Real-World IOL Performance with Bilateral Plano Outcomes After Cataract Surgery: A Prospective, Comparative Study

To compare visual performance and patient satisfaction of various intraocular lenses (IOLs) in individuals who underwent bilateral cataract extraction with plano outcomes.

Patients underwent staged, bilateral cataract surgery with implantation of AcrySof PanOptix Trifocal, AcrySof SA60 Monofocal, or TECNIS Eyhance monofocal IOLs. All surgeries were performed by a single surgeon using femtosecond laser-assisted cataract surgery. Patients were followed postoperatively at day one, one month, and three months. A validated patient-reported outcome questionnaire, Refractive Cataract Surgery Survey (RCSS), was performed at one month. Exclusion criteria included postoperative spherical equivalent > 0.5 diopters and/or cylinder > 0.75 diopters in either eye. Outcomes were analyzed per patient; thus, both eyes were excluded if the above criteria was not met.

The study included 242 eyes of 121 patients, consisting of 62 (51.2%) females and 59 (48.8%) males with a mean age of 66.8 ± 8.2 years (range 31-83 years). A total of 66 eyes (27.2%) received the SA60 IOL, 124 eyes (51.3%) received the PanOptix Trifocal IOL, and 52 eyes (21.5%) received the Eyhance IOL. Toric IOL selection occurred in 65% for SA60, 50% for Eyhance, and 49% for PanOptix. The SA60 showed better uncorrected distance visual acuity compared to other lenses (p < 0.05). The PanOptix showed significantly better binocular uncorrected near visual acuity compared to other lenses (p < 0.001). RCSS lens satisfaction scores were highest with the PanOptix despite having the highest level of dysphotopsia.

Overall lens satisfaction was highest with the PanOptix IOL despite having the highest prevalence and severity of dysphotopsias. Some patients may prioritize functional spectacle independence at all distances, explaining high satisfaction rates despite optical trade-offs such as diffractive dysphotopsias.