Comparative Clinical Outcomes Between Successive Generations of Liberty Trifocal Intraocular Lenses

Purpose: To compare the clinical and functional outcomes of two successive generations of a trifocal intraocular lens (IOL), the original Liberty 677MY and the optimized Liberty 677CMY. To the best of our knowledge, this is the first head-to-head comparison between two successive generations of any IOL model reported. Methods: This retrospective study included 42 patients (84 eyes) who underwent bilateral phacoemulsification with implantation of either the Liberty 677MY (26 eyes) or the Liberty 677CMY (58 eyes). The primary outcome was postoperative binocular intermediate visual acuity (VA). Secondary outcomes included monocular intermediate VA, monocular and binocular distance and near VA, the proportion of patients or eyes achieving ≤0.1 LogMAR, and defocus curves. Exploratory outcomes included spectacle independence, patient-reported satisfaction (Quality of vision-QoV- and Catquest-9SF), photic phenomena, and intraoperative or postoperative complications. Results: At 3 months, binocular UIVA differed by approximately 0.10 LogMAR in favor of the 677CMY cohort, which was considered clinically significant, although the difference did not reach statistical significance (p = 0.052). Supporting this tendency, monocular UIVA was significantly better with the 677CMY IOL (p = 0.012). Also, a significantly higher percentage of patients and eyes achieved binocular and monocular UIVA ≤ 0.1 LogMAR with the 677CMY IOL (p = 0.025). Defocus curves additionally showed significant between-group differences at intermediate defocus levels (-1.00 and -1.50 D; p < 0.05), favoring the 677CMY cohort. No between-group differences were observed for any distance VA parameter. Binocular near VA and near-vision thresholds were also comparable between groups, although a greater proportion of eyes achieved monocular UNVA ≤ 0.1 LogMAR with the 677CMY IOL (p = 0.016). Spectacle use, overall satisfaction, photic phenomena profile, and postoperative complications were comparable between groups. Conclusions: The optimized Liberty 677CMY exhibited a favorable pattern of intermediate visual performance compared with the 677MY while maintaining comparable distance and near VA and a similar safety profile. These findings suggest potential clinical benefits of the design modifications, although larger prospective studies are warranted to confirm these observations.