Comparision of a Novel Trifocal Intraocular Lens and a Monofocal Enhanced Depth of Focus Intraocular Lens in Visual Performance and Quality of Life Scores

Comparision of a Novel Trifocal Intraocular Lens and a Monofocal Enhanced Depth of Focus Intraocular Lens in Visual Performance and Quality of Life Scores | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparision of a Novel Trifocal Intraocular Lens and a Monofocal Enhanced Depth of Focus Intraocular Lens in Visual Performance and Quality of Life Scores Mustafa Talan¹, Aysegul Penbe, Güzide Akçay This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3104554/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The aim of this study was to investigate the effects of trifocal and monofocal intraocular lens with enhanced depth of focus implantations Methods 40 patients who had bilateral implantation of the trifocal or monofocal extended depth of focus intaocular lenses after phacoemulsification were included in the study. The preoperative and postoperative examination findings were analyzed. At the 6th postoperative month, binocular defocus curves, contrast sensitivity measurements, subjective complaints, spectacles independence, and the quality of life questionnaire results of the VF-14 questionnaire were also examined. Results While distance and intermediate visual acuities were similar at 6 months postoperatively, near visual acuities were found to be statistically significantly better in the trifocal group. The contrast sensitivity values were found to be statistically better in the edof group. In the trifocal group, 25% of the patients had low-intensity and 5% of the patients had moderate intensity of photopic complaints respectively, while 10% of the patients in the edof group had low-intensity photopic complaints. While spectacles independence could be achieved in all patients in the trifocal group, in the edof group, 80% of patients needed spectacles. When examining VF-14 test values without spectacles, it was found that the values of the trifocal group were significantly higher. Conclusions Trifocal group performed better at near, although far and intermediate vision was comparable between the groups. On the other hand, a higher rate of photic phenomena was observed in the trifocal group. Trial registration: Retrospectively registered Cataract presbyopia trifocal intraocular lens extended depth of focus Figures Figure 1 Figure 2 Figure 3 Background Thanks to advancements and technological developments in the technique of phacoemulsification, expectations have surpassed complication-free surgery, aiming for low postoperative residual refractive error, rapid visual rehabilitation, and routine independence from glasses at all distances [ 1 ]. The most commonly implanted intraocular lenses (IOLs) in cataract surgeries are still monofocal IOLs due to their low cost, satisfactory visual function for distance vision, suitability for patients with comorbidities such as corneal and retinal diseases, and lesser occurrence of photic phenomena [ 2 ]. However, these IOLs still fall short in intermediate and near activities, leading to a need for glasses [ 3 ]. In order to provide clear vision simultaneously at near and far, bifocal refractive IOLs were first introduced in 1986 [ 4 ]. However, these IOLs did not provide sufficient correction for intermediate functions [ 5 ]. Additionally, the multiple focal points of light refraction caused a decrease in contrast sensitivity and resulted in photic phenomena such as halos and glare [ 6 , 7 ]. The discovery of multifocal diffractive IOLs has relatively reduced dysphotopsia complaints and improved vision at far, intermediate, and near [ 8 ]. Trifocal IOLs create three different focal points to provide vision at different distances, while extended depth of focus (EDOF) IOLs, whose fundamental principle is to create a longitudinal focal plane, have been introduced to increase the range of vision [ 9 , 10 ]. This extended focal plane can be achieved through the modification of spherical aberrations, diffractive optical designs, pinhole effect, or bio-analogical Technologies [ 11 ]. Nowadays, to achieve better visual performance, one or more of the available IOL technologies in the market can be combined [ 12 ]. In this study, we aimed to investigate the effects of newly designed Acriva UD Trinova Pro C lenses, which utilize the principle of diffractive trifocal IOLs, and Tecnis Eyhance lenses, which utilize the principle of extended depth of focus, on distance, intermediate, and near visual acuity, contrast sensitivity, photic phenomena, and quality of life. The absence of studies reported in the literature with Trinova Pro IOLs makes our research significant. Methods Patients who underwent phacoemulsification and IOL implantation at Kartal Dr. Lütfi Kırdar City Hospital Ophthalmology Clinic between January 2021 and December 2021 were retrospectively screened. The preoperative and postoperative examination findings of patients implanted with Trinova Pro C and Tecnis Eyhance following bilateral uncomplicated phacoemulsification were analyzed. All included patients were provided with detailed information about cataract surgery and the implanted IOLs during preoperative visits, and their informed consent was obtained. In accordance with the principles and ethical rules of the Helsinki Declaration, patients participating in the study were informed that their medical records would be used for the performed surgery and follow-up visits, and their consent was obtained. Patient selection: Twenty patients with a total of 40 eyes who were literate and aged 40 years and above, and who received uncomplicated bilateral phacoemulsification followed by Trinova Pro C implantation, as well as twenty patients with a total of 40 eyes who received Tecnis Eyhance implantation, were included in the study. Patients with a need for high contrast sensitivity due to their profession or unrealistic expectations were not included. Patients with severe dry eye symptoms or ocular surface irregularities, corneal pathology, uveitis, pseudoexfoliation syndrome, glaucoma, retinopathy, and other additional eye diseases, as well as patients with neuro-ophthalmologic pathologies, were not included in the study. Patients who had undergone any previous eye surgery, had a mesopic pupil diameter above 6 mm or a photopic pupil diameter below 2 mm, had hyperopia or myopia greater than 5 D, had corneal astigmatism of 1 D or higher, or had axial length below 22 mm or above 26 mm were not included in the study. Preoperative assessments: The patients' complaints and expectations, as well as their ophthalmological and systemic medical history, were thoroughly evaluated. Their educational status, occupations, daily activities, and hobbies were questioned. Autorefraction measurements of the patients were taken using an autorefractor/keratometer (NIDEK ARK-1a, Japan). Intraocular pressure (IOP) measurements were performed using applanation tonometry. Light reflexes and relative afferent pupillary defect examinations were evaluated. Keratometry values and pupil diameters under photopic and mesopic conditions were measured (Sirius, CSO, Italy). Monocular uncorrected and best-corrected distance (at 4 meters) visual acuity were measured and converted to logMAR units (MUDVA and MBCDVA) using Snellen equivalents. Detailed anterior segment and dilated fundus examinations were performed. Central macular morphology were evaluated using optic coherence tomography (TOPCON DRI OCT TRITON, Japan). Axial lengths were measured using optical biometry (Haag-Streit Lenstar LS900, Switzerland) and confirmed using A-scan mode ultrasound (Sonomed Escalon E-Z AB5500+, U.S.A). Biometric measurements were performed targeting emmetropia in both eyes using the SRK/T formula. Surgical Technique: All cases were performed by the same experienced surgeon (A.P) using the standard small incision phacoemulsification technique with a continuous curvilinear capsulorhexis of 5-5.5 mm diameter created with micro forceps. The pre-planned IOLs were implanted into the capsular bag. IOL centration was checked using Purkinje reflexes. The same phacoemulsification machine (Bausch and Lomb, Stellaris, USA) and microscope (Zeiss, OPMI LUMERA T S88, Germany) were