Comparison of Visual Performance and Optical Quality Between a Diffractive Trifocal Lens and an Extended Depth of Focus Lens

Purpose: To compare visual outcomes, optical properties, and subjective quality of vision between bilateral implantation of a diffractive trifocal intraocular lens (IOL), Alcon Acrysof IQ® PanOptix® TNFT00 (group A), and an extended depth of focus lens, J&J Tecnis Symfony® ZXR00 (group B) in patients with senile cataract. Methods: This prospective comparative study aimed to assess 80 eyes of 40 patients who were implanted with two different types of multifocal IOL each by one surgeon with a follow-up range of 3-18 months. Exclusion criteria were the existence of any ocular disorder and surgery other than cataract. Ophthalmological evaluation included plotting visual defocus curve considering monocular corrected distance visual acuity, and measurement of Binocular uncorrected visual acuity at far, intermediate and near distances. Quality of vision was assessed using VFQ25 questionnaire plus 5 more specified questions evaluating spectacle independence in each visual zone and subjective halo and glare status. Results: The total area under defocus curves were 86.65% and 66.41% for groups A and B, respectively. Considering different visual zones, the difference was more evident in the near zone (75.33% vs. 23.50%). The Binocular uncorrected visual acuities were significantly better for the group A at near (P<0.001) with no statistical significance difference at other distances. Total VFQ25 scores were 87.3 and 76.3 in groups A and B, respectively (P=0.015). Spectacle independence scores were greater in group A compared to B at near and intermediate zones (P<0.001). Scores for lack of halo were lower in group A but not statistically significant (P=0.166). Conclusion: Both lens combinations were able to provide good far visual acuity; however, for intermediate and specially near distances PanOptix lens showed significantly better performance than Symfony. Regarding spectacle independence, PanOptix Lens was notably better in near and intermediate distances but questionably in exchange for a bit more subjective halo disturbance.