Trifocal intraocular lenses (IOLs) provide better binocular distance-corrected near visual acuity (VA) than extended depth of focus (EDOF) IOLs, according to research published in the Canadian Journal of Ophthalmology.

Researchers conducted a prospective, randomized study of 67 patients who underwent bilateral cataract surgery and received either EDOF or trifocal IOL implantation. They conducted follow-up visits 3 months after the surgeries in which they measured binocular visual acuity and administered a questionnaire to assess quality of life (QOL).

The team noted significantly better distance-corrected near (40 cm) VA in patients with trifocal IOLs compared with those who underwent EDOF IOL implantation (0.054 vs 0.228 logMAR; P <.0001). They did not observe statistically significant differences in distance-corrected intermediate (60 cm) or distance (6 m) VA between the 2 groups. 

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The 10% contrast VA test for both groups indicated an approximate 2-line reduction in distance and near VA, which did not decrease when glare was induced with a flashlight or cellular phone. 

QOL analysis revealed that 62% of patients with trifocal IOLs had little or no difficulty performing tasks described in the assessment compared with 48% in the EDOF group. Patients with trifocal IOLs reported less difficulty in reading newspapers, doing fine handwork, or writing checks compared with individuals implanted with EDOF lenses. Patients with EDOF lenses were less likely to have difficulty recognizing people at a distance, going to movies,  shaving, and styling hair, but these differences were small and may have arisen strictly by chance, according to the report. 

“Our study identifies differences between these 2 implants early after surgery, some of which are likely related to their inherent optical properties and design,” according to the researchers. “The information presented will help to better counsel patients before cataract surgery.”

Study limitations include the lack of a standardized method of assessing the effect of glare on 10% contrast VA, subjectivity of the QOL questionnaire, small sample size, and short follow-up duration.

Disclosure: This research was supported by Alcon. One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Scheepers MA, Bunce CB, Michaelides M, Hall B. Clinical outcomes of a trifocal compared with an EDOF IOL following bilateral cataract surgery. Can J Ophthalmol. Published online June 1, 2022. doi:10.1016/j.jcjo.2022.05.005