Medium-term visual and refractive outcomes in patients with pseudoexfoliation implanted with a toric or multifocal intraocular lens.

PURPOSE: To report medium-term visual acuity and refractive outcomes of patients with pseudoexfoliation implanted with toric or multifocal intraocular lenses (IOLs). METHODS: We retrospectively reviewed patients with pseudoexfoliation who had undergone phacoemulsification between 2016 and 2020 with at least 24 months follow-up. RESULTS: Mean follow-up was 44.17 ± 14.95 months. Toric IOLs were implanted in 48 eyes: mean uncorrected LogMAR visual acuity one month after surgery was 0.03 ± 0.09, decreasing to 0.08 ± 0.11 at the last visit (p = .01). Mean refractive cylinder was -0.12 ± 0.36 diopters one month after surgery and -0.25 ± 0.44 diopters at the last follow-up visit, p = .012. Multifocal IOLs were implanted in 42 patients: binocular uncorrected distance visual acuity was -0.02 ± 0.04 one month after surgery and 0.01 ± 0.05 at the last visit (p = .004); near acuity was 0.01 ± 0.03 and 0.04 ± 0.06 respectively (p = .001). In eyes with pseudoexfoliation, absolute spherical equivalent prediction error was 0.22 ± 0.20 diopters for toric and 0.21 ± 0.19 diopters for multifocal IOLs. One month after surgery 68.6% of eyes with toric IOLs and 74.2% of eyes with multifocal IOLs were within ±0.25 diopters of target spherical equivalent and 91.6% and 90.5% were within ±0.5 diopters, respectively. Spherical equivalent did not change significantly during follow-up for either group. CONCLUSION: Prediction error in eyes with pseudoexfoliation implanted with toric or multifocal IOLs was low and similar to values reported for normal eyes. Postoperative refractive cylinder with toric IOLs was low, with little change during follow-up. Visual function in patients receiving multifocal IOLs was excellent. Therefore, the implantation of these IOLs in eyes with pseudoexfoliation does not seem to cause medium-term problems.

Visual Performance of Eyes with Residual Refractive Errors after Implantation of an Extended Vision Intraocular Lens.

Background: To analyze the tolerance on distance vision of different combined residual astigmatic situations in patients implanted with a novel wavefront shaping extended depth of focus (EDoF) intraocular lens (IOL). Methods: The study included patients implanted with the Acrysof® IQ Vivity® IOL. Uncorrected (UDVA) and corrected distance visual acuity (CDVA) were measured three months after surgery, considering CDVA as the reference situation of the study. Distance VA was also measured in different refractive situations: (A) with 0.50 diopters (D) of positive (myopization) and negative (hyperopization) defocus and (B) with a residual mixed astigmatic refraction induced by adding a combination of -0.25 D spherical and 0.50 D cylindrical lenses placed in vertical (against the rule-ATR), oblique, and horizontal (with the rule-WTR) positions. Results: The study included 30 eyes of 30 patients. UDVA and CDVA were -0.04 ± 0.05 and -0.05 ± 0.05 logMAR, respectively. VA values with +0.50 D and -0.50 D of defocus were 0.01 ± 0.06 and 0.00 ± 0.04 logMAR, respectively. VA was better with distance correction (p < 0.001) and no differences were found between the myopic and the hyperopic situations (p=0.09). Distance VA for the ATR, oblique, and WTR astigmatic situations was 0.01 ± 0.05, 0.01 ± 0.06, and 0.01 ± 0.04 logMAR, respectively. VA was better for the reference situation (p < 0.001) and no differences were found among the three astigmatic situations (p=0.21). Conclusions: Low residual defocus and mixed astigmatic errors, regardless of its orientation, seem to be tolerated by patients implanted with the studied EDoF IOL. This trial is registered with NCT05392998. Registered 26 May 2022-Retrospectively registered.

Visual performance and impact of residual refractive errors with trifocal intraocular lenses of different aspheric design.

