Standard Automated Perimetry Before and After Extended Depth-of-Focus Intraocular Lens Implantation: Longitudinal Changes in Global Indices and Test Reliability

Purpose: To describe changes in standard automated perimetry (SAP) parameters before and after extended depth-of-focus (EDOF) intraocular lens implantation (Symfony) in a longitudinal before-and-after design. Methods: Patients undergoing cataract surgery with EDOF IOL implantation were evaluated with SAP preoperatively (baseline) and postoperatively (6-12 months after surgery). Thirteen patients (23 eyes) completed both examinations. The right and left eyes were analyzed separately. Outcomes included foveal threshold, mean deviation (MD), pattern standard deviation (PSD), visual field index (VFI), and reliability indices (false-positive and false-negative rates). Data were summarized as mean ± standard deviation (SD) and compared between time points using paired tests. SAP was performed with the Humphrey Field Analyzer II using the SITA Standard 24-2 strategy. Results: SAP outcomes showed small, non-significant changes from baseline to follow-up. MD improved slightly (right: -1.1 ± 1.2 to -0.8 ± 1.2 dB, p = 0.32; left: -1.9 ± 0.9 to -1.2 ± 1.1 dB, p = 0.12). VFI remained stable (right: 99.1% ± 1.1% to 98.8% ± 1.4%, p = 0.43; left: 98.0% ± 1.1% to 98.0% ± 2.1%, p = 1.00). Foveal threshold was unchanged (right: 35.1 ± 1.9 to 35.2 ± 0.9 dB, p = 0.86; left: 34.0 ± 1.0 to 34.5 ± 1.3 dB, p = 0.26). PSD showed no significant variation (right: 1.9 ± 0.9 to 1.7 ± 0.4 dB, p = 0.34; left: 1.8 ± 0.3 to 1.9 ± 1.2 dB, p = 0.73). Reliability indices were also stable: false positives (right: 1.9% ± 2.6% to 2.1% ± 1.4%, p = 0.75; left: 1.4% ± 2.5% to 0.5% ± 0.6%, p = 0.21) and false negatives (right: 1.6% ± 2.1% to 1.7% ± 3.1%, p = 0.91; left: 2.2% ± 2.9% to 1.1% ± 1.5%, p = 0.35). Conclusion: In this longitudinal before-and-after evaluation, EDOF IOL implantation was not associated with clinically meaningful changes in SAP outcomes, with stable global indices, foveal threshold, and reliability measures.