A Novel Standardized Test System to Evaluate Dynamic Visual Acuity Post Trifocal or Monofocal Intraocular Lens Implantation: a Multicenter Study

Objectives: To compare the dynamic visual acuity (DVA) following implantation of trifocal with monofocal intraocular lenses (IOL) and using a novel test system.

Methods: The present research was a retrospective, multicenter clinical study. Two hundred and ten eyes of 149 patients that underwent cataract phacoemulsification and IOL implantation were enrolled. One hundred and ten eyes of patients received trifocal (AT LISA tri839MP, Carl Zeiss Meditec, Germany) and 100 eyes received monofocal (Tecnis ZCB00, Abbott, United States) lenses and were evaluated 3 months after implantation. Outcome measures included monocular uncorrected distance (UDVA), intermediate (UIVA) and near (UNVA) visual acuity and best corrected distance visual acuity (BCDVA; logMAR units); contrast sensitivity under photopic, mesopic, with glare conditions; and dynamic visual acuity using a self-developed system.

Results: There was no statistically significant difference in baseline characteristics between groups. Monocular UDVA, UIVA, and UNVA were significantly better (all p < 0.001) in the trifocal IOL group, but not BCDVA. The trifocal IOL group showed better contrast sensitivity under photopic, mesopic, with or without glare conditions (p < 0.05) and statistically significantly better dynamic vision at 15, 30, 60, and 90 degrees per second (dps) compared with the monofocal group (all p < 0.001). The strength of positive association only between UIVA and dynamic visual acuity increased as the velocity increased, but not UDVA or UNVA.

Conclusions: Diffractive trifocal IOL provides better postoperative full range vision acuity, contrast sensitivity, and dynamic vision compared with monofocal IOLs. And intermediate visual acuity is increasingly associated with DVA as the velocity increasing.