BACKGROUND: To assess the visual quality and the tolerance to low refractive errors of two trifocal intraocular lenses (IOL) with different amounts of spherical aberration (SA). METHODS: The study included patients having bilateral implantation of the AcrySof® IQ PanOptixTM (aberration-correcting) or the RayOneTM (aberration-free) Trifocal IOL. Three months after the surgery patients underwent: monocular/binocular and uncorrected/corrected distance visual acuity (VA) and binocular defocus curves. Binocular contrast sensitivity (CSF) and subjective halo perception were assessed with the best distance correction (CDVA), with a positive defocus of + 0.50D and with a negative defocus of -0.50D. Patient's satisfaction was evaluated with the Catquest9-SF questionnaire. RESULTS: This study included 54 eyes (28 with PanOptix and 26 with RayOne) of 27 patients. Both groups achieved corrected/uncorrected and monocular/binocular distance VA values better than 0.0 logMAR (1.0 decimal) with no statistically significant differences between them (p > 0.05 for all cases). Defocus curves showed a VA of 0.1 logMAR or better between -2.5 and + 1.0D with no differences between groups (p > 0.05 at all distances). Overall CSF values remained stable under the induced residual refractions for both groups. The halo effect remained stable for the PanOptix group but increased with myopization in the RayOne group (p = 0.02). The questionnaire showed high rates of patient's satisfaction with no differences between groups. CONCLUSION: Both lenses showed overall good visual outcomes and offered high rates of patient's satisfaction. Moreover, in normal patients with trifocal IOLs, the combination of residual refractive errors and certain amounts of SA may increase some visual disturbances.

Patient Satisfaction and Visual Performance in Patients with Ocular Pathology after Bilateral Implantation of a New Extended Depth of Focus Intraocular Lens.

Aim: To evaluate visual results and patient-perceived outcomes in patients with ocular pathologies implanted with a new extended depth-of-focus intraocular lens (IOL). Methods: Patients with ocular pathology undergoing cataract surgery and bilaterally implanted with Vivity® IOLs were evaluated three months after surgery. The control group included patients with no ocular pathologies. Binocular defocus curves, corrected and uncorrected mono- and binocular distance visual acuity (DVA), and binocular contrast sensitivity were measured. Patients completed the Catquest-9SF questionnaire and reported on dysphotopsia and their need for spectacle-correction. Results: Twenty-five patients were included in each group. Monocular uncorrected DVA was better in the control group (-0.01 ± 0.07) compared with the study group (0.03 ± 0.08), p=0.027. There were no other statistically significant differences in DVA, with an uncorrected binocular acuity of -0.06 ± 0.06 for the control group and -0.05 ± 0.06 for the study group. Binocular defocus curves were similar for both groups and there were no differences in contrast sensitivity values. Pooling the refractive results, 96% of eyes were within ±0.50 D of target refraction. Seventy percent of patients in the control group reported no halos, compared with 40% in the study group, p=0.047. In both groups, 40% of patients reported being completely spectacle-independent, with the other 60% requiring glasses for near vision always or often. All patients reported being fairly or very satisfied with their vision. Conclusion: Initial results of visual function after Vivity implantation in patients with ocular pathologies are encouraging, with high patient satisfaction and few difficulties for daily activities.

Visual and refractive outcomes of monofocal toric intraocular lens implantation in amblyopic eyes.

PURPOSE: To evaluate the visual and refractive outcomes of monofocal toric intraocular lens (IOL) implantation after cataract surgery in amblyopic eyes. METHODS: Our center's database was used to identify patients who had undergone bilateral cataract surgery between 2016 and 2020 with the implantation of a toric IOL in their amblyopic eye. Exclusion criteria were the presence of strabismus, ocular pathologies other than cataract or intra-surgical complications. The outcomes analysed were uncorrected distance visual acuity (UDVA), subjective refraction and corrected distance visual acuity (CDVA) one month after surgery. RESULTS: Ninety patients were included, with a mean age of 68.96 ± 7.81years. CDVA was lower for the amblyopic eye, both before and after surgery. There was a mean improvement in CDVA of 0.23 ± 0.21 LogMAR for the dominant eye and of 0.39 ± 0.33 for the amblyopic eye, p < 0.001 in both cases. Postoperative subjective refractive cylinder was higher in the amblyopic eye (-0.24 ± 0.39 D versus -0.10 ± 0.25 D, p < 0.01), as well as mean cylinder prediction error (-0.30 ± 0.47 D versus 0.02 ± 0.42 D, p < 0.01), compared to the dominant eye. There was a statistically significant correlation between preoperative and postoperative CDVA in amblyopic eyes (Spearmans Rho = 260, p = 0.013). Mean postoperative UCVA was 0.15 ± 0.25 for amblyopic and 0.03 ± 0.12 for dominant eyes. Only one patient required distance spectacle correction due to residual astigmatism. CONCLUSIONS: Cataract surgery with toric IOL implantation in amblyopic eyes leads to an improvement in visual acuity and to spectacle independence in almost all cases, even in the presence of a higher cylinder prediction error.

