Balancing Optical Quality And Spectacle Independence: Clinical Outcomes Of Multifocal Versus Monofocal Iols

To compare visual and refractive outcomes, contrast sensitivity, higher-order aberrations, posterior capsule opacification (PCO) rate, patient satisfaction, and perioperative complications in eyes implanted with presbyopia-correcting intraocular lenses (FVR IOL,  EDoF IOL and low-add bifocal IOL) versus monofocal IOLs during a 12-month follow-up period.

University Eye Hospital Svjetlost, Zagreb, Croatia

This comparative clinical study included patients undergoing cataract surgery with implantation of either prebyopia-correcting IOLs (FVR IOL,  EDoF IOL and low-add bifocal IOL) or monofocal IOLs. Evaluations were performed at 1 week, 1 month, 6 months, and 12 months postoperatively. Outcome measures included uncorrected and corrected distance, intermediate, and near visual acuity; manifest refraction; contrast sensitivity under photopic and mesopic conditions; higher-order ocular aberrations; incidence of PCO and Nd:YAG capsulotomy; patient satisfaction; photic phenomena; and intraoperative and postoperative complications. Intra- and intergroup analyses were performed.

All groups showed significant improvement in distance visual acuity and reduction in spherical and cylindrical refractive error. Presbyopia-correcting IOLs achieved significantly better uncorrected and corrected intermediate and near visual acuity than monofocal IOLs (p<0.01). Spherical and coma aberrations decreased, with a shift toward negative spherical aberration. Contrast sensitivity declined early postoperatively in all groups and remained lower in presbyopia-correcting IOLs under photopic and mesopic conditions. PCO ranged from 13.6–33%. Satisfaction exceeded 80%, higher for near vision in multifocal IOLs. Complications were infrequent.

FVR, EDoF and bifocal IOLs provided superior intermediate and near visual acuity and reduced spectacle dependence compared with monofocal IOLs, with high levels of patient satisfaction at 12 months. These benefits were accompanied by reduced contrast sensitivity, while overall safety profiles were comparable between groups. Careful patient selection remains essential to optimize outcomes.