Visual Performance, Optical Quality, and Patient-Reported Outcomes After Trifocal Lens Implantation in Patients With Clear Lens or Early Cataract.

Purpose

To evaluate visual and refractive outcomes, visual quality, patient satisfaction, and spectacle independence after bilateral implantation of a diffractive trifocal intraocular lens (IOL).

Methods

Thirty-three patients (66 eyes) underwent refractive lens exchange (54.5%) or cataract surgery (45.5%). Exclusion criteria included prior ocular surgery, corneal aberrations greater than 0.5 µm, and tear film instability. Refractive target was emmetropia. Toric IOLs were used for corneal astigmatism greater than 1.00 diopter (D). Objective optical quality metrics including Objective Scatter Index, modulation transfer function, Strehl ratio, and visual Strehl optical transfer function were measured before and after surgery. Patient-reported outcomes were assessed using the Catquest-9SF questionnaire.

Results

At 3 months (follow-up rate: 90.9%), manifest refraction spherical equivalent was 0.09 ± 0.34 D. Binocular uncorrected distance visual acuity at 4 m and 66 and 40 cm was 0.02 ± 0.10, 0.10 ± 0.09, and 0.12 ± 0.09 logarithm of the minimum angle of resolution, respectively. Defocus curve showed peaks at 0.00 and -2.50 D. Objective depth of field weakly correlated with subjective depth of field. Objective Scatter Index decreased insignificantly after cataract surgery but significantly increased following refractive lens exchange. Strehl ratio, modulation transfer function, and visual Strehl optical transfer function improved in all eyes (P < .05). Most patients reported minimal difficulty across Catquest-9SF domains. Spectacle independence was 93% for distance and intermediate and 87% for near vision. Photic phenomena were infrequent and mild. All patients expressed satisfaction.

Conclusions

Bilateral implantation of a diffractive trifocal IOL provided good optical performance at far, intermediate, and near distances, high patient satisfaction, and spectacle independence at 3 months. Subjective and objective DOF measurements are not interchangeable.