Effect of residual astigmatism and defocus in eyes with trifocal intraocular lenses.

PURPOSE: To assess the effect on visual function of different residual astigmatic situations combined with 0.50 diopters (D) negative defocus at different distances in patients with trifocal intraocular lenses (IOLs). SETTING: Clínica Rementería, Madrid, Spain. DESIGN: Prospective case series. METHODS: The study included patients implanted with AcrySof IQ PanOptix IOL. Visual acuity (VA) was measured at far distance (0.00 D of vergence) and at -1.5 D, -2.5 D, and -3.0 D of vergence. Residual astigmatism was induced by adding 0.50 D and 1.00 D cylindrical lenses placed at 90 degrees (against the rule [ATR]), 45 degrees (oblique), and 180 degrees (with the rule). All measurements were made with distance correction (emmetropia as the reference situation) and with a simulated residual myopia of 0.50 D. RESULTS: The study included 61 eyes of 61 patients. Residual astigmatism of 0.50 D and 1.0 D was induced in 28 and 33 eyes, respectively. For both groups, distance and intermediate VAs were better for the reference situation (P < .001 for all cases). With 1.0 D of cylinder (without and with induced defocus), the proportion of patients who lost ≥2 lines was higher for the ATR astigmatism. For near vision, differences were smaller for all simulated situations. CONCLUSIONS: Residual astigmatism of up to 0.50 D, regardless of its orientation, seems to be tolerated at all distances. For astigmatisms of 1.0 D, distance and intermediate VAs decreased significantly, and ATR orientations showed worse results in a higher proportion of patients. The combination of astigmatism with residual myopia significantly decreased distance VA, whereas this negative shift affected near VA less.

Changes in Optical Quality Induced by Tilt and Decentration of a Trifocal IOL and a Novel Extended Depth of Focus IOL in Eyes With Corneal Myopic Ablations.

PURPOSE: To assess the effect of decentration and tilt combined with prior myopic ablations on the optical performance of a trifocal intraocular lens (IOL) and a novel IOL with an extended depth of focus (EDOF) design. METHODS: The XACT Mono-EDOF ME4 (Santen Pharmaceutical Co Ltd) and the trifocal FineVision (PhysIOL) IOLs were analyzed with and without simulated previous myopic ablations. The optical quality of the IOLs was evaluated with the PMTF optical bench (LAMBDA-X). The through-focus modulation transfer function (MTF) curves were recorded. Measurements were done for three situations: centered, 0.4 mm decentered, and 4 degrees tilted. RESULTS: The trifocal IOL showed three peaks of vision and the EDOF IOL showed a far distance peak with intermediate addition. When decentration or tilt were induced, the trifocal IOL showed negligible changes but the EDOF IOL showed a -0.50 diopters (D) shift of the overall curve. With simulated myopic ablation, the trifocal IOL showed a -0.50 D shift of the curve. When tilt or decentration were also induced, the better optical results were found at -1.00 D. With myopic ablations, the EDOF IOL showed a -0.50 D shift of the optical quality and when decentration or tilt were then induced, negative shifts over -1.00 D were found. CONCLUSIONS: The trifocal IOL was less affected by mis-alignments. When myopic ablations were induced, both lenses decreased their optical quality and the effects of misalignments were higher. In patients who have undergone corneal myopic ablation procedures, proper alignment of the implanted IOL and obtaining effective emmetropia becomes even more critical. [J Refract Surg. 2021;37(8):532-537.].

Visual Function and Patient Satisfaction with Multifocal Intraocular Lenses in Patients with Glaucoma and Dry Age-Related Macular Degeneration.

