A More Natural Way of Seeing: Visual Performance of Three Presbyopia Correcting Intraocular Lenses

Purpose: To compare the visual and refractive outcomes, patient satisfaction and spectacle independence between three novel designs of diffractive IOLs. Method: Prospective study including 150 patients with implantation of three IOLs: trifocal diffractive IOL AT LISA tri 839 MP (ATLISA, n = 50), trifocal diffractive IOL PhysIOL FineVision (FineVision, n = 50) and the extended range of vision IOL Tecnis Symfony ZRX00 (Symfony, n = 50). Patients were followed up for 6 months after surgery. Major parameters were monocular and binocular uncorrected (UDVA) and corrected (CDVA) distance, uncorrected (UIVA) and distance corrected (DCIVA) intermediate (80 cm), and uncorrected (UNVA) and distance corrected (DCNVA) near (40 cm) visual acuities (UNVA), contrast sensitivity (CS), defocus curve as well as patient satisfaction and spectacle use. Results: Mean postoperative decimal UDVA was 1.01 for Symfony, 0.96 for ATLISA and 0.95 for the FineVision IOL. Postoperative UIVA was 0.95 with Symfony, 0.72 with ATLISA and 0.85 with the FineVision IOL. Postoperative UNVA was 0.96 with the FineVision, 0.72 with the ATLISA and 0.63 with the Symfony IOL. The Symfony defocus curve showed the smoothest profile. Mean mesopic CS was 0.84 log units with the Symfony, 0.83 with the ATLISA (0.83) and 0.65 with the FineVision IOL. Mean photopic CS with the Symfony, ATLISA and FineVision was 1.05, 0.85 and 0.69 log units, respectively. Twenty percent of the patients with the ATLISA and FineVision IOLs and 5.6% of the Symfony patients reported halos and glare as troublesome or disabling. Reading glasses were frequently used by 5.6% of the Symfony patients. All patients with the trifocal IOLs reported to be spectacle-free for any distance. Conclusion: All 3 IOLs produce excellent results with high levels of spectacle independence. The Symfony produces better levels of distance and intermediate visual acuity, whereas the trifocal IOLs produced better near vision. Higher frequency of dysphotopsia was seen with the trifocal IOLs.