used in all surgeries. In all cases, the eye causing more complaints was operated on first, followed by the other eye approximately 1–4 weeks later. The IOLs used in our study According to the company data, Trinova Pro C is a trifocal IOL that features a sinusoidal design and a smooth transition diffractive surface area. Unlike traditional overlapping design trifocal IOLs, this smooth transition sinusoidal design aims to increase light distribution efficiency and minimize postoperative photic phenomena. With its enhanced pupil adaptive feature, Trinova Pro C maintains visual quality under different lighting conditions. Approximately 93% of the light entering the eye reaches the retina with Trinova Pro C [ 13 ]. With + 1.8 D intermediate and + 3.6 D near additions, Trinova Pro C provides clear vision for activities such as phone usage, reading, and computer use at intermediate and near. Tecnis Eyhance is a single-piece hydrophobic acrylic posterior chamber lens. With a modified aspheric front surface, this monofocal IOL aims to expand the depth of focus and increase the range of vision. The modified aspheric front surface provides a continuous power profile that increases from the periphery to the center. As a result, it offers better vision at intermediate distances compared to a standard monofocal IOL. Based on modification of spherical aberrations, this design does not include refractive or diffractive zones and cannot be distinguished from a standard monofocal IOL macroscopically [ 3 , 14 ]. The increased range of vision provided by this design, along with the depth of field created, is less affected by photic phenomena caused by multifocal IOLs that create multiple focal points. Postoperative evaluations All patients were prescribed dexamethasone sodium phosphate 0.1% and moxifloxacin 0.5% eye drops for the postoperative period. Dexamethasone sodium phosphate 0.1% was gradually discontinued. During the postoperative 1st day and 1st week examinations, IOP, MUDVA, detailed anterior segment examinations, and dilated fundus examinations were evaluated. Additionally, at the 1st and 3rd-month follow-up visits, MBCDVA and binocular uncorrected distance visual acuity (BUDVA) were measured using Snellen charts and converted to the logMAR unit. Monocular and binocular uncorrected intermediate (60 cm) visual acuity (MUIVA, BUIVA), along with monocular distance-corrected intermediate visual acuity (MDCIVA), and monocular and binocular uncorrected near (40 cm) visual acuity (MUNVA and BUNVA) were measured and recorded using a Turkish reading chart prepared according to the international standards of Bailey-Lovie and Early Treatment Diabetic Retinopathy Study reading charts [ 15 ]. At the 6th-month postoperative evaluation, in addition to the aforementioned assessments, posterior capsule opacity (PCO) was evaluated during biomicroscopic examination and scored as follows: 0 = none, 1 = transparent and only assessable with retroillumination, 2 = distinct fibrosis visible during retroillumination, 3 = intense white fibrosis with Elsching pearls [ 16 ]. Monocular glare and glare-free photopic contrast sensitivity values were examined using CSV-1000E (VectorVision, USA) after correcting any existing refractive errors. Moreover, binocular defocus curves were generated with 0.50 D increments within the range of + 2.0 D to -5.0 D. Patients were also questioned about photopic symptoms such as halos, glare, sunbursts, and dark areas, and they were asked to rate the severity of their symptoms on a scale of 1 = none, 2 = mild, 3 = moderate, 4 = severe. The Visual Function 14 questionnaire (VF-14), consisting of 14 questions, was conducted to evaluate patients' visual satisfaction and quality of life [ 17 ]. In contrast to the original version of the questionnaire, responses were also noted without glasses to assess patients' functional ability to perform activities without glasses. Statistical Analysis: Statistical analysis was performed using R version 2.15.3 software (R Core Team, 2013). The study data was reported using measures such as minimum, maximum, mean, standart deviation, median, frequency and percentage. The normality of quantitative data was evaluated using the Shapiro-Wilk test and graphical examinations. Between-group comparisons of normally distributed quantitative variables were performed using independent samples t-test. Within-group comparisons of normally distributed quantitative variables were analyzed using dependent samples t-test, repeated measure analysis of variance, and pairwise comparison with Bonferroni correction. The comparison of qualitative data was conducted using pearson’s chi – square test. A p-value of less than 0.05 was considered statistically significant. Results During postoperative follow-ups, all cases exhibited round and light sensitive pupils and a centralized IOL position. Demographic characteristics and preoperative evaluations are summarized in Table 1 . Table 1 Preoperative characteristics of patients in both groups Trinova Pro C Group Tecnis Eyhance Group P value Patients / eyes (n) 20 / 40 20/40 Gender (n / %) Female Male 9 / %45 11 / %55 10 / %50 10 / %50 Age (y) 60.65 ± 10.83 61.50 ± 8.32 0.694 Manifest Spherical Equivalent (D) -0.23 ± 1.96 -0.44 ± 1.8 0.615 Cylindrical Power (D) -0.44 ± 0.15 -0.46 ± 0.15 0.714 IOP (mm/hg) 13.53 ± 1.74 13.52 ± 1.45 0.899 MUDVA (Logmar) 0.59 ± 0.28 0.58 ± 0.26 0.953 MBCDVA (Logmar) -0.29 ± 0.11 -0.3 ± 0.12 0.685 Axial length 23.50 ± 0.55 23.51 ± 0.65 0.917 Photopic Pupil Diameter 3.56 ± 0.21 3.53 ± 0.26 0.476 Mesopic Pupil Diameter 4.86 ± 0.20 4.83 ± 0.18 0.465 Upon examining visual acuity values, it was observed that at the postoperative 1 st month, the MUDVA and MBCDVA values of the Trinova Pro C group were significantly higher compared to the Tecnis Eyhance group (p = 0.001,p = 0.003) However, near visual acuity values were significantly lower in the Trinova Pro C group at all visits (p < 0.001). The visual acuity values for each group are summarized in Table 2 . The cumulative binocular uncorrected visual acuity at 6 months postoperatively is shown in Fig. 1. Defocus curves evaluated between the groups are displayed in Fig. 2. Table 2 Postoperative parameters of patients in both groups Trinova Pro C Group Tecnis Eyhance Group P value 1. Month MUDVA LogMAR 0.07 ± 0.04 0.03 ± 0.06 0.001* MBCDVA logMAR 0.06 ± 0.04 0.03 ± 0.04 0.003* BUDVA LogMAR -0.02 ± 0.03 -0.04 ± 0.04 0.276 MUIVA LogMAR 0.22 ± 0.06 0.23 ± 0.06 0.452 MDCIVA LogMAR 0.22 ± 0.05 0.22 ± 0.06 0.962 BUIVA LogMAR 0.11 ± 0.04 0.13 ± 0.04 0.165 MUNVA LogMAR 0.22 ± 0.07 0.44 ± 0.06 < 0.001* BUNVA LogMAR 0.13 ± 0.06 0.36 ± 0.07 < 0.001* 3. Month MUDVA LogMAR 0.04 ± 0.04 0.02 ± 0.05 0.053 MBCDVA logMAR 0.04 ± 0.04 0.02 ± 0.04 0.074 BUDVA LogMAR -0.03 ± 0.04 -0.04 ± 0.05 0.540 MUIVA LogMAR 0.17 ± 0.06 0.19 ± 0.05 0.234 MDCIVA LogMAR 0.17 ± 0.05 0.19 ± 0.06 0.392 BUIVA LogMAR 0.09 ± 0.05 0.10 ± 0.04 0.503 MUNVA LogMAR 0.17 ± 0.06 0.43 ± 0.06 < 0.001* BUNVA LogMAR 0.12 ± 0.05 0.36 ± 0.06 < 0.001* 6 Month Spherical equivalent(D) -1.06 ± 0.36 -0.14 ± 0.35 < 0.001* Cylindrical value (D) -0.43 ± 0.15 -0.43 ± 0.14 0.999 MUDVA LogMAR 0.03 ± 0.04 0.02 ± 0.05 0.058 MBCDVA logMAR 0.03 ± 0.03 0.01 ± 0.05 0.087 BUDVA LogMAR -0.03 ± 0.06 -0.05 ± 0.05 0.438 MUIVA LogMAR 0.16 ± 0.06 0.17 ± 0.05 0.495 MDCIVA LogMAR 0.16 ± 0.05 0.17 ± 0.07 0.512 BUIVA LogMAR 0.08 ± 0.05 0.10 ± 0.05 0.179 MUNVA LogMAR 0.13 ± 0.06 0.43 ± 0.06 < 0.001* BUNVA LogMAR 0.12 ± 0.05 0.35 ± 0.06 < 0.001* At the postoperative 6th month, spherical equivalent values were significantly more myopic in the Trinova Pro C group compared to the Tecnis Eyhance group (p 0.05). In the Trinova Pro C group, contrast sensitivity values at 12 cpd and 18 cpd in glare-free photopic conditions, as well as at 12 cpd in glare conditions, were significantly lower (p = 0.004, p = 0.031, p = 0.007). The contrast sensitivity graph are shown in Fig. 3. There was no significant difference in PCO scoring between the groups at 6 months (p > 0.05). Weak posterior capsule opacification, assessable with retroillumination, was observed in 4 eyes (10%) in the Trinova Pro C group and in 3 eyes (7.5%) in the Tecnis Eyhance group. Subjective photic complaints were significantly higher in the Trinova Pro C group at 6 