PURPOSE: To report visual function and self-reported satisfaction of patients with glaucoma and dry age-related macular degeneration (dAMD) implanted with multifocal intraocular lenses (MIOL). METHODS: Patients with glaucoma or dAMD as well as healthy individuals implanted with MIOL were invited to participate. Explorations performed were uncorrected and corrected distance visual acuity (UDVA and CDVA), low-contrast visual acuity (LCVA), binocular contrast sensitivity, and defocus curves. Patients completed the Catquest-9 questionnaire and reported on the presence of dysphotopsias and the need for spectacles. RESULTS: 38 subjects were included: 11 in the healthy/control group and 9 each in the preperimetric glaucoma, perimetric glaucoma, and dAMD groups. Controls had statistically better monocular UDVA, CDVA, and LCVA than patients with glaucoma and dAMD, as well as better binocular acuity in the defocus curves between -2.00 D and +0.50 D. Differences between controls and patients with preperimetric glaucoma were not statistically significant. Between -3.0 D and +0.5 D, all groups except dAMD achieved acuities better than 0.2 logMAR. Patients with dAMD had worse contrast sensitivity than all others for 3 cycles per degree (cpd), and patients with glaucoma had worse values than all others for 12 cpd; other differences did not reach statistical significance. Healthy subjects and patients with preperimetric glaucoma perceived halos more often than patients with glaucoma or dAMD, while suffering less from glare. Patients with glaucoma and dAMD found more difficulties when driving at night and required spectacles for near more often than the other subjects. Patients with dAMD were less satisfied with their vision. CONCLUSIONS: MIOLs may be implanted in patients with preperimetric glaucoma with little fear of patient dissatisfaction. In glaucoma and dAMD, MIOLs might be considered with caution, after explaining the increased risk of glare and the higher need for spectacle correction for reading.

Impact of Trifocal and Trifocal Toric Intraocular Lenses on Spectral-domain OCT Retinal Measurements.

PRECIS: Monofocal, trifocal, and trifocal toric intraocular lenses (IOLs) induce similar changes on overall retinal optical coherence tomography (OCT) measurements. PURPOSE: The purpose of this study was to assess whether trifocal and trifocal toric IOLs affect the measurement of retinal parameters using spectral-domain OCT. METHODS: This cross-over study included patients undergoing implantation of a trifocal IOL: AcrySof IQ PanOptix, a trifocal toric IOL: AcrySof IQ PanOptix Toric, and a monofocal IOL: AcrySof IQ. The monofocal group was considered as the control group. The refractive target was emmetropia in all cases. Mean average macular thickness, macular volume, and retinal nerve fiber layer (RNFL) thickness were measured with the Cirrus HD-OCT. All measurements were performed before and 3 months after the surgery. RESULTS: The study analyzed 150 eyes of 150 patients (50 for each IOL group). Macular thickness and macular volume showed statistically significant differences before and after the surgery for the 3 groups (P<0.05 in all cases). RNFL thickness was found to be similar before and after the surgery in all groups (P>0.05 in all cases). Mean difference values (before and after the surgery) in the monocular, trifocal, and trifocal toric group for macular thickness, macular volume, and RNFL thickness were 4.9±7.8, 7.9±10.0, and 7.7±13.7 µm, respectively; 0.1±0.2, 0.2±0.4, and 0.2±0.3 mm3, respectively; and 0.8±5.5, 1.3±6.0, and 0.8±6.7 µm, respectively. Mean differences were found to be similar for the 3 groups. CONCLUSION: The trifocal and the trifocal toric IOLs under study did not induce an additional impact on spectral-domain OCT retinal measurements compared with monofocal IOLs.

Tolerance to Residual Refractive Errors After Trifocal and Trifocal Toric Intraocular Lens Implantation.

OBJECTIVE: The objective of this study was to assess the impact of 0.50 diopter (D) positive or negative defocus on visual function in patients implanted with trifocal and trifocal toric intraocular lenses (IOLs). METHODS: The study included patients implanted with the AcrySof IQ PanOptix IOL or the PanOptix Toric. Visual acuity (VA) at high (100%), medium (50%) and low (10%) contrast, contrast sensitivity function (CSF), and halo perception were assessed three months after surgery. Explorations were performed with corrected distance visual acuity (CDVA), with a positive defocus of +0.50D (myopization) and with a negative defocus of -0.50D (hyperopization). RESULTS: The study included 60 eyes of 60 patients (30 eyes with PanOptix and 30 eyes with PanOptix Toric). For both groups, VA was better for all contrast settings at the CDVA situation (P<0.05 in all cases). For low spatial frequencies, no differences in CSF were found among the three refractive situations in either group. For higher frequencies, the results showed an overall trend for better CSF results for the CDVA situation. The halo effect was lower for the CDVA situation if compared to myopization and hyperopization in both the PanOptix and the PanOptix Toric groups (P<0.05 for all cases). CONCLUSIONS: There is an impact on visual quality and halo perception in patients implanted with trifocal or trifocal toric IOLs even for low residual refractive errors.

Automated refraction after trifocal and trifocal toric intraocular lens implantation.

