Visual outcome and optical quality after implantation of zonal refractive multifocal and extended-range-of-vision IOLs: a prospective comparison

Purpose: To compare the visual outcomes and optical quality of 2 presbyopia-correcting intraocular lenses (IOLs) with those of a monofocal IOL. Settings: Eye Center, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China. Design: Prospective cohort study. Methods: The study included patients who had cataract surgery and were implanted with a Tecnis Symfony Extended Range of Vision (EROV) IOL (ZXR00), a zonal refractive multifocal IOL (Lentis Comfort LS-313 MF15), or a monofocal IOL (Lentis L-313). Postoperative examinations took place at 1 week, 1 month, and 3 months and included visual acuity at far, intermediate, and near distances, defocus curves, contrast sensitivity, wavefront aberrations, and modulation transfer function (MTF). Patients completed the Visual Function Index questionnaire (VF-14), the Quality of Vision questionnaire (QoV), and a visual quality self-evaluation. Results: One hundred thirteen patients were enrolled. The EROV and multifocal IOLs achieved a significantly better range of intermediate vergences ( P < .05), better distance-corrected intermediate visual acuity ( P ≤ .001), higher VF-14 ( P < .05) and visual quality self-evaluation scores ( P < .05) than the monofocal IOL, but there were no significant differences between the 2 presbyopia-correcting IOLs. The EROV provided lower total wavefront aberrations and better MTF than the multifocal and the monofocal IOLs ( P < .05) but demonstrated a worse QoV score ( P < .05), especially for severity of halo ( P < .01) and starburst ( P < .05) symptoms. Conclusions: Both the Tecnis Symfony ZXR00 and the Lentis Comfort LS-313 MF15 offered excellent visual restoration and stable distance and intermediate visual acuity, good subjective visual function, and good contrast sensitivity. The EROV IOL provided better objective optical quality and more prominent dysphotopsia symptoms than the multifocal IOL.