Subjective refraction and functional assessment are critical after EDOF IOL implantation.

## Abstract

Extended depth-of-focus (EDOF) intraocular lenses (IOLs) are increasingly used to provide a broad range of vision after cataract surgery. However, their unique optical design can produce misleading results when postoperative refraction is assessed using automated methods. We report three pseudophakic patients implanted bilaterally with Tecnis PureSee IOLs, all of whom demonstrated excellent uncorrected visual acuity (1.0) but appeared myopic on autorefractor testing. Based on these values, opticians prescribed minus-powered spectacles, including night-driving glasses and progressive lenses. All three patients developed asthenopic symptoms such as headaches, nausea, diplopia, or dizziness. Symptoms resolved rapidly upon discontinuation of spectacles. However, diagnosis was delayed by 2.5 to 4 weeks. These cases illustrate the risk of overcorrection due to objective refraction artifacts in EDOF optics. The myopic shift observed on autorefraction did not reflect functional visual performance. Lack of communication between surgeons and opticians, as well as unawareness of IOL model-specific refraction behavior, contributed to incorrect prescriptions and patient dissatisfaction. Subjective refraction and functional assessment are essential following EDOF IOL implantation. Communication between ophthalmologists and optical professionals should be improved, and IOL-specific refractive behavior must be considered to avoid unnecessary spectacle correction and ensure optimal visual outcomes with high patient satisfaction. Understanding the optical behavior of new IOLs and tailoring refractive care accordingly should be standard practice in the management of premium IOL patients.