BACKGROUND: To analyze the correlation between automated refraction and manifest refraction after implantation of a trifocal intraocular lens or its toric version. METHODS: This cross-sectional study involved 105 eyes of 105 patients. Subjects were divided in two groups: 62 with trifocal (AcrySof PanOptix) and 43 with trifocal toric (AcrySof PanOptix Toric) intraocular lenses. Automated refraction was employed as starting point for obtaining the manifest refraction. Automated refraction and manifest refraction measurements were analyzed and compared using the vector analysis 3 months after the surgery. RESULTS: In both groups, the higher differences between automated refraction and manifest refraction measurements were found for the cylinder and the spherical equivalent (M). Cylinder values for PanOptix were: -0.60 ± 0.36 D with automated refraction and -0.17 ± 38 D with manifest refraction (p < 0.001); for PanOptix Toric, the values were: -0.49 ± 0.31 D with automated refraction and -0.05 ± 0.21 D with manifest refraction (p < 0.001). M values for PanOptix were: -0.23 ± 0.31 D with automated refraction and -0.03 ± 0.16 D with manifest refraction (p < 0.001); for PanOptix Toric, the values were: -0.13 ± 0.40 D with automated refraction and 0.01 ± 0.12 D with manifest refraction (p < 0.001). For the PanOptix group, intraclass correlation coefficients were: 0.51 (sphere), 0.64 (cylinder), 0.42 (M), 0.62 (J0), and 0.37 (J45). For the PanOptix Toric group, the intraclass correlation coefficients were: 0.39 (sphere), 0.61 (cylinder), 0.39 (M), 0.53 (J0), and 0.09 (J45). CONCLUSION: The results of this study suggest that patients implanted with the trifocal and the trifocal toric intraocular lens under study showed similar automated refraction results between them, with a slight trend to more negative amounts of cylinder and M. Nevertheless, clinicians should carefully confirm all parameters of the refraction with manifest refraction.

Real-world evaluation of visual results and patient satisfaction for extended range of focus intraocular lenses compared to trifocal lenses.

PURPOSE: To report visual outcomes and patient-perceived satisfaction after trifocal or extended depth-of-focus (EDOF) intraocular lens (IOL) implantation in a real-world scenario. METHODS: Three months after bilateral cataract surgery, corrected and uncorrected visual acuity for far, intermediate and near distances and binocular defocus curves and contrast sensitivity were measured. The patients also completed the Catquest SF-9 questionnaire and reported on dysphotopsia and spectacle use. RESULTS: There were 23 patients in the Symfony, 32 patients in the Finevision and 36 patients in the Panoptix group. The percentage of eyes receiving a toric IOL was 41.2%. There were no differences in uncorrected binocular visual acuities, save for near vision, which was lower in the Symfony group. Binocular defocus curves for the trifocal IOLS were almost identical, while vision achieved with the Symfony IOL was significantly lower starting at - 1.5 D defocus. Contrast sensitivity, as well as the perception of halos and glare and the difficulty for night-driving was similar for all groups, except for contrast sensitivity at 6 cycles per degree, which was lower in the Symfony group compared to both Finevision and Panoptix. For near vision, only 47.6% of the Symfony patients reported being completely spectacle-free, compared to 93.3% and 94.4% for the Finevision and Panoptix groups. CONCLUSIONS: Clinically relevant differences were only detected for near vision, with lower values for EDOF IOLs. In order to achieve patient satisfaction, it is imperative to explain the results expected with each IOL; for EDOF IOLs, patients should be advised that they may require near-spectacle correction.

Changes in Ganglion Cell Complex and Peripapillary Retinal Nerve Fiber Layer after Femtosecond Laser-Assisted Cataract Surgery Compared to Manual Phacoemulsification in Patients Receiving a Trifocal Intraocular Lens.

