Patients Report High Satisfaction With Trifocals, Extended Depth-of-Focus IOLs

intraocular lens insertion
Investigators say the EDOF lens may be preferable for optimal uncorrected near visual acuity.

Overall patient satisfaction is high for both the trifocal TFNT00 (AcrySof® IQ PanOptixTM, Alcon), and the extended depth-of-focus (EDOF) ZXR00 (TECNIS Symfony® IOL Johnson & Johnson Vision, Inc.), intraocular lenses (IOLs), according to the results of a study published in Clinical Ophthalmology.

Investigators compared the trifocal TFNT00 and extended depth-of-focus (EDOF) ZXR00 intraocular lenses (IOLs) in terms of overall satisfaction with near and distance vision, visual acuity, dysphotopsia symptoms, spectacle dependence, and mesopic best corrected contrast sensitivity (MBCCS) in a nonrandomized, retrospective study. In total, 11 participants received the TFNT00 IOL and 13 received the ZXR00 IOL, with assessments lasting up to 4 years postimplantation. 

More than 50% of participants in either implant group stated a need for spectacle use some of the time or more. Patients with the PanOptix IOL had better binocular uncorrected near visual acuity (UNVA), whereas MBCCS in higher spatial frequencies was better with the ZXR00 IOL. 

The study authors suggest that the trifocal TFNT00 IOL may be preferred by those who desire optimal UNVA, although mesopic contrast sensitivity may be compromised. On the other hand, the EDOF ZXR00 IOL could function better at higher spatial frequencies in mesopic conditions; however, consideration of target refraction could be needed to optimize near vision. 

Limitations of the current study include a small sample size and a lack of randomization in the IOL groups. Participants were enrolled non-consecutively and follow-up times in the 2 IOL groups differed, which marked other limitations. The authors may have also missed subtle posterior capsular opacities or glistenings due to the performance of slit lamp on participants only with vision less than 20/20.

“Future studies should evaluate the effects of LED headlights under mesopic conditions, given their more common use in newer vehicles,” investgiators report. “FDA regulations indicate that the illuminance of halogen glare beams should be 2.5 cd/m2 however we were unable to find standardized guidelines as to how to test glare under mesopic conditions while using neutral density filters and a chart in a light box.”


Britton JJL, El-Defrawy S, Wong BM, et al. Patient satisfaction and visual function following implantation of trifocal or extended range of vision intraocular lenses. Clin Ophthalmol. Published online on March 5, 2022. doi:10.2147/OPTH.S339385