To evaluate the visual performance of a diffractive bifocal intraocular lens (IOL) with + 4.0 D near addition (ZMB00) and a diffractive trifocal IOL with + 2.17 D and + 3.25 D near addition (AcrySof IQ PanOptix TFNT00), we investigated the 10-week postoperative parameters after cataract surgery in which ZMB00 or TFNT00 lenses were implanted bilaterally from 2011 to 2020 (with a 3-month interval between implantation of the right and left lenses). The study included 1448 eyes of 724 patients. The diffractive bifocal group comprised 1326 eyes of 663 patients (aged 67.0 ± 7.8 years; females/males, 518/145), and the diffractive trifocal group comprised 122 eyes of 61 patients (aged 66.6 ± 7.3 years; females/males, 35/26). A linear mixed-effects model using data for both eyes, with strict adjustments for sex, age, subjective refraction spherical equivalent, subjective refraction cylinder, corneal astigmatism, axial length, corneal higher-order aberrations, and pupil diameter, ensured statistical validity. Uncorrected near visual acuity and higher-order aberrations (ocular/internal, scaled to a pupil size of 4 mm) (WF_4_post_O_Spherical, WF_4_post_I_Spherical) were significantly better in the bifocal group (p < 0.00068, Wald test). Uncorrected intermediate visual acuity, contrast sensitivity (6.3/4.0/2.5/1.6/1.0/0.7 degrees), and contrast sensitivity with glare (4.0/1.6/1.0/0.7 degrees) were significantly better in the trifocal group (p < 0.00068, Wald test).

We compared the visual performance of a monofocal intraocular lens (IOL) (ZCB00) and a rotationally asymmetric refractive IOL with + 1.5 diopters near addition (Lentis Comfort LS-313 MF15) by investigating postoperative parameters ten weeks after surgery from both eyes of cataract patients who underwent bilateral implantation with one of the two IOLs within three months between 2011 and 2019. A total of 1352 eyes of 676 patients were enrolled; the ZCB00 group comprised 904 eyes of 452 patients (72.3 ± 6.8 years; females/males, 268/184), and the LS-313 MF15 group included 448 eyes of 224 patients (73.6 ± 7.0 years; females/males, 125/99). A linear mixed-effects model using data for both eyes, with strict adjustments for sex, age, subjective refraction spherical equivalent, subjective refraction cylinder, corneal astigmatism, axial length, corneal higher-order aberrations, and pupil diameter, ensured statistical validity. Corrected distance visual acuity was significantly better, and the higher-order aberrations (ocular/internal, scaled to a 4/6-mm pupil; WF_4_post_O_TotalHOA, _Third, _Fourth, _Trefoil, _Coma, _Tetrafoil, _Spherical; WF_4_post_I_TotalHOA, _Third, _Fourth, _Trefoil, _Coma, _Tetrafoil, _Spherical, WF_6_post_O_Spherical, and WF_6_post_I_Spherical) were significantly smaller in the ZCB00 group (p < 0.00068, Wald test). Contrast sensitivity with glare (6.3 degrees) and spectacle independence (near) were significantly better in the LS-313 MF15 group (p < 0.00068, Wald test).