Abstract
Purpose :
To compare the efficacy between trifocal and bifocal diffractive intraocular lens (IOL) implantation in presbyopic patients who underwent cataract surgery or refractive lens exchange
Methods :
Through Pubmed, Medline, Embase, and Cochrane Controlled Trials Register, we searched potentially relevant articles published from 1990 to 2016. Distance, intermediate, and near visual acuities (VAs) and defocus curves were measured as primary outcomes. Spectacle dependence, postoperative refraction, higher-order aberrations (HOAs), and contrast sensitivity (CS) were measured as secondary outcomes. Effects were pooled using random-effects method. Relative risk (RR), mean difference (MD), and 95% confidence intervals (CI) were used to compare the parameters.
Results :
Among the 124 studies, 5 randomized controlled trials were selected, with a total of 260 eyes of 130 subjects. The trifocal IOL showed better monocular uncorrected distance VA than the bifocal IOL (MD, -0.03 logMAR; 95% CI, -0.06 to 0.00; P=.03). The proportion of patients who did not achieve binocular uncorrected intermediate VA of 0.1 logMAR was lower in the trifocal IOL (7.7%) than in the bifocal IOL (43.5%) (RR, 0.18; 95% CI, 0.04 to 0.75; P=.02; Fig. 1). The trifocal IOL showed better binocular distance VA corrected with defocus levels of -1.0, -1.5, and -2.5 diopter (D) than the bifocal IOL (All P≤.001; Fig. 2). No significant differences were found between the two groups in monocular uncorrected intermediate and near VAs; monocular corrected distance, intermediate, and near VAs; and binocular distance, intermediate, and near VAs. Spectacle dependence was lower in the trifocal IOL (10.0%) than in the bifocal IOL (29.2%) with marginal significance (RR, 0.38; 95% CI, 0.13-1.13; P=.08). Refractive cylinder was higher in the bifocal IOL than in the trifocal IOL (MD, 0.18 D; 95% CI, 0.07 to 0.28; P=.001). Spherical equivalent, CS, and HOAs were not significantly different from each other.
Conclusions :
The overall findings indicate that both bifocal and trifocal IOLs provide comparable distance and near VAs. Trifocal IOL implantation may provide better intermediate VA and greater spectacle independence.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.