Extended depth-of-focus (EDOF) intraocular lenses (IOL) offer a new approach to improve depth perception after cataract surgery but may come with potential drawbacks. The use of EDOF IOLs requires thorough evaluation of options and performance as well as careful consideration of the recipients’ working requirements and existing regulations. There may be a high risk of a mismatch.

The principles of EDOF IOLs will be reviewed, significant differences from classic, approved, monofocal IOL designs outlined, and a specific group of patients identified: pilots. In this context, a case in which EDOF IOLs were implanted will be discussed, with emphasis on the consequences.

Although EDOF IOLs have become a common choice for many patients and perform well, not all current EDOF IOLs perform in compliance with the rules and regulations for aviation. Disparities and misconceptions exist as to whether or not EDOF IOLs can be considered acceptable in aviation. Depending on applicable rules and regulations, there are globally significant differences. Even when individual performance may allow for continuation of flying duties, the regulations of some regions are not yet generally permissive, leading to undesirable and unnecessary negative sequelae.

In contrast to classic monofocal IOLs, EDOF IOLs cannot be presumed to be generally accepted by all authorities engaged in global aviation. As EDOF IOL designs vary, their effects on contrast sensitivity, halo, and glare may also differ considerably. Therefore, prior surgery and prior to opting for an EDOF IOL, both the ophthalmic surgeon and the pilot should obtain detailed knowledge of the matter before decision making and, if unsure, consult the AME as well as the relevant aviation authorities if there are any questions.

EDOF IOLs are not yet generally accepted for aviation. Although the enhanced performance of EDOF IOLs might be tempting, the postoperative results and their acceptability might vary considerably, currently necessitating a very careful approach.