Abstract:AIM: To compare objective visual quality and vision-related quality of life after implantation of different presbyopia-correcting intraocular lenses(PC-IOLs).
METHODS:A prospective, non-randomized controlled study. Cataract patients who underwent phacoemulsification combined with PC-IOL implantation at Jinan Mingshui Eye Hospital from September 2023 and December 2025 were included. These patients were divided into three groups according to the type of IOL: the Trifocal IOL group,the Vivity group, and the Synergy group. Follow-ups were conducted at 1 wk,1 and 3 mo postoperatively. Uncorrected distance visual acuity(UDVA), uncorrected intermediate visual acuity(UIVA), and uncorrected near visual acuity(UNVA), objective scatter index(OSI), modulation transfer function cut off(MTF-cut off), and Strehl ratio(SR), as well as contrast visual acuity(CVA)at 100%, 20%, and 9% contrast were assessed. Postoperative defocus curves were plotted. Vision-related quality of life and spectacle independence were evaluated using questionnaires.
RESULTS: This study included 101 cataract patients(101 eyes),aged 30-70(53.8±9.7)y,with 59 males and 42 females.The Trifocal group consisted of 33 patients(33 eyes), aged 30-71(51.7±11.3)y, with 21 males and 12 females; the Vivity group consisted of 37 patients(37 eyes), aged 36-71(54.2±9.0)y, with 18 males and 19 females; and the Synergy group consisted of 31 patients(31 eyes), aged 30-73(55.9±8.5)y, with 20 males and 11 females.No significant differences were observed among the three groups in UDVA or UIVA(all P>0.05). Significant differences were found in UNVA among groups(P<0.05). UDVA differed significantly across different time points(P<0.05), while there were no significant differences in UIVA and UNVA(all P>0.05). At 3 mo postoperatively, significant differences were found among the three groups in OSI, MTF -cut off, SR, and CVA at all contrast levels(all P<0.05). The defocus curve at postoperative 1 mo showed that the Trifocal group had a smooth and continuous profile from +1.0 D to -3.0 D, providing good distance, intermediate, and near vision. All groups demonstrated smooth transitions in the intermediate range(-1.0 D to -1.5 D), with LogMAR visual acuity better than 0.2. In the near range(-2.5 D to -3.5 D), the Trifocal and Synergy groups performed significantly better than the Vivity group. No significant differences were observed in VF-14 questionnaire scores among groups(P>0.05). For night driving(motorized or non-motorized), the Vivity group performed better than the Trifocal and Synergy groups. Spectacle independence rates were 92.3% in the Trifocal group, 54.1% in the Vivity group, and 80.0% in the Synergy group(P<0.05).
CONCLUSION: All types of PC-IOLs can effectively improve postoperative full-range visual acuity in cataract patients. There are discrepancies in the objective visual quality between Trifocal IOLs and extended depth of focus(EDOF)IOLs. Some patients suffer from postoperative optical disturbances, which result in certain difficulties with night driving, although patients generally report favorable subjective visual perceptions.