INTRODUCTION: During femtosecond laser-assisted cataract surgery (FLACS), there is a significant increase in intraocular pressure, which might lead to ganglion cell damage. We aimed to determine whether there were differences in the changes produced in the ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (pRNFL) thickness, as evaluated with optical coherence tomography (OCT), between phacoemulsification and FLACS, after implantation of a trifocal intraocular lens (IOL). METHODS: Patients with no coexistent pathologies undergoing cataract surgery with implantation of a PanOptix IOL were explored with the Cirrus-OCT before and three months after surgery. GCC values were obtained from the built-in software. The differences between pre- and postoperative GCC and pRNFL thicknesses after phacoemulsification were compared to differences after FLACS. RESULTS: A total of 171 eyes were included, 74 undergoing FLACS and 97 phacoemulsification. For both groups, there was a statistically significant increase in GCC values after cataract surgery, except for the inferior and inferonasal sectors. There were no statistically significant differences between FLACS and phacoemulsification. Mean change in average GCC and minimum GCC were 1.08 ± 1.40 µm (range -1 to +6 µm) and 1.69 ± 2.54 µm (range -3 to +11 µm) after FLACS and 0.99 ± 1.67 µm (range -5 to +6 µm) and 2.02 ± 3.54 µm (-6 to +18 µm) after phacoemulsification. These values are similar to those previously reported after phacoemulsification with monofocal IOL implantation. No significant changes after surgery were detected for the pRNFL, with no differences between groups. Discussion. There were no differences in the changes produced by FLACS and phacoemulsification in either GCC or pRNFL values. Although mean change was small, the range of variation was wide. Therefore, it is necessary to establish a new baseline for GCC and pRNFL thicknesses after cataract surgery in order to monitor any subsequent changes.

Visual and Refractive Outcomes of Cataract Surgeries Performed in One Year in a Private Practice Setting: Review of 2714 Procedures.

METHODS: Our center's database was used to identify all isolated cataract procedures performed during 2017. The electronic records were reviewed to collect the preoperative information, presence of intra- or postsurgical complications, and visual and refractive outcomes one month after surgery. RESULTS: In 2017, 2714 eyes of 1543 patients underwent cataract surgery in our center. Mean patient age was 70.42 years. 775 eyes (28.55%) had prior ophthalmic pathologies, and 113 eyes (4.16%) had undergone previous surgical procedures. Surgical complications developed in 35 eyes (1.29%), including 9 posterior capsule tears (0.33%) and 3 cases of dropped lens fragments (0.11%). A toric or multifocal intraocular lens was implanted in 45.6% of eyes. As regards postoperative complications, 59 eyes (2.17%) required a return to the operating theater, including 29 eyes (1.07%) requiring reinterventions due to an unexpected refractive result. There were no cases of endophthalmitis. Mean LogMAR-corrected distance visual acuity (CDVA) improved from 0.25 (SD 0.34) preoperatively to 0.04 (SD 0.17) postoperatively; 86.5% of eyes achieved a CDVA ≤0.0, with 97.5% achieving ≤0.3. In 86.4% of eyes, the difference between target and residual spherical equivalent difference was of 0.50 D or lower; 88% of eyes had a spherical equivalent ±0.50 D. CONCLUSIONS: The visual and refractive outcomes of cataract surgery in a private practice setting were excellent, well over the benchmarks set by the ESCRS. The safety profile was also within expected standards. This study provides information for ophthalmologists in private practice on expected outcomes.

Visual quality and patient satisfaction with a trifocal intraocular lens and its new toric version.

PURPOSE: To assess and compare the visual quality and subjective outcomes of a trifocal spherical intraocular lens (IOL) and its new toric version. SETTING: Clínica Rementería, Madrid, Spain. DESIGN: Prospective case series. METHODS: Patients had bilateral implantation of the AcrySof IQ PanOptix spherical or toric IOL. Three months postoperatively, monocular and the binocular uncorrected and corrected distance, intermediate, and near visual acuities; binocular defocus curves; and binocular contrast sensitivity function (CSF) were assessed. Patient satisfaction was evaluated with the Catquest 9SF questionnaire. RESULTS: The study comprised 250 eyes (166 with spherical IOL; 84 with toric IOL) of 125 patients. Both groups had good monocular visual acuity at all distances with no statistically significant differences between groups. The mean monocular uncorrected acuity in the spherical group was 0.06 logarithm of the minimum angle of resolution (logMAR) ± 0.07 (SD), 0.20 ± 0.10 logMAR, and 0.05 ± 0.07 logMAR for far, intermediate, and near, respectively, and in the toric group, 0.07 ± 0.10 logMAR, 0.23 ± 0.20 logMAR, and 0.07 ± 0.12 logMAR, respectively. Defocus curves showed a visual acuity of 0.1 logMAR or better between -2.5 diopters (D) and +0.5 D with no differences between groups. The CSF values were within normal ranges with both IOLs. The questionnaire showed high rates of patient satisfaction with no differences between groups. CONCLUSIONS: The visual outcomes with the 2 IOLs were similar. With optimum implantation and alignment, the trifocal toric IOL seems to provide visual quality and patient satisfaction that is equivalent to that with the nontoric version with the same platform.