months postoperatively (p = 0.034). In the Trinova Pro C group, 14 patients (70%) reported no complaints, 5 patients (25%) reported mild complaints, and 1 patient (5%) reported moderate complaints. No patients reported severe complaints. In the Tecnis Eyhance group, 18 patients (90%) reported no complaints, and 2 patients (10%) reported mild complaints. When examining VF-14 test values, it was found that the values of the Trinova Pro C group were significantly higher (p < 0.001). For near visual activities (questions 1, 2, 7, 8, and 9), the values of the Trinova Pro C group were significantly higher than those of the Tecnis Eyhance group (p 0.05). In our study, all patients in the Trinova Pro C group achieved spectacle independence in distance, intermediate, and near visual functions. In the Tecnis Eyhance group, 16 patients (80%) used near glasses. Among these 16 patients, 12 always used glasses, 3 frequently used glasses, and 1 occasionally used glasses for near activities. Finally, 95% of patients in the Trinova Pro C group and 90% of patients in the Tecnis Eyhance group reported that they would recommend the implanted IOL to others. Discussion The findings of our study indicate that both Trinova Pro C and Tecnis Eyhance IOLs provide satisfactory visual outcomes in distance and intermediate. However, Trinova Pro C performed better in near vision. All patients in the Trinova Pro C group achieved spectacle independence, while the majority of patients in the Tecnis Eyhance group required near glasses. The rate of photic phenomena was reported to be lower in the Tecnis Eyhance group, which minimally reduces incoming light to the eye. The high rates of patients satisfaction and recommendations for both IOLs suggest that they are well received by patients. In a study conducted with Trinova, the first diffractive IOL that the manufacturer produced using a sinusoidal design, MUDVA results similar to those of Trinova Pro C were obtained at our postoperative 6th month [ 18 ]. In another study, Trinova and FineVision Micro F (PhysIOL SA, Belgium), a trifocal diffractive IOL, were compared and the DVA values were found to be similar [ 19 ]. In the study, when comparing the DVA values obtained with Trinova and those obtained with Trinova Pro C better results were found. According to data obtained from the producer, light transmission which was 92% in Trinova was increased to %93 in Trinova Pro C. This difference may partially explain the better DVA values observed. The DVA values obtained in our study were similar to the studies conducted with other trifocal IOLs available in the market [ 20 – 22 ]. Similarly, studies comparing Tecnis Eyhance with standard monofocal IOLs did not show a significant difference in terms of UDVA [ 14 , 23 ]. The lack of standardization in tests evaluating near and intermediate visual performance makes the design of studies difficult and hinders comparison [ 24 ]. In the study by Amigo et al., no statistically significant difference was found in terms of intermediate visual acuity between Trinova and FineVision Micro F at 3 months postoperatively [ 19 ]. Trinova’s + 1,50 D intermediate vision addition was increased to + 1,8 D by Trinova Pro C, which we used in our study. Alió et al. reported higher intermediate visual levels with AcrySof IQ Panoptix at 6 months postoperatively compared to our study [ 20 ]. AcrySof IQ Panoptix provides + 2.17 D addition for intermediate. Ünsal and Sabur obtained similar results to the MUIVA values we obtained in our study with Tecnis Eyhance [ 23 ]. On the other hand, Mencucci et al. reported MUIVA and MDCIVA values lower than those we obtained in our study with Eyhance [ 14 ]. In our study, Trinova Pro C achieved better results in near visual acuity. Amigo et al found the MUNVA and BUNVA values to be statistically better with FineVision Micro F compared to Trinova [ 19 ]. The Trinova near additional strength is 3.0 D, which value was raised to 3,6 D in Trinova Pro that we used in our study. Alió et al. reported lower near vision MUNVA levels with Panoptix compared to those we obtained with Trinova Pro C [ 20 ]. Mencucci et al. found similar MUNVA values for Tecnis Eyhance at 6 months compared to our study [ 14 ]. In a study evaluating Mini Well as a monofocal EDOF lens, Bellucci et al. reported better MUNVA values than those obtained with Tecnis Eyhance [ 25 ]. In this study, the mean spherical equivalent measured by postoperative autorefraction was − 0.59 ± 0.58 D, which was more negative than the values obtained in our study. When spherical equivalent values were examined at 6 months postoperatively, significantly more myopic values were obtained with Trinova Pro C. The depth of focus of trifocal IOLs is larger than that of standard monofocal IOLs. The absence of a single focal plane makes it challenging to determine the patients' objective or subjective refraction accurately [ 26 ]. In our study, the negative measurements in spherical equivalent obtained in the Trinova Pro C group could be attributed to variations in pupil size and differences in depth of focus depending on different lighting conditions. The lack of standardization of ambient lighting in autorefraction measurements and the absence of objective refraction measurements can be considered as limitations of our study. However, the fact that the MUDVA and MBCDVA values obtained at 6 months were quite similar and no change in visual acuity was observed during the examination with myopic corrections applied suggests that the values obtained by autorefraction may not reflect the true refractive error. Both IOLs used in our study are hydrophobic and have sharp edge designs. Shah et al. compared the rates of Nd:YAG laser capsulotomy for multifocal and monofocal IOLs and reported a higher rate of posterior capsulotomy in the multifocal group [ 27 ]. Dönmez et al. implanted hydrophobic Panoptix IOLs in 138 eyes of 69 patients and reported a PCO rate of 10% at 6 months postoperatively [ 28 ]. Çınar et al. reported that no cases of PCO development were observed in any patient who underwent Tecnis Eyhance IOL implantation during a follow-up period of 3.02 ± 1.3 months [ 29 ]. The incidence of PCO development can vary over time. Further clinical studies with longer follow-up periods are needed to evaluate both lens groups used in our study. In our study, subjective photic complaints were more frequently observed in Trinova Pro C cases. Hamid et al. compared the results of AT LISA tri839MP, FineVision, and Tecnis Symfony IOLs and reported a lower frequency of photic complaints in the EDOF Tecnis Symfony group compared to trifocal IOLs at 6 months postoperatively [ 30 ]. In their study, Ceran et al. reported, at postoperative 6 months, halo in 13.3% of the patients, and glare complaints at a level that would prevent vehicle use at night in 3.33% of the patients [ 18 ]. However, there are also studies reporting a higher incidence of photic complaints with multifocal IOLs. Kohnen et al. reported a 93% incidence of halo complaints at 3 months postoperatively with Panoptix [ 31 ]. Amigo et al. reported similar halo and glare complaints for Trinova and FineVision Micro F [ 19 ] Contrast sensitivity function is another important aspect that has been investigated with numerous IOLs with different materials and optical designs. Cochener et al. mentioned that EDOF IOLs could theoretically be superior to trifocal IOLs in terms of contrast sensitivity due to compensation for chromatic and spherical aberrations [ 32 ]. Mencucci et al. compared the EDOF Tecnis Symfony with the AT LISA Tri839MP and Acrysof IQ PanOptix trifocal diffractive IOL designs and showed that Tecnis Symfony was associated with improved contrast sensitivity under both photopic and mesopic conditions [ 33 ]. Assessment of improvement in patients' daily activities after cataract surgery is becoming increasingly important. One of the questionnaires developed for this purpose is VF-14, reported by Steinberg et al., and it has been validated for use in populations with cataract [ 34 ]. Brydon et al. found higher VF-14 values measured without glasses in the multifocal group compared to the monofocal group in their study [ 35 ]. Dyrda et al. compared hybrid multifocal, refractive multifocal, diffractive