Subjective visual quality after bilateral implantation of three diffractive trifocal intraocular lenses: A prospective randomized clinical trial.

PURPOSE: To compare subjective visual quality and patient-reported outcomes after bilateral implantation of three diffractive trifocal intraocular lenses (IOLs): AT LISA tri 839MP, AcrySof IQ PanOptix, and Tecnis Synergy.

DESIGN

Prospective, randomized, comparative clinical trial.

METHODS

Forty-three patients with bilateral cataract were randomized to one of the three trifocal IOL models. A single surgeon used standardized techniques, and assessments were performed 3 months after second-eye surgery. Subjective visual quality was evaluated using three validated patient-reported outcome measures: Cataract TyPE Spec (TyPE), Near Activity Visual Questionnaire (NAVQ), and Catquest-9SF (Rasch-modeled). Outcomes included global and item-level scores, satisfaction, and photic phenomena. Nonparametric tests (Kruskal-Wallis; Mann-Whitney U with Bonferroni) were applied at the patient level.

RESULTS

All IOLs yielded high visual function and satisfaction, with ceiling effects across questionnaires. The median TyPE global scores were 56 (AT LISA tri), 54 (PanOptix), and 59 (Synergy) ( P = 0.322). NAVQ indicated minimal difficulty with near/intermediate tasks ( P = 0.127). The Catquest-9SF Rasch person measures were -3.52 ± 0.77, -3.64 ± 0.35, and -3.79 ± 0.29, respectively ( P = 0.221). One TyPE intermediate-vision item favored Synergy over PanOptix ( P = 0.015). Photic phenomena were infrequent and comparable among groups.

CONCLUSIONS

All three diffractive trifocal IOLs provided excellent subjective visual performance, satisfaction, and spectacle independence. Although Synergy showed a slight advantage for intermediate tasks, overall differences were minimal, supporting consistently high patient-reported outcomes with current trifocal optics.