This study compares the performance of 2 diffractive trifocal and 1 extended depth-of-focus (EDOF) IOLs.

Study design

This study assessed the visual outcomes of 60 patients who were equally randomized to receive the trifocal AcrySof IQ PanOptix, the trifocal FineVision Micro F, or the EDOF Tecnis Symfony IOL. All patients expressed a desire for decreased spectacle dependence, with an Ocular Scatter Index of greater than 2 and a cylinder of less than 0.75 D. The study excluded patients with amblyopia, ocular surface disease, macular or retinal abnormalities, glaucoma, diabetes mellitus, inflammatory disease, or other systemic diseases.

At 6 months, the authors assessed and compared the groups’ self-reported quality of vision; manifest refraction; and monocular and binocular near, intermediate, and distance vision.

Outcomes

The Symfony, which was targeted for myopia, had a lower percentage of manifest refraction within 0.5 D than either the FineVision or the AcrySof (18% vs 73% and 76%, respectively), although all 3 IOLs yielded similar monocular and binocular uncorrected distance vision.

In terms of intermediate vision, there were no significant statistical differences. The EDOF IOL did perform better than the trifocal IOLs when targeted for emmetropia, however. Near vision was the only measured category to show a significant statistical difference, with the trifocal IOLs outperforming the EDOF IOLs.

Approximately 90% of patients achieved spectacle independence and all IOL groups achieved a good quality of vision.

Limitations

Although there were no statistical differences in intermediate vision, the authors only measured it at 60 cm and the FineVision Micro F may actually perform better at 70 to 80 cm. The visual targets for each IOL were also limited. The trifocal IOLs were targeted for emmetropia and the EDOF IOL was targeted for micro-monovision, which skews the refractive distribution toward myopic values. Finally, longer follow-up times might have improved the study’s ability to assess the stability of outcomes and development of posterior capsule opacification.

Clinical significance

Trifocal lenses are not yet available in the United States, but that may change in the near future. The EDOF and bifocal IOLs, which are available, can provide a decreased spectacle dependence as shown by the EDOF Symfony in this study. However, these lenses have limited effects on monocular intermediate or near vision. Mixing and matching IOLs is performed in an off-label fashion to increase binocular depth of focus, yet trifocals offer the opportunity for full monocular and binocular depth of focus. As such, refractive cataract surgeons should be fully aware of this emerging technology so that they can deliver optimal results.