Clinical comparison of patient outcomes following implantation of trifocal or bifocal intraocular lenses: a systematic review and meta-analysis

Abstract

To assess the visual effects of trifocal intraocular lenses (IOLs) compared to bifocal IOLs in cataract surgery, a meta-analysis of prospective comparative clinical trials (including 4 randomized controlled trials and 4 cohorts) was conducted. The defocus curves showed a better distance-corrected intermediate visual acuity (VA) for the trifocal group (MD -0.07; 95% CI, -0.10 to -0.05; p < 0.00001), while the VA outcomes showed no significant difference in distance VA (MD -0.03; 95% CI, -0.06 to 0.01; p = 0.13 for uncorrected distance VA and MD -0.00; 95% CI, -0.01 to 0.01; p = 0.78 for distance-corrected distance VA), near VA (MD -0.01; 95% CI, -0.07 to 0.04; p = 0.68 for uncorrected near VA and MD -0.01; 95% CI, -0.06 to 0.04; p = 0.66 for distance-corrected near VA) or refraction between the two groups. Contrast sensitivity and subjective visual quality yielded less conclusive results. Overall, a patient may achieve better intermediate VA with a trifocal IOL than with a bifocal IOL without any adverse effect on distance or near VA. The findings on contrast sensitivity and subjective visual quality were heterogeneous, with no clear results favoring either option.

Figure 1. Flow chart showing selection of articles.

IOL = intraocular lens; RCTs = randomized controlled trials.

Figure 2. Pooled mean differences (MDs) for uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA) and distance-corrected near visual acuity (DCNVA) in logMAR by meta-analysis.

(a) Forest plot showing the MD of UDVA comparing trifocal intraocular lens (IOL) with bifocal IOL postoperatively (only for RCTs). (b) Forest plot showing MD of CDVA comparing trifocal IOL with bifocal IOL postoperatively (only for RCTs). (c) Forest plot showing the MD of UNVA comparing trifocal IOL with bifocal IOL postoperatively. (d) Forest plot showing the MD of DCNVA comparing trifocal IOL with bifocal IOL postoperatively.