multifocal, and monofocal IOLs and reported statistically significantly better VF-14 values with hybrid and diffractive optic-designed IOLs compared to monofocal IOLs [ 36 ]. In our study, all patients in the Trinova Pro C group achieved spectacle independence in their daily activities. In the Tecnis Eyhance group, 80% of patients reported using near glasses with varying frequency. Ceran et al. reported a spectacle independence rate of 96.6% at 6 months postoperatively with Trinova [ 18 ]. Amigo et al. reported that all patients implanted with Trinova were able to read unaided at near and intermediate distances without difficulty [ 19 ]. Ünsal and Sabur reported spectacle independence rates of 97% at distance, 84% at intermediate, and 6% at near with Tecnis Eyhance [ 23 ]. Our study has certain limitations. Firstly, it was designed retrospectively and limited to patients who completed the follow-up period. Another important limitation is the short follow-up duration and the limited number of patient groups. The absence of control groups involving IOL implantations with similar designs is another significant limitation of our study. Parameters such as reading speed, critical print size, and contrast sensitivity, which are important indicators of near vision, were not evaluated. Additionally, contrast sensitivity values were not detailed for different lighting conditions. Objective questionnaires or measurement methods to assess subjective photic complaints such as halo and glare were not used in our study. Nevertheless, we believe that if there is any bias in our study, it would affect the clinical outcomes of both IOLs, and parameters that would create different clinical outcomes are discussed in the relevant sections of our study, thus ensuring the reliability of the results. Conclusions Trinova Pro C and Tecnis Eyhance IOLs have achieved patient expectations and clinically satisfactory outcomes. Further clinical research is needed to examine visual quality, contrast sensitivity values, and photic phenomena with these IOLs of different designs. List Of Abbreviations IOL Intraocular lens EDOF Extended depth of focus IOP Intraocular pressure MUDVA Monocular uncorrected distance visual acuity MBCDVA Monocular best corrected distance visual acuity OCT Optic coherence tomography BUDVA Binocular uncorrected distance visual acuity MUIVA Monocular uncorrected intermediate (60 cm) visual acuity BUIVA Binocular uncorrected intermediate (60 cm) visual acuity MDCIVA Monocular distance-corrected intermediate visual acuity MUNVA Monocular uncorrected near (40 cm) visual acuity BUNVA Binocular uncorrected near (40 cm) visual acuity PCO Posterior capsule opacity VF-14 The Visual Function − 14 questionnaire Declarations Ethics approval and consent to participate: This study was conducted in accordance with the tenets of the Declaration of Helsinki, and written consents were obtained from all patients. The study protocol was reviewed and approved by the Institution’s local ethics committee of Kartal Dr. Lutfi Kırdar City Hospital before the participants’ enrollment with study protocol number of 2022/514/223/3. Consent for publication: Not applicable. Availability of data and materials: The datasets generated and/or analysed during the current study are not publicly available due to the funding polites but are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests Funding: The design of the study and collection, analysis, and interpretation of data and in writing the manuscript were funded by VSY Biotechnology GMBH. Authors' contributions: Conception or design of the work: MT, AP, GA. Data collection: MT, AP. Data analysis and interpretation: MT, AP, GA. Drafting the article: MT, AP, GA. Critical revision of the article: MT, AP. Acknowledgements: Not applicable. References Davis G. 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Visual function with bilateral implantation of monofocal and multifocal intraocular lenses: a prospective, randomized, controlled clinical trial. J Refract Surg . 2008;24(3):257. Walkow T, Liekfield A, Anders N, Pham DT, Hartmann C, Wollensak J. A Prospective Evaluation of a Diffractive versus a Refractive Designed Multifocal Intraocular Lens. Ophthalmology . 1997;104(9):1380-1386. doi:10.1016/S0161-6420(97)30127-4 Davison JA, Simpson MJ. History and development of the apodized diffractive intraocular lens. J Cataract Refract Surg . 2006;32(5):849-858. doi:10.1016/j.jcrs.2006.02.006 Madrid-Costa D, Ruiz-Alcocer J, Ferrer-Blasco T, García-Lázaro S, Montés-Micó R. Optical Quality Differences Between Three Multifocal Intraocular Lenses: Bifocal Low Add, Bifocal Moderate Add, and Trifocal. J Refract Surg . 2013;29(11):749-754. doi:10.3928/1081597X-20131021-04 Akella SS, Juthani VV. Extended depth of focus intraocular lenses for presbyopia. Curr Opin Ophthalmol . 2018;29(4):318-322. doi:10.1097/ICU.0000000000000490 Rocha KM. Extended Depth of Focus IOLs: The Next Chapter in Refractive Technology? J Refract Surg . 2017;33(3):146-149. doi:10.3928/1081597X-20170217-01 Kim S, Yi R, Chung SH. Comparative Analysis of the Clinical Outcomes of Mix-and-Match Implantation of an Extended Depth-of-Focus and a Diffractive Bifocal Intraocular Lens. Eye Contact Lens Sci Clin Pract . 2022;48(6):261-266. doi:10.1097/ICL.0000000000000887 Hakan Kaymak. “Optical Bench Results and Optical Design of Enhanced Sinusoidal Vision Technology (SVT®).” ESCRS, Amsterdam 2021. Mencucci R, Cennamo M, Venturi D, Vignapiano R, Favuzza E. Visual outcome, optical quality, and patient satisfaction with a new monofocal IOL, enhanced for intermediate vision: preliminary results. J Cataract Refract Surg . 2020;46(3):378-387. doi:10.1097/j.jcrs.0000000000000061 Uluslararası standartlara uygun bir Türkçe yakın okuma eşeli | TR Dizin. Accessed May 25, 2022. https://app.trdizin.gov.tr/makale/TkRrNU1qazU=/uluslararasi-standartlara-uygun-bir-turkce-yakin-okuma-eseli Aslam TM. Systems of analysis of posterior capsule opacification. Br J Ophthalmol . 2002;86(10):1181-1186. doi:10.1136/bjo.86.10.1181 Baykara M, Akova YA, Arslan OS, et al. Visual Outcomes at 12 Months in Patients Following Implantation of a Diffractive Multifocal Intraocular Lens. Ophthalmol Ther . 2015;4(1):21-32. doi:10.1007/s40123-015-0032-4 Ceran B, Arifoglu H, Ozates S, Tasindi E. Refractive results, visual quality and patient satisfaction with a new trifocal intraocular lens design. Ann Med Res . 2020;27(11):3018. doi:10.5455/annalsmedres.2020.08.852 Amigó-Francés A, Castillo-Gómez A, Carmona-González D, Martínez-Sorribes P, Amigó A. Comparative study of visual results obtained with two trifocal lens models in cataract surgery. J Clin Res Ophthalmol . 2020;7(2):054-060. Alió JL, Plaza-Puche AB, Alió del Barrio JL, et al. Clinical outcomes with a diffractive trifocal intraocular lens. Eur J Ophthalmol . 2018;28(4):419-424. doi:10.1177/1120672118762231 Bilbao-Calabuig R, Llovet-Rausell A, Ortega-Usobiaga J, et al. Visual Outcomes Following Bilateral lmplantation of Two Diffractive Trifocal Intraocular Lenses in 10 084 Eyes. Am J Ophthalmol . 2017;179:55-66. doi:10.1016/j.ajo.2017.04.013 Ucar F, Cetinkaya S. The evaluation of postoperative objective and subjective refraction for premium intraocular lenses. 2020;79(6):386-390. doi:10.5935/0034-7280.20200084 Unsal U, Sabur H. Comparison of new monofocal innovative and standard monofocal intraocular lens after phacoemulsification. Int Ophthalmol . 2021;41(1):273-282. doi:10.1007/s10792-020-01579-y Vargas V, Radner W, Allan BD, Reinstein DZ, Burkhard Dick H, Alió JL. Methods for the study of near, intermediate vision, and accommodation: an overview of subjective and objective approaches. Surv Ophthalmol . 2019;64(1):90-100. doi:10.1016/j.survophthal.2018.08.003 Bellucci R, Cargnoni M, Bellucci C. Clinical and aberrometric evaluation of a new extended depth-of-focus intraocular lens based on spherical aberration. J Cataract Refract Surg . 2019;45(7):919-926. doi:10.1016/j.jcrs.2019.02.023 Kretz F, Linz K, Mueller M, et al. Richtiges Refraktionieren nach Implantation von Multifokal- und presbyopiekorrigierenden Intraokularlinsen. Klin Monatsblätter Für Augenheilkd . 