Vision Quality With Trifocal IOL Rated High Despite Occasional Halos, Glare

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After 3 months, mean visual acuity with trifocal IOL was better than 20/25 at test distances, uncorrected and distance-corrected.

Patients may express caution when considering multifocal intraocular lenses (IOLs) due to their association with the possibility for glare or halos. If postoperative dry eye is well-managed, though, those with trifocal IOLs are highly satisfied with their vision quality and eyeglass independence even with periodic visual disturbances such as night-driving halos, according to an investigation published in Clinical Ophthalmology.

Evaluations at 1 and 3 months after implantation showed study participants achieved mean binocular acuity better than 0.1 logMAR at far, intermediate, and reading distances in uncorrected and distance-corrected conditions. Previous research finds that patients with trifocal IOLs rated visual quality the same or better — especially for reading — than those who scored their vision with extended depth of focus IOLs, suggesting there may be a “tradeoff” between visual disturbances and more finely-tuned near vision. 

The current single-site, prospective investigation from October 2019 to October 2020 analyzes outcomes for 29 participants, mean age 58 years, after same-day bilateral cataract removal and implantation with toric or nontoric PanOptix® (Alcon AG) IOLs ( NCT04124952).

After 3 months, binocular distance-corrected visual acuity at 4 meters was less than half a line better than uncorrected acuity (P <.01). At intermediate focus of 60 cm and for near work at 40 cm, distance-corrected acuity was not significantly different from the uncorrected state, (P =.16 and P =.33, respectively). “The clarity of vision achieved at the tested distances was very good,” the study explains.

Participants completed the Patient Reported Spectacle Independence Questionnaire (PRSIQ) and Quality of Vision survey after 3 months. PRSIQ responses indicated 86% no longer needed reading glasses, and 97% did not need spectacles for far or intermediate points. Dry eye was identified in 2 individuals, along with variable refractive outcomes. In Quality of Vision surveys, some “moderate” or “severe” visual disturbances were reported in the study population: halos for 12 (41.4%), starbursts in 4 (13.8%), and glare for 3 (10.3%). At the more “bothersome” 2 of 4 rating levels, 6 described halos, 3 had glare, and 2 noted starbursts.

PanOptix is the only trifocal IOL currently approved for use in the US. This lens is based on an aspheric quadrifocal design, with light from the 120 cm focal point diffracted toward far focus, adding light for distance vision, thus the lens acts as a trifocal. Functional vision assessments in prior studies are similar to results of this analysis, with some papers reporting intermittent need for near vision glasses. Overall, trifocal IOLs provided eyeglass independence for almost all individuals in this cohort.

Limitations include a small sample size, and no measurement of low contrast visual acuity. A strength of this work is the addition of specific qualitative data on visual disturbances, and observations concerning the importance of treating dry eye. “The major considerations for the patient are usually the distances at which they desire spectacle independence and whether the slightly increased potential for visual disturbances is likely to be a bother to them,” according to the analysis.

Disclosures: This research was supported by Alcon. One of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for more complete disclosures.


Shatz AC, Potvin R. Spectacle independence and quality of vision after bilateral implantation of a trifocal intraocular lens. Clin Ophthalmol. 2021;15:2545–2551. doi:10.2147/OPTH.S318203