Comparison of Postoperative Visual Performance Between Bifocal and Trifocal Intraocular Lens Based on Randomized Controlled Trails: A Meta-Analysis

Abstract

Background：To compare the clinical performance of bifocal and trifocal intraocular lenses (IOLs) in cataract surgery, a meta-analysis on randomized controlled trials was conducted. Methods: A comprehensive literature retrieval of PubMed, Science Direct and EMBASE was performed in this systematic review. Clinical outcomes included visual acuity (VA), contrast sensitivity (CS), spectacle independence, postoperative refraction and surgical satisfaction. Results: There were 8 RCTs included in this study. The difference of uncorrected near VA (UNVA) between the bifocal IOLs and trifocal IOLs had no clinical significance [MD=-0.01, 95%CI: (-0.02,0.00)]. There was no significant difference in the distant-corrected near VA (DCNVA) with MD of 0.04 [95%CI (-0.02, 0.10)]. Compared with trifocal group, the uncorrected intermediate visual acuity (UIVA) [MD=0.09,95%CI:(0.01,0.17)] was significantly worse in the bifocal group. No difference was found in distance-corrected intermediate VA(DCIVA) [MD= 0.09, 95%CI: (-0.04, 0.23)] between two groups. Analysis on AT LISA subgroup indicated the bifocal group had worse intermediate VA than trifocal group (AT LISA tri 839M) [MD= 0.18, 95%CI: (0.12, 0.24) for UIVA and MD= 0.19, 95%CI: (0.13, 0.25) for DCIVA]. However, there was no statistically significant difference between the two groups in the uncorrected distance VA(UDVA) and corrected distance visual acuity (CDVA) [MD=0.01, 95%CI: (-0.01,0.04) for UDVA; MD=0.00, 95%CI: (-0.01,0.01) for CDVA]. The postoperative refraction of bifocal group was similar to that of trifocal group [MD=-0.08, 95% CI: (-0.19, 0.03) for spherical equivalent; MD=-0.09, 95%CI: (-0.21, 0.03) for cylinder; MD=-0.09, 95% CI: (-0.27, 0.08) for sphere]. No difference was found for spectacle independence, posterior capsular opacification (PCO) incidence and patient satisfaction between bifocal IOLs and trifocal IOLs. [RR=0.89, 95% CI: (0.71, 1.12) for spectacle independence; RR=1.81, 95% CI: (0.50, 6.54) for PCO incidence; RR=0.98, 5% CI: (0.86, 1.12) for patient satisfaction]. Conclusion: Patients receiving trifocal IOLs, especially AT LISA tri 839M, have a better intermediate VA than those receiving bifocal IOLs. Near and distance visual performance, spectacle independence, postoperative refraction and surgical satisfaction of bifocal IOLs were similar to those of trifocal IOLs. Keywords: bifocal; trifocal; intraocular lenses; cataract surgery; randomized; IOLs; meta-analysis.

First Results after Implantation of Hydrophilic and Hydrophobic Trifocal Intraocular Lenses: Visual and Optical Performance

“…As patients can no longer accommodate after IOL implantation, they need to use spectacles to see other distances in focus. e first-generation "bifocal" IOLs provided two focal points, one for far and the other for near vision, but thanks to an upsurge in computer, tablet, and smartphone use over recent years, there has been an upsurge in demand for IOLs that offer good intermediate vision too-something that bifocal IOLs cannot achieve [1]. In 2010, the first trifocal IOL (FineVision Micro F, PhysIOL, Liège, Belgium) was introduced [2], and numerous studies have shown that this IOL provides good far, intermediate, and near visual acuities (VA) and results in high levels of patient satisfaction [3][4][5][6][7][8].…”

Pseudophakic Approaches for Addressing Presbyopia

“…The advantage of trifocal IOLs in providing better intermediate vision than bifocal IOLs has been reported in several studies [73]. The excellent intermediate vision is also shown in a prospective trial of refractive lens exchange (no clinically significant cataract present) from 2016 that evaluates the visual acuity after implantation of a trifocal IOL (AT LISA, Zeiss, Germany) in patients with a crystalline lens.…”