2015;232(08):953-956. doi:10.1055/s-0035-1545832 Shah VC, Russo C, Cannon R, Davidson R, Taravella MJ. Incidence of Nd:YAG Capsulotomy After Implantation of AcrySof Multifocal and Monofocal Intraocular Lenses: A Case Controlled Study. J Refract Surg . 2010;26(8):565-568. doi:10.3928/1081597X-20100303-01 Donmez O, Asena BS, Kaskaloglu M, Akova YA. Patients satisfaction and clinical outcomes of binocular implantation of a new trifocal intraocular lens. Int Ophthalmol . 2020;40(5):1069-1075. doi:10.1007/s10792-020-01390-9 Cinar E, Bolu H, Erbakan G, et al. Vision outcomes with a new monofocal IOL. Int Ophthalmol . 2021;41(2):491-498. doi:10.1007/s10792-020-01599-8 Hamid A, Sokwala A. A More Natural Way of Seeing: Visual Performance of Three Presbyopia Correcting Intraocular Lenses. Open J Ophthalmol . 2016;06(03):176-183. doi:10.4236/ojoph.2016.63025 Kohnen T, Herzog M, Hemkeppler E, et al. Visual Performance of a Quadrifocal (Trifocal) Intraocular Lens Following Removal of the Crystalline Lens. Am J Ophthalmol . 2017;184:52-62. doi:10.1016/j.ajo.2017.09.016 Cochener B, Boutillier G, Lamard M, Auberger-Zagnoli C. A Comparative Evaluation of a New Generation of Diffractive Trifocal and Extended Depth of Focus Intraocular Lenses. J Refract Surg . 2018;34(8):507-514. doi:10.3928/1081597X-20180530-02 Mencucci R, Favuzza E, Caporossi O, Savastano A, Rizzo S. Comparative analysis of visual outcomes, reading skills, contrast sensitivity, and patient satisfaction with two models of trifocal diffractive intraocular lenses and an extended range of vision intraocular lens. Graefes Arch Clin Exp Ophthalmol . 2018;256(10):1913-1922. doi:10.1007/s00417-018-4052-3 Cassard SD. Reproducibility and Responsiveness of the VF-14: An Index of Functional Impairment in Patients With Cataracts. Arch Ophthalmol . 1995;113(12):1508. doi:10.1001/archopht.1995.01100120038005 Brydon KW, Tokarewicz AC, Nichols BD. AMO array multifocal lens versus monofocal correction in cataract surgery. J Cataract Refract Surg . 2000;26(1):96-100. doi:10.1016/S0886-3350(99)00335-1 Dyrda A, Martínez-Palmer A, Martín-Moral D, et al. Clinical Results of Diffractive, Refractive, Hybrid Multifocal, and Monofocal Intraocular Lenses. J Ophthalmol . 2018;2018:1-12. doi:10.1155/2018/8285637 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3104554","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":212852307,"identity":"a0302899-8793-4620-89e3-1d26f13bd538","order_by":0,"name":"Mustafa Talan¹","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIie2PsQrCMBRFUwIdnSv+RKfgUOqHuKQE6tTdoUNddOvuRwhOzq8EOoVmDdRBEZw7iZP4FHSRVt0EcyDhBu7hEkIsll8E8OwejykJ8HZm0K1QQvg9YVAkvinZV4p8TrfSq3XR8HQ79jUGSHW4WkhcSYNxm9KvBPV4eUzWBgOUtdioCJUyTrIWxVeUeNyVqFAyaNxaMEDFyWSXQs/8goqW9AyXSjC9f6u4XjRHBYTrFXMImXmz0leUDaNcJksj2LDIBWcGV3jHX3rKOZjmJJNcFwcDp3DE9GS/a9KgVXkhujf5p/Ubo2/KFovF8h9cARa2cCab58+8AAAAAElFTkSuQmCC","orcid":"","institution":"Kartal Dr. Lutfi Kirdar City Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Mustafa","middleName":"","lastName":"Talan¹","suffix":""},{"id":212852308,"identity":"685f7d0a-3312-42ab-84c1-0ef0223d7b2c","order_by":1,"name":"Aysegul Penbe","email":"","orcid":"","institution":"Kartal Dr. Lutfi Kirdar City Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Aysegul","middleName":"","lastName":"Penbe","suffix":""},{"id":212852309,"identity":"df42926e-f080-409b-8c87-0d94040ca176","order_by":2,"name":"Güzide Akçay","email":"","orcid":"","institution":"Kartal Dr. Lutfi Kirdar City Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Güzide","middleName":"","lastName":"Akçay","suffix":""}],"badges":[],"createdAt":"2023-06-24 16:44:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3104554/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3104554/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":39082970,"identity":"7bc32f60-a94a-48f5-a24c-06af91ef27dc","added_by":"auto","created_at":"2023-06-26 14:18:37","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":546717,"visible":true,"origin":"","legend":"\u003cp\u003eThe cumulative binocular uncorrected visual acuities of patients. ( UDVA: uncorrected distance visual acuities, UIVA: uncorrected intermediate visual acuities, UNVA: uncorrected near visual acuities, logMAR:logarithm of the minimum angle of resolution)\u003c/p\u003e","description":"","filename":"fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3104554/v1/4a29ea558a905d98e0d44b4f.jpg"},{"id":39082969,"identity":"e5e61d2f-55a7-4bb9-b1bd-df46157fce26","added_by":"auto","created_at":"2023-06-26 14:18:37","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":178750,"visible":true,"origin":"","legend":"\u003cp\u003eMean uncorrected binocular defocus curves of the patients in both groups at postoperative 6th month.\u003c/p\u003e","description":"","filename":"fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3104554/v1/53e446401172244363d5d28a.jpg"},{"id":39082968,"identity":"35039bb2-7d59-4524-b829-f82c81f14bf0","added_by":"auto","created_at":"2023-06-26 14:18:37","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":328974,"visible":true,"origin":"","legend":"\u003cp\u003eContrast sensitivity values glare in both groups. (CS: Contrast Sensitivity, logMAR: logarithm of the minimum angle of the resolution.)\u003c/p\u003e","description":"","filename":"fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3104554/v1/f19bed1c05575a648a85d6b7.jpg"},{"id":49507324,"identity":"b9487bee-fa31-43f0-88a9-13364b16c047","added_by":"auto","created_at":"2024-01-12 04:38:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":515666,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3104554/v1/65a304d0-0580-4e53-ac58-ceecc7cf14a0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparision of a Novel Trifocal Intraocular Lens and a Monofocal Enhanced Depth of Focus Intraocular Lens in Visual Performance and Quality of Life Scores","fulltext":[{"header":"Background","content":"\u003cp\u003eThanks to advancements and technological developments in the technique of phacoemulsification, expectations have surpassed complication-free surgery, aiming for low postoperative residual refractive error, rapid visual rehabilitation, and routine independence from glasses at all distances [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The most commonly implanted intraocular lenses (IOLs) in cataract surgeries are still monofocal IOLs due to their low cost, satisfactory visual function for distance vision, suitability for patients with comorbidities such as corneal and retinal diseases, and lesser occurrence of photic phenomena [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, these IOLs still fall short in intermediate and near activities, leading to a need for glasses [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn order to provide clear vision simultaneously at near and far, bifocal refractive IOLs were first introduced in 1986 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, these IOLs did not provide sufficient correction for intermediate functions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Additionally, the multiple focal points of light refraction caused a decrease in contrast sensitivity and resulted in photic phenomena such as halos and glare [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The discovery of multifocal diffractive IOLs has relatively reduced dysphotopsia complaints and improved vision at far, intermediate, and near [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTrifocal IOLs create three different focal points to provide vision at different distances, while extended depth of focus (EDOF) IOLs, whose fundamental principle is to create a longitudinal focal plane, have been introduced to increase the range of vision [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This extended focal plane can be achieved through the modification of spherical aberrations, diffractive optical designs, pinhole effect, or bio-analogical Technologies [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Nowadays, to achieve better visual performance, one or more of the available IOL technologies in the market can be combined [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, we aimed to investigate the effects of newly designed Acriva\u003csup\u003eUD\u003c/sup\u003e Trinova Pro C lenses, which utilize the principle of diffractive trifocal IOLs, and Tecnis Eyhance lenses, which utilize the principle of extended depth of focus, on distance, intermediate, and near visual acuity, contrast sensitivity, photic phenomena, and quality of life. The absence of studies reported in the literature with Trinova Pro IOLs makes our research significant.