Visual Outcomes After Trifocal Iol Implantation: An Age-Based Comparative Study
Published 2026 - 44th Congress of the ESCRS
Reference: FP32.14 | Type: Free paper | DOI: 10.82333/vgwm-vc78
Authors: Dr Javier H. Humberto Gonzalez-Lugo* 1 , Dr Hao Zhang 1 , Dr Ronald Steven Medalle II 1 , Dr Mario Cantó-Cerdán 1 , Dr Antonio Martinez-Abad 1 , A/Prof. Jorge L. Alió 1 , Dr Carlos Moreno-Pascual 1 , Dr Sol Benbunan-Ferreiro 1 , A/Prof. Jorge L. Alió del Barrio 1
1Vissum Grupo Miranza,Alicante,Spain
Purpose
To determine whether advancing age independently affects functional visual outcomes after diffractive trifocal IOL implantation, specifically distance-corrected near visual acuity (DCNVA), while maintaining comparable refractive outcomes across age groups.
Setting
Retrospective observational cohort study conducted at a tertiary referral center (Vissum, Miranza Group), Alicante, Spain.
Methods
A total of 455 eyes from 249 patients undergoing uncomplicated phacoemulsification with diffractive trifocal IOL implantation (November 2019–February 2025) were included. All patients were candidates for trifocal IOL based on a strictly normal preoperative ophthalmic examination, except for cataract, with normal macular OCT in all cases. Eyes were stratified into three age groups: <60, 60–69, and ≥70 years. The primary endpoint was postoperative DCNVA (logMAR). Secondary outcomes included UDVA, CDVA, UNVA, refractive parameters, axial length, and anterior chamber depth. Linear mixed-effects models accounted for inter-eye correlation.
Results
Postoperative refractive outcomes were comparable across age groups, with mean spherical equivalent near emmetropia (−0.10 ± 0.33 D) and no significant differences in sphere or near addition (p > 0.05). In contrast, near visual performance declined with age. Mean DCNVA worsened from 0.074 logMAR (<60 years) to 0.162 logMAR (≥70 years) (p < 0.001). Patients ≥70 years showed significantly worse DCNVA than younger groups. Other visual acuity metrics showed a similar trend, with modest but significant reductions in both distance and near performance with advancing age.
Conclusions
Diffractive trifocal IOL implantation provided consistently high refractive accuracy across all age groups. Nonetheless, visual performance; particularly at near; declined significantly with advancing age, with a more pronounced effect beyond the seventh decade. These findings suggest that age-related optical and neurovisual changes may modulate functional outcomes independently of refractive precision. Careful preoperative counseling and individualized IOL selection should therefore be considered when managing older candidates for trifocal implantation.