Abstract
This meta-analysis aimed to evaluate the clinical outcomes following implantation of trifocal intraocular lenses (IOLs) or a hybrid multifocal-extended depth of focus (EDOF) IOL in cataract or refractive lens exchange surgeries. We examined 13 comparative studies with bilateral implantation of trifocal (898 eyes) or hybrid multifocal-EDOF (624 eyes) IOLs published through 1 March 2020. Better uncorrected and corrected near visual acuity (VA) were observed in the trifocal group (MD: − 0.143, 95% CI: − 0.192 to − 0.010, P < 0.001 and MD: − 0.149, 95% CI: − 0.217 to − 0.082, P < 0.001, respectively), while the hybrid multifocal-EDOF group presented better uncorrected intermediate VA (MD: 0.055, 95% CI: 0.016 to 0.093, P = 0.005). Trifocal IOLs were more likely to achieve spectacle independence at near distance (RR: 1.103, 95% CI: 1.036 to 1.152, P = 0.002). The halo photic effect was generated more frequently by the trifocal IOLs (RR: 1.318, 95% CI: 1.025 to 1.696, P = 0.031). Contrast sensitivity and subjective visual quality yielded comparable results between groups. Trifocal IOLs demonstrated better performance at near distance but apparently led to more photic disturbances. Our findings provided the most up-to-date and comprehensive evidence by comparing the benefits of advanced IOLs in clinical practice.
Highlights
The ultimate goal of cataract treatment, presbyopia correction and refractive lens exchange (RLE) surgery is to reduce dependence on spectacles and attain full range of vision from near to far d istances[1]
13 studies which reported on 898 eyes (449 patients) implanted with trifocal intraocular lenses (IOLs) and 624 eyes (312 patients) implanted with the hybrid multifocal-extended depth of focus (EDOF) IOL were included in the meta-analysis
Our results suggested that trifocal IOLs were 32% more likely to generate a halo effect (RR: 1.318, 95% confidence intervals (CIs): 1.025 to 1.696, P = 0.031)
Summary
The ultimate goal of cataract treatment, presbyopia correction and refractive lens exchange (RLE) surgery is to reduce dependence on spectacles and attain full range of vision from near to far d istances[1]. Initial studies concerning the visual outcomes of trifocal IOLs, such as the FineVision Micro F IOL (PhysIOL Liege, Belgium) and the AT LISA tri 839MP IOL (Carl Zeiss Meditec AG, Jena, Germany) have demonstrated promising results[3,7,8,9,10,11,12,13] Another trifocal IOL design, the AcrySof IQ PanOptix IOL (Alcon Surgical, Inc., Fort Worth, TX), which diffracts the light from the first focal point to the distance focus, achieves a more natural transition from intermediate to far distance with improved visual o utcomes[14]. We have conducted an up-to-date and comprehensive metaanalysis of the existing randomized controlled trials (RCTs) and prospective cohorts to compare the visual performance, spectacle independence and photic disturbance of trifocal IOLs and the hybrid multifocal-EDOF IOL after cataract or RLE surgeries
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