gms | German Medical Science

Purpose: Cataract surgery with trifocal intraocular lens (IOL) implantation aims for good quality vision and high spectacle independence. Various approaches have been proposed, which include a conventional trifocal, an extended depth-of-focus (EDoF) trifocal, or a complementary system. This study aimed to compare the optical quality and the range of vision of contemporary presbyopia-correcting technology using an optical bench.

Methods: Three IOL models were included, a conventional trifocal – AT LISA Tri (Carl Zeiss Meditec), an EDoF trifocal – Triumf POD L GF (PhysIOL), and an Artis Symbiose complementary system (Cristalens Industrie), which consists of MID and PLUS models to achieve binocular trifocality. The IOLs’ polychromatic optical performance was assessed, considering spherical and chromatic aberrations. The weighted optical transfer function was calculated and used as a parameter to simulate postoperative visual acuity.

Results: The EDoF trifocal demonstrated the highest optical quality and the far-point, which was followed by the conventional trifocal and the complementary system. However, the MID model yielded more extended intermediate, while the PLUS produced improved near. In the simulated binocular vision, the complementary approach resulted in a 16% larger area under the defocus curve across the intermediate and near range. The EDoF trifocal demonstrated a greater intermediate area than the conventional approach, but it was reversed at near.

Conclusions: The complementary system has the potential to extend patients’ visual range through binocular trifocality. Besides distance vision, the EDoF trifocal model favors the intermediate distance while the conventional trifocal favors near, indicating differences in energy distribution.