Beyond Visual Acuity: Digital Functional Vision Assessment Reveals Real-World Performance After Premium Iol Implantation

Premium (IOL) technologies aim to improve visual performance at multiple distances and reduce spectacle dependence. However, conventional visual acuity testing may not fully capture functional visual performance during everyday activities such as reading, digital screen use or night driving. This study evaluated whether digital functional vision assessment combined with patient-reported outcome measures provides additional insight into real-world visual performance after implantation of different IOL technologies and whether these measures may support more personalized IOL selection in routine clinical practice.

Single-center eye clinic. Patients who underwent cataract surgery with implantation of monofocal, EDOF, or trifocal IOLs between 2022 and 2025 were evaluated postoperatively under standardized clinical conditions with consistent testing protocols and controlled lighting environments.

An observational cohort study included 74 patients who underwent uneventful cataract surgery with implantation of monofocal, EDOF, or trifocal IOLs between 2022 and 2025. Visual performance was assessed using ETDRS charts at far, intermediate, and near distances. Digital functional testing with a tablet-based mHealth application generated an algorithm-derived composite functional visual performance score from standardized tasks and calibrated simulations of everyday near (30–40 cm) and intermediate (60–80 cm) viewing. Patient-reported outcomes were collected using the Near Activity Visual Questionnaire (NAVQ) and the Quality of Vision (QoV) questionnaire. Defocus curves were generated to analyse functional visual range.

All IOL groups demonstrated significant postoperative improvement in visual acuity for far distance. Premium IOL technologies provided greater spectacle independence and improved performance for intermediate and near tasks. Functional visual performance scores showed significant association with NAVQ and QoV outcomes (p<0.05). Assessment based on simulated real-life visual tasks reflected patient-perceived visual quality and helped characterise differences among IOL technologies beyond standard visual acuity, particularly for intermediate and near visual demands.

Digital functional vision assessment combined with patient-reported outcomes provides additional insight into real-world visual performance after cataract surgery. Integrating these tools with traditional visual acuity testing may improve evaluation of visual quality and support more personalized IOL selection in modern cataract and refractive surgery. These approaches may also enhance preoperative counseling, postoperative outcome assessment, and alignment between patient expectations and visual experience, while contributing to more standardized assessment of visual outcomes across IOL types and clinical settings.