The percentage of cataract patients seeking spectacle independence with presbyopia-correcting IOLs is increasing. Multifocal IOLs have provided functional distance and near vision in patients undergoing cataract surgery and refractive clear lens exchange. The main limitations with bifocal presbyopia-correcting implants have included dysphotopsias such as halos and glare and poor intermediate vision. Trifocal IOLs were developed to add a third foci and improve intermediate function. There have been numerous studies comparing visual outcomes and patient satisfaction with bifocal and trifocal IOLs.
Assessing patient satisfaction can be challenging, because the subjective perception of each patient to an identical objective stimulus, like an IOL, can be highly variable. The aim of this study by Bucci Jnr was to directly compare patient preference and visual quality of the bifocal +3.25 Tecnis IOL to the trifocal PanOptix IOL when one of each is implanted in the same patient. The purpose was not only to quantitate levels of satisfaction and preference, but also to determine "why" they preferred one IOL over another.
Patients received a +3.25 Tecnis bifocal IOL in one eye and a PanOptix trifocal IOL in the opposite eye. Eyes were unilaterally evaluated and included UDVA, UIVA, UNVA, mesopic contrast sensitivity testing, and subjective questionnaires about overall satisfaction, and IOL preference.
Sixty eyes of thirty patients were evaluated. Patients preferred (p=0.028) +3.25 to PanOptix. Overall satisfaction was significantly greater (p=0.05) for +3.25 (4.70 vs 4.43/5.00). UDVA (p=0.032) and "freq. of glasses use distance" (p=0.05) were significantly better for +3.25 eyes. Objective intermediate (Jaeger) vision was significantly better (p=0.034) for PanOptix eyes. "Freq. of glasses use intermediate" favored +3.25. Regression revealed variables related to intermediate vision and "ability to read fine print without glasses" were significant predictors of overall satisfaction for both IOLs. Variables related to contrast sensitivity both with and without glare were significant predictors exclusively for PanOptix eyes.
Despite achieving better objective uncorrected intermediate vision with a trifocal IOL, patients still prefer and can achieve greater levels of overall satisfaction with a bifocal IOL.
Regression analysis strongly suggested that issues related to contrast sensitivity may be responsible for the patient's subjective preference for the bifocal IOL.
Source: Bucci Jnr; Clinical Ophthalmology 2022:16
https://doi.org/10.2147/OPTH.S388462