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

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.