Comparison of Visual Performance between Diffractive Bifocal and Diffractive Trifocal Intraocular Lenses

Abstract

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).

Comparison of Visual Performance between Monofocal and Rotationally Asymmetric Refractive Intraocular Lenses

“…Before surgery, all patients underwent a comprehensive eye examination identical to that in our previous studies. [17][18][19][20] The examination included assessments of the curvature of the cornea, corneal astigmatism, axial length, refractive status, ocular aberrations, pupil size, visual acuity at different distances, and contrast sensitivity with and without glare. Additionally, the anterior segment of the eye was evaluated using slit-lamp microscopy, tonometry, and indirect fundoscopy.…”

“…After being informed of the bene ts and drawbacks of each type of lens, the patients opted for implantation of either monofocal or rotationally asymmetric refractive IOLs, as described in our previous studies. [17][18][19][20] Patients in the monofocal group were implanted with Tecnis monofocal IOLs (ZCB00) bilaterally, while those in the rotationally asymmetric refractive group received the rotationally asymmetric refractive IOLs with + 1.5 diopters near addition (Lentis Comfort LS-313 MF15) bilaterally. The ZCB00 lens features a 6.0-mm acrylic optics design that is hydrophobic and clear.…”

“…As in our previous studies, [17][18][19][20] we compared the two groups-those who received monofocal IOLs and those who received rotationally asymmetric refractive IOLs-in terms of various postoperative measures, which were assessed 10 weeks after surgery for both eyes. The postoperative parameters included visual acuity (uncorrected/corrected, distance/intermediate/near), contrast sensitivity (with/without glare), and higher-order aberrations (ocular/internal, scaled to a pupil size of 4 mm/6 mm), which were assessed via mixed-effects linear regression.…”

“…S2 displays the postoperative parameters for both eyes of the monofocal and rotationally asymmetric refractive groups and the results of their analysis through multiple regression analysis adjusted by the explanatory variables in Table 1 and following the same protocol as in our previous study. [17][18][19][20] The results were obtained 10 weeks after surgery. Corrected distance visual acuity and the higher-order aberrations (ocular/internal, scaled to a pupil size of 4 mm/6 mm) 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 signi cantly better in the monofocal group (p<0.00068, Wald test) (Table 2 and Fig.…”

“…These parameters have been adjusted through multiple regression using the explanatory variables illustrated in Table 1, following the same methodology as in our previous studies. [17][18][19][20]…”