The Effect of Brimonidine Tartrate 0.2% on Visual Quality after Phaco and Extended Depth of Focus Intraocular Lens Implantation

Objective: To investigate the effect of brimonidine tartrate 0.2% ophthalmic solution on visual quality after phaco and EDOF IOLs implantation. Methods The prospective non-randomized study comprised 21 eyes of 21 age-related cataract patients who underwent phacoemulsification and EDOF IOLs implantation in the eye center of the Affiliated Hospital of Weifang Medical University from July 2020 to November 2021. The pseudophakic eye was administered topically with bromonidine tartrate 0.2% at 1 month follow up after EDOF IOL implantation. Before and 2 hours,4 hours after brimonidine tartrate drops was administered topically.Under mesopic conditions,OPD-ScanⅢ was used to measure the objective visual quality such as Strehl Ratio (SR),higher order aberrations (HOA),spherical aberration (SA),Coma and Trefoil. The pupil size and palpebral fissure height were evaluated under mesopic conditions. Uncorrected distance visual acuity (UDVA) and the best corrected distance visual acuity (CDVA) were measured using a high-contrast projected logMAR chart. The Visual Functioning-14 (VF-14) scale was used to assess visual functioning and vision-related functional impairment. Results After brimonidine tartrate 0.2% was administered topically,compared to baseline,there were significant differences in ocular HOA,SA and Trefoil, as well as in optical quality parameters (P < 0.05). The visual quality improved and reached its optimum value 2 h after brimonidine tartrate 0.2% administration, which could last more than 4h after administration.There was no significant difference in ocular Coma after administration (P > 0.05).There were significant differences in the mesopic pupil size evaluated after 2 hours and 4 hours brimonidine administration compared to baseline (P < 0.05).The mesopic pupil size reached its minimum value 2 h after brimonidine administration. There was no significant difference in UDVA, CDVA and palpebral fissure height after brimonidine administration (P > 0.05). The VF-14 demonstrated that symptoms of glare or halos can be eliminated after brimonidine administration in 67% in pseudophakic eyes, be alleviated in 24% in pseudophakic eyes and not improved in 9% in pseudophakic eyes. Conclusion Brimonidine tartrate 0.2% ophthalmic solution had an antimydriatic effect under mesopic conditions in the patients with EDOF IOLs implantation. Brimonidine tartrate 0.2% may be used to improve night visual quality in pseudophakic eyes through reducing ocular HOA, SA and Trefoil,increasing SR,and alleviating symptoms of glare or halos in pseudophakic eyes.