Aka Report 2: One Year Real-World Data Of Visual Performance, Patient Satisfaction, And Spectacle Independence With Three Presbyopia-Correcting Iols Versus Monofocal Iol: A Prospective Comparative Study

To compare visual outcomes, patient satisfaction, and spectacle independence following bilateral implantation of three intraocular lenses (IOLs) with different optical approaches to enhance intermediate vision (AcrySof® IQ Vivity®, TECNIS Eyhance ICB00, and LuxSmart™) versus a standard monofocal IOL (CT ASPHINA 409M) in cataract surgery.

Augenklinik Ahaus - Fachkrankenhaus, Ahaus, North Rhine-Westphalia, Germany.

Prospective, single-center, comparative clinical trial with patient-preference methodology. Consecutive adults aged 22–85 years undergoing bilateral cataract surgery were enrolled between 2022 and 2024, selecting independently their preferred IOL based on individualized comprehensive counseling. Evaluations included uncorrected and best distance-corrected visual acuity at distance (4m), intermediate DCIVA (80cm, 60cm), and near DCNVA (40cm), binocular defocus curves, depth of focus (DOF) analysis at 0.1 and 0.2 logMAR thresholds, contrast sensitivity under photopic, mesopic, and mesopic-with-glare conditions, and validated questionnaires (VF-14, McAlinden's Quality of Vision). Follow-up at 1 day, 1 week, 1 month, 3 months, and 12 months.

Eighty-nine patients (178 eyes; 44.9% male; mean age 67.2±6.3 years) completed 12-month follow-up. Corrected distance visual acuity was comparable across all IOLs (P>0.05). At 80 cm, LuxSmart, Vivity, and Eyhance achieved better monocular DCIVA than CT ASPHINA (−0.105, −0.103, −0.100 logMAR; all P<0.01). At 60 cm, Vivity outperformed CT ASPHINA (−0.106 logMAR; P<0.001) and Eyhance (−0.063 logMAR; P=0.043). Significant DCNVA gain was observed only with Vivity (−0.062 logMAR; P=0.044). Negative-side DOF (0.2/0.1 logMAR) was greatest with Vivity (−1.88/−1.56 D). Contrast sensitivity favored CT ASPHINA and Eyhance. Intermediate spectacle independence was 92% (Vivity), 90.5% (LuxSmart), and 89.5% (Eyhance); satisfaction ≥90.5% across groups.

The three IOLs with different optical approaches to enhance intermediate vision demonstrated clinically significant improvements in intermediate visual performance compared to monofocal IOL while maintaining excellent distance vision. AcrySof IQ Vivity provided the broadest depth of focus with better performance at 60 and 40 cm. LuxSmart showed significant improvement at 80 cm with excellent spectacle independence for intermediate activities. Eyhance delivered significant intermediate gains at 80 cm while preserving contrast sensitivity comparable to monofocal reference. All three IOLs demonstrated excellent safety and satisfaction supporting individualized IOL selection based on patient visual needs.