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003ePatients who underwent phacoemulsification and IOL implantation at Kartal Dr. L\u0026uuml;tfi Kırdar City Hospital Ophthalmology Clinic between January 2021 and December 2021 were retrospectively screened. The preoperative and postoperative examination findings of patients implanted with Trinova Pro C and Tecnis Eyhance following bilateral uncomplicated phacoemulsification were analyzed.\u003c/p\u003e \u003cp\u003eAll included patients were provided with detailed information about cataract surgery and the implanted IOLs during preoperative visits, and their informed consent was obtained. In accordance with the principles and ethical rules of the Helsinki Declaration, patients participating in the study were informed that their medical records would be used for the performed surgery and follow-up visits, and their consent was obtained.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatient selection:\u003c/h2\u003e \u003cp\u003eTwenty patients with a total of 40 eyes who were literate and aged 40 years and above, and who received uncomplicated bilateral phacoemulsification followed by Trinova Pro C implantation, as well as twenty patients with a total of 40 eyes who received Tecnis Eyhance implantation, were included in the study.\u003c/p\u003e \u003cp\u003ePatients with a need for high contrast sensitivity due to their profession or unrealistic expectations were not included. Patients with severe dry eye symptoms or ocular surface irregularities, corneal pathology, uveitis, pseudoexfoliation syndrome, glaucoma, retinopathy, and other additional eye diseases, as well as patients with neuro-ophthalmologic pathologies, were not included in the study. Patients who had undergone any previous eye surgery, had a mesopic pupil diameter above 6 mm or a photopic pupil diameter below 2 mm, had hyperopia or myopia greater than 5 D, had corneal astigmatism of 1 D or higher, or had axial length below 22 mm or above 26 mm were not included in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePreoperative assessments:\u003c/h2\u003e \u003cp\u003eThe patients' complaints and expectations, as well as their ophthalmological and systemic medical history, were thoroughly evaluated. Their educational status, occupations, daily activities, and hobbies were questioned. Autorefraction measurements of the patients were taken using an autorefractor/keratometer (NIDEK ARK-1a, Japan). Intraocular pressure (IOP) measurements were performed using applanation tonometry. Light reflexes and relative afferent pupillary defect examinations were evaluated. Keratometry values and pupil diameters under photopic and mesopic conditions were measured (Sirius, CSO, Italy). Monocular uncorrected and best-corrected distance (at 4 meters) visual acuity were measured and converted to logMAR units (MUDVA and MBCDVA) using Snellen equivalents. Detailed anterior segment and dilated fundus examinations were performed. Central macular morphology were evaluated using optic coherence tomography (TOPCON DRI OCT TRITON, Japan). Axial lengths were measured using optical biometry (Haag-Streit Lenstar LS900, Switzerland) and confirmed using A-scan mode ultrasound (Sonomed Escalon E-Z AB5500+, U.S.A). Biometric measurements were performed targeting emmetropia in both eyes using the SRK/T formula.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSurgical Technique:\u003c/h2\u003e \u003cp\u003eAll cases were performed by the same experienced surgeon (A.P) using the standard small incision phacoemulsification technique with a continuous curvilinear capsulorhexis of 5-5.5 mm diameter created with micro forceps. The pre-planned IOLs were implanted into the capsular bag. IOL centration was checked using Purkinje reflexes. The same phacoemulsification machine (Bausch and Lomb, Stellaris, USA) and microscope (Zeiss, OPMI LUMERA T S88, Germany) were used in all surgeries. In all cases, the eye causing more complaints was operated on first, followed by the other eye approximately 1\u0026ndash;4 weeks later.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eThe IOLs used in our study\u003c/h2\u003e \u003cp\u003eAccording to the company data, Trinova Pro C is a trifocal IOL that features a sinusoidal design and a smooth transition diffractive surface area. Unlike traditional overlapping design trifocal IOLs, this smooth transition sinusoidal design aims to increase light distribution efficiency and minimize postoperative photic phenomena. With its enhanced pupil adaptive feature, Trinova Pro C maintains visual quality under different lighting conditions. Approximately 93% of the light entering the eye reaches the retina with Trinova Pro C [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. With +\u0026thinsp;1.8 D intermediate and +\u0026thinsp;3.6 D near additions, Trinova Pro C provides clear vision for activities such as phone usage, reading, and computer use at intermediate and near.\u003c/p\u003e \u003cp\u003eTecnis Eyhance is a single-piece hydrophobic acrylic posterior chamber lens. With a modified aspheric front surface, this monofocal IOL aims to expand the depth of focus and increase the range of vision. The modified aspheric front surface provides a continuous power profile that increases from the periphery to the center. As a result, it offers better vision at intermediate distances compared to a standard monofocal IOL. Based on modification of spherical aberrations, this design does not include refractive or diffractive zones and cannot be distinguished from a standard monofocal IOL macroscopically [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The increased range of vision provided by this design, along with the depth of field created, is less affected by photic phenomena caused by multifocal IOLs that create multiple focal points.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003ePostoperative evaluations\u003c/h2\u003e \u003cp\u003eAll patients were prescribed dexamethasone sodium phosphate 0.1% and moxifloxacin 0.5% eye drops for the postoperative period. Dexamethasone sodium phosphate 0.1% was gradually discontinued.\u003c/p\u003e \u003cp\u003eDuring the postoperative 1st day and 1st week examinations, IOP, MUDVA, detailed anterior segment examinations, and dilated fundus examinations were evaluated. Additionally, at the 1st and 3rd-month follow-up visits, MBCDVA and binocular uncorrected distance visual acuity (BUDVA) were measured using Snellen charts and converted to the logMAR unit. Monocular and binocular uncorrected intermediate (60 cm) visual acuity (MUIVA, BUIVA), along with monocular distance-corrected intermediate visual acuity (MDCIVA), and monocular and binocular uncorrected near (40 cm) visual acuity (MUNVA and BUNVA) were measured and recorded using a Turkish reading chart prepared according to the international standards of Bailey-Lovie and Early Treatment Diabetic Retinopathy Study reading charts [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAt the 6th-month postoperative evaluation, in addition to the aforementioned assessments, posterior capsule opacity (PCO) was evaluated during biomicroscopic examination and scored as follows: 0\u0026thinsp;=\u0026thinsp;none, 1\u0026thinsp;=\u0026thinsp;transparent and only assessable with retroillumination, 2\u0026thinsp;=\u0026thinsp;distinct fibrosis visible during retroillumination, 3\u0026thinsp;=\u0026thinsp;intense white fibrosis with Elsching pearls [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Monocular glare and glare-free photopic contrast sensitivity values were examined using CSV-1000E (VectorVision, USA) after correcting any existing refractive errors. Moreover, binocular defocus curves were generated with 0.50 D increments within the range of +\u0026thinsp;2.0 D to -5.0 D. Patients were also questioned about photopic symptoms such as halos, glare, sunbursts, and dark areas, and they were asked to rate the severity of their symptoms on a scale of 1\u0026thinsp;=\u0026thinsp;none, 