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Original article

Trifocal Versus Monofocal Intraocular Lenses: A Prospective Assessment of Visual Outcomes and Patient-Reported Satisfaction

Arnab Sadhukhan ORCID
Vikas Sharma ORCID – Vikas Sharma ORCID – Thory Prakash Tilokaram ORCID – Vipin Rana ORCID – Gaurav Kapoor ORCID – Sanjay Kumar Mishra ORCID

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Keywords: contrast sensitivity, monofocal intraocular lens, patient satisfaction, phacoemulsification, trifocal intraocular lens, visual acuity

Summary

Aims: To compare trifocal versus monofocal intraocular lenses in terms of postoperative visual outcomes and patient satisfaction.

Material and Methods: In this prospective comparative study, 60 eyes of 46 patients with senile cataract were assigned in a 1:1 ratio to a trifocal IOL (AT LISA tri 839MP, Carl Zeiss Meditec) and a monofocal IOL (CT ASPHINA 203MP/603MP, Carl Zeiss Meditec). The following metrics were assessed before surgery at one, three, and six weeks after the procedure: uncorrected distance visual acuity (UDVA), best-corrected visual acuity (BCVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), and contrast sensitivity. Using the Near Activity Visual Questionnaire (NAVQ), patient satisfaction as reported by patients was compared between both groups.

Results: Mean UDVA after 6 weeks postoperatively was comparable between the trifocal and monofocal group (p = 0.27). Compared to monofocal IOLs, trifocal IOLs had superior uncorrected intermediate visual acuity (UIVA: 0.10 ±0.05) and uncorrected near visual acuity (UNVA: 0.08 ±0.03). Contrast sensitivity, assessed using the Pelli-Robson chart, was similar between the two groups at 6 weeks (p=0.31). 93% of patients in the trifocal group reported being independent of their glasses for everyday tasks, indicating improved patient satisfaction, compared to 18% of patients in the monofocal cohort.

Conclusion: When compared to monofocal IOLs, trifocal IOL implantation after phacoemulsification provides superior distance, intermediate, and near visual acuity, along with high levels of spectacle independence and patient satisfaction, without sacrificing contrast sensitivity.

References

  1. Miret JJ, Camps VJ, García C, Caballero MT, Sempere-Molina A, Gonzalez-Leal JM. Analysis of the Effect of Pupil Size and Corneal Aberration on the Optical Performance of Premium Intraocular Lenses. Journal of Clinical Medicine. 2025;14(15):5336.
  2. Ristvedt D, Bosc C, Thompson V. Clinical outcomes of a hydrophobic diffractive trifocal intraocular lens (FineVision HP): review of 18 clinical studies (2019–2024). Frontiers in Medicine. 2025.
  3. Can E, Senel EC, Holmström STS, Piñero DP. Comparison of the optical behaviour of five different multifocal diffractive intraocular lenses in a model eye. Scientific Reports. 2023;13:19646.
  4. Tañá-Sanz S, Tañá-Sanz P, Rodríguez-Carrillo MD, Ruiz-Santos M, de Toledo CÁ, Tañá-Rivero P. Clinical Outcomes of a Bi-Aspheric Trifocal Diffractive Intraocular Lens. Clin Ophthalmol. 2024 Jan 4;18:27-40.
  5. Cano-Ortiz A, Sánchez-Ventosa Á, Villalba-González M, et al. Clinical and Patient Reported Outcomes of an Optimized Trifocal Intraocular Lens. J Clin Med. 2024 Jul 15;13(14):4133.
  6. Nomura Y, Ota Y, Fujita Y, et al. Clinical outcomes in eyes with diffractive continuous depth-of-focus intraocular lenses enhanced for near vision: comparison with trifocal intraocular lenses. BMC Ophthalmol. 2023 Nov 21;23(1):475.
  7. Zhang W, Peng T, Cheng X, et al. Comparison of postoperative visual performance between trifocal intraocular lens and monofocal intraocular lens. Saudi Med J. 2023 May;44(5):456-462.
  8. Gatinel D, Pagnoulle C, Houbrechts, Gobin L. Design and qualification of a diffractive trifocal optical profile for intraocular lenses. J Cataract Refract Surg. 2011;37: 2060-2067.
  9. Mojzis P, Peña-García P, Liehneova I, Ziak P, Alió JL. Outcomes of a new diffractive trifocal intraocular lens. J Cataract Refract Surg. 2014 Jan;40(1):60-69.
  10. Kretz FT, Müller M, Gerl M, Gerl RH, Auffarth GU. Binocular function to increase visual outcome in patients implanted with a diffractive trifocal intraocular lens. BMC Ophthalmol. 2015 Aug 21;15:110.
  11. Sheppard AL, Shah S, Bhatt U, Bhogal G, Wolffsohn JS. Visual outcomes and subjective experience after bilateral implantation of a new diffractive trifocal intraocular lens. J Cataract Refract Surg. 2013 Mar;39(3):343-349.
  12. Meng J, Fang Y, Lian J, et al. Visual and patient-reported outcomes of a diffractive trifocal intraocular lens in highly myopic eyes: a prospective multicenter study. Eye Vis (Lond). 2023 Apr 6;10(1):19.
  13. Cochener B, Vryghem J, Rozot P, et al. Visual and refractive outcomes after implantation of a fully diffractive trifocal lens. Clin Ophthalmol. 2012;6:1421-1427.
  14. Talan M, Penbe A, Akcay G. Comparision of a Novel Trifocal Intraocular Lens and a Monofocal Enhanced Depth of Focus Intraocular Lens in Visual Performance and Quality of Life Scores. Beyoglu Eye J. 2025 Mar 25;10(1):1-8.
  15. Ristvedt D, Bosc C, Thompson V. Clinical outcomes of a hydrophobic trifocal diffractive intraocular lens: a literature review. Front Med (Lausanne). 2025 Jan 22;12:1533161.
  16. Gil MÁ, Varón C, Cardona G, Buil JA. Far and Near Contrast Sensitivity and Quality of Vision with Six Presbyopia Correcting Intraocular Lenses. J Clin Med. 2022 Jul 17;11(14):4150.
  17. Kretz FT, Müller M, Gerl M, Gerl RH, Auffarth GU. Binocular function to increase visual outcome in patients implanted with a diffractive trifocal intraocular lens. BMC Ophthalmol. 2015 Aug 21;15:110.