[Evaluation of early clinical outcomes after implantation of monofocal, bifocal, and extended depth-of-focus intraocular lenses].

Authors

T Chen, E J Li, Z Y Wang, X F Ding, X J Wu, Y X Jia, P L Yue, Q Zhang, X D Song

Published in

[Zhonghua yan ke za zhi] Chinese journal of ophthalmology. Volume 62. Issue 8. Pages 629-637. Aug 11, 2026.

Abstract

Objective: To compare the subjective and objective visual outcomes after implantation of monofocal, bifocal, and extended depth-of-focus (EDOF) intraocular lenses (IOLs). Methods: This non-randomized controlled clinical trial enrolled cataract patients scheduled for phacoemulsification and IOL implantation at Beijing Tongren Eye Center, Capital Medical University, between April and December 2025. According to the implanted IOL type, patients were assigned to monofocal, bifocal, diffractive EDOF, and non-diffractive EDOF groups. Visual acuity, defocus curves, objective visual quality, and the Visual Function Index-14 (VF-14) questionnaire were evaluated at 3 months postoperatively. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), distance-corrected intermediate visual acuity (DCIVA), and distance-corrected near visual acuity (DCNVA) were measured and recorded in logarithm of the minimum angle of resolution (logMAR). Defocus curves were obtained from +1.00 to -4.00 D in 0.50-D steps under best distance correction. Intraocular wavefront aberrations and modulation transfer function (MTF) were measured at a 4.0-mm pupil diameter using an optical path difference-based aberrometer. Objective scatter index, MTF cut-off frequency, and Strehl ratio (SR) were assessed using a double-pass optical quality analysis system. Intergroup comparisons were performed using one-way analysis of variance or the Kruskal-Wallis H test with Bonferroni post hoc correction. Pearson correlation analysis and linear regression models were used to identify factors associated with intraocular higher-order aberrations (HOAs). Results: A total of 67 patients (67 eyes) were enrolled. Except three patients lost to follow-up and one patient incomplete data, 63 patients (63 eyes) were included in the analysis, with 15 eyes in the monofocal group, 17 eyes in the bifocal group, 14 eyes in the diffractive EDOF group, and 17 eyes in the non-diffractive EDOF group. The mean age was (67.24±6.85) years. There were 17 men and 46 women. Baseline characteristics were comparable among the four groups (all P>0.05). At 3 months postoperatively, UDVA did not differ significantly among the groups (P=0.054). The bifocal group achieved the best CDVA (-0.02±0.07), which was significantly better than that of the monofocal group (0.07±0.09) and the diffractive EDOF group (0.05±0.05) (P=0.033). The bifocal group also demonstrated significantly higher MTF cut-off frequency and SR than the monofocal and non-diffractive EDOF groups (both P<0.05). Both EDOF groups showed significantly better DCIVA than the monofocal and bifocal groups (both P<0.001). On defocus curve analysis, the diffractive EDOF group maintained visual acuity of 0.2 logMAR or better within a defocus range of up to -2.00 D, whereas the non-diffractive EDOF group maintained this level within -1.50 D. The monofocal group exhibited the poorest DCNVA (0.60±0.23), while no significant difference was observed among the other three groups. Postoperative spherical equivalent refraction was close to emmetropia in the monofocal [(-0.15±0.44) D] and bifocal [(0.12±0.37) D] groups, whereas mild myopia was observed in the diffractive EDOF [(-0.73±0.41) D] and non-diffractive EDOF [(-0.63±0.51) D] groups (P<0.001). The spherical aberration was significantly higher in the non-diffractive EDOF group than in the other three groups (all P<0.05). Nevertheless, this group achieved the highest VF-14 score and showed better performance in night driving and fine handwork tasks. Correlation and regression analyses demonstrated that the MTF cut-off and SR were independently associated with intraocular HOAs. Conclusions: EDOF IOLs provided superior intermediate visual acuity and a broader continuous functional range of vision. The non-diffractive EDOF group showed a trend toward better subjective visual function, although VF-14 scores did not differ significantly among the four groups. Bifocal IOLs demonstrated superior objective optical performance. Selection of IOLs should be individualized according to the functional visual range, optical quality, and patient-specific visual demands.

PMID:
42552122
Bibliographic data and abstract were imported from PubMed on 05 Aug 2026.

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