2\u0026thinsp;=\u0026thinsp;mild, 3\u0026thinsp;=\u0026thinsp;moderate, 4\u0026thinsp;=\u0026thinsp;severe. The Visual Function 14 questionnaire (VF-14), consisting of 14 questions, was conducted to evaluate patients' visual satisfaction and quality of life [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In contrast to the original version of the questionnaire, responses were also noted without glasses to assess patients' functional ability to perform activities without glasses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis:\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using R version 2.15.3 software (R Core Team, 2013). The study data was reported using measures such as minimum, maximum, mean, standart deviation, median, frequency and percentage. The normality of quantitative data was evaluated using the Shapiro-Wilk test and graphical examinations. Between-group comparisons of normally distributed quantitative variables were performed using independent samples t-test. Within-group comparisons of normally distributed quantitative variables were analyzed using dependent samples t-test, repeated measure analysis of variance, and pairwise comparison with Bonferroni correction. The comparison of qualitative data was conducted using pearson\u0026rsquo;s chi \u0026ndash; square test. A p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eDuring postoperative follow-ups, all cases exhibited round and light sensitive pupils and a centralized IOL position. Demographic characteristics and preoperative evaluations are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePreoperative characteristics of patients in both groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrinova Pro C Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTecnis Eyhance Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients / eyes (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 / 40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20/40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (n / %)\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 / %45\u003c/p\u003e \u003cp\u003e11 / %55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 / %50\u003c/p\u003e \u003cp\u003e10 / %50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (y)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.65\u0026thinsp;\u0026plusmn;\u0026thinsp;10.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.50\u0026thinsp;\u0026plusmn;\u0026thinsp;8.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.694\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManifest Spherical Equivalent (D)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.615\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCylindrical Power (D)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.714\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIOP (mm/hg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.52\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.899\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMUDVA (Logmar)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.953\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMBCDVA (Logmar)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.685\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAxial length\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.917\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhotopic Pupil Diameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.476\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMesopic Pupil Diameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eUpon examining visual acuity values, it was observed that at the postoperative 1 st month, the MUDVA and MBCDVA values of the Trinova Pro C group were significantly higher compared to the Tecnis Eyhance group (p\u0026thinsp;=\u0026thinsp;0.001,p\u0026thinsp;=\u0026thinsp;0.003) However, near visual acuity values were significantly lower in the Trinova Pro C group at all visits (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The visual acuity values for each group are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The cumulative binocular uncorrected visual acuity at 6 months postoperatively is shown in Fig.\u0026nbsp;1. Defocus curves evaluated between the groups are displayed in Fig.\u0026nbsp;2.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePostoperative parameters of patients in both groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrinova Pro C Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTecnis Eyhance Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMUDVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMBCDVA logMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.003*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBUDVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e-0.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.276\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMUIVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.452\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMDCIVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.962\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBUIVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.165\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMUNVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBUNVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMUDVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMBCDVA logMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBUDVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e-0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.540\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMUIVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.234\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMDCIVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.392\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBUIVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.503\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMUNVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBUNVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 Month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpherical equivalent(D)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e-1.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCylindrical value (D)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e-0.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMUDVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMBCDVA logMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBUDVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e-0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.438\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMUIVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.495\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMDCIVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.512\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBUIVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMUNVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBUNVA LogMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAt the postoperative 6th month, spherical equivalent values were significantly more myopic in the Trinova Pro C group compared to the Tecnis Eyhance group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, no significant difference was observed in cylindrical values (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In the Trinova Pro C group, contrast sensitivity values at 12 cpd and 18 cpd in glare-free photopic conditions, as well as at 12 cpd in glare conditions, were significantly lower (p\u0026thinsp;=\u0026thinsp;0.004, p\u0026thinsp;=\u0026thinsp;0.031, p\u0026thinsp;=\u0026thinsp;0.007). The contrast sensitivity graph are shown in Fig.\u0026nbsp;3.\u003c/p\u003e \u003cp\u003eThere was no significant difference in PCO scoring between the groups at 6 months (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Weak posterior capsule opacification, assessable with retroillumination, was observed in 4 eyes (10%) in the Trinova Pro C group and in 3 eyes (7.5%) in the Tecnis Eyhance group.\u003c/p\u003e \u003cp\u003eSubjective photic complaints were significantly higher in the Trinova Pro C group at 6 months postoperatively (p\u0026thinsp;=\u0026thinsp;0.034). In the Trinova Pro C group, 14 patients (70%) reported no complaints, 5 patients (25%) reported mild complaints, and 1 patient (5%) reported moderate complaints. No patients reported severe complaints. In the Tecnis Eyhance group, 18 patients (90%) reported no complaints, and 2 patients (10%) reported mild complaints.\u003c/p\u003e \u003cp\u003eWhen examining VF-14 test values, it was found that the values of the Trinova Pro C group were significantly higher (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). For near visual activities (questions 1, 2, 7, 8, and 9), the values of the Trinova Pro C group were significantly higher than those of the Tecnis Eyhance group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No significant difference was found in VF-14 test values for other activities and questionnaire questions repeated with the presence of glasses (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eIn our study, all patients in the Trinova Pro C group achieved spectacle independence in distance, intermediate, and near visual functions. In the Tecnis Eyhance group, 16 patients (80%) used near glasses. Among these 16 patients, 12 always used glasses, 3 frequently used glasses, and 1 occasionally used glasses for near activities. Finally, 95% of patients in the Trinova Pro C group and 90% of patients in the Tecnis Eyhance group reported that they would recommend the implanted IOL to others.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of our study indicate that both Trinova Pro C and Tecnis Eyhance IOLs provide satisfactory visual outcomes in distance and intermediate. However, Trinova Pro C performed better in near vision. All patients in the Trinova Pro C group achieved spectacle independence, while the majority of patients in the Tecnis Eyhance group required near glasses. The rate of photic phenomena was reported to be lower in the Tecnis Eyhance group, which minimally reduces incoming light to the eye. The high rates of patients satisfaction and recommendations for both IOLs suggest that they are well received by patients.\u003c/p\u003e \u003cp\u003eIn a study conducted with Trinova, the first diffractive IOL that the manufacturer produced using a sinusoidal design, MUDVA results similar to those of Trinova Pro C were obtained at our postoperative 6th month [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In another study, Trinova and FineVision Micro F (PhysIOL SA, Belgium), a trifocal diffractive IOL, were compared and the DVA values were found to be similar [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In the study, when comparing the DVA values obtained with Trinova and those obtained with Trinova Pro C better results were found. According to data obtained from the producer, light transmission which was 92% in Trinova was increased to %93 in Trinova Pro C. This difference may partially explain the better DVA values observed. The DVA values obtained in our study were similar to the studies conducted with other trifocal IOLs available in the market [\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Similarly, studies comparing Tecnis Eyhance with standard monofocal IOLs did not show a significant difference in terms of UDVA [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe lack of standardization in tests evaluating near and intermediate visual performance makes the design of studies difficult and hinders comparison [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In the study by Amigo et al., no statistically significant difference was found in terms of intermediate visual acuity between Trinova and FineVision Micro F at 3 months postoperatively [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Trinova\u0026rsquo;s\u0026thinsp;+\u0026thinsp;1,50 D intermediate vision addition was increased to +\u0026thinsp;1,8 D by Trinova Pro C, which we used in our study. Ali\u0026oacute; et al. reported higher intermediate visual levels with AcrySof IQ Panoptix at 6 months postoperatively compared to our study [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. AcrySof IQ Panoptix provides\u0026thinsp;+\u0026thinsp;2.17 D addition for intermediate. \u0026Uuml;nsal and Sabur obtained similar results to the MUIVA values we obtained in our study with Tecnis Eyhance [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. On the other hand, Mencucci et al. reported MUIVA and MDCIVA values lower than those we obtained in our study with Eyhance [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, Trinova Pro C achieved better results in near visual acuity. Amigo et al found the MUNVA and BUNVA values to be statistically better with FineVision Micro F compared to Trinova [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The Trinova near additional strength is 3.0 D, which value was raised to 3,6 D in Trinova Pro that we used in our study. Ali\u0026oacute; et al. reported lower near vision MUNVA levels with Panoptix compared to those we obtained with Trinova Pro C [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMencucci et al. found similar MUNVA values for Tecnis Eyhance at 6 months compared to our study [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In a study evaluating Mini Well as a monofocal EDOF lens, Bellucci et al. reported better MUNVA values than those obtained with Tecnis Eyhance [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In this study, the mean spherical equivalent measured by postoperative autorefraction was \u0026minus;\u0026thinsp;0.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58 D, which was more negative than the values obtained in our study.\u003c/p\u003e \u003cp\u003eWhen spherical equivalent values were examined at 6 months postoperatively, significantly more myopic values were obtained with Trinova Pro C. The depth of focus of trifocal IOLs is larger than that of standard monofocal IOLs. The absence of a single focal plane makes it challenging to determine the patients' objective or subjective refraction accurately [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In our study, the negative measurements in spherical equivalent obtained in the Trinova Pro C group could be attributed to variations in pupil size and differences in depth of focus depending on different lighting conditions. The lack of standardization of ambient lighting in autorefraction measurements and the absence of objective refraction measurements can be considered as limitations of our study. However, the fact that the MUDVA and MBCDVA values obtained at 6 months were quite similar and no change in visual acuity was observed during the examination with myopic corrections applied suggests that the values obtained by autorefraction may not reflect the true refractive error.\u003c/p\u003e \u003cp\u003eBoth IOLs used in our study are hydrophobic and have sharp edge designs. Shah et al. compared the rates of Nd:YAG laser capsulotomy for multifocal and monofocal IOLs and reported a higher rate of posterior capsulotomy in the multifocal group [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. D\u0026ouml;nmez et al. implanted hydrophobic Panoptix IOLs in 138 eyes of 69 patients and reported a PCO rate of 10% at 6 months postoperatively [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. \u0026Ccedil;ınar et al. reported that no cases of PCO development were observed in any patient who underwent Tecnis Eyhance IOL implantation during a follow-up period of 3.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3 months [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The incidence of PCO development can vary over time. Further clinical studies with longer follow-up periods are needed to evaluate both lens groups used in our study.\u003c/p\u003e \u003cp\u003eIn our study, subjective photic complaints were more frequently observed in Trinova Pro C cases. Hamid et al. compared the results of AT LISA tri839MP, FineVision, and Tecnis Symfony IOLs and reported a lower frequency of photic complaints in the EDOF Tecnis Symfony group compared to trifocal IOLs at 6 months postoperatively [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In their study, Ceran et al. reported, at postoperative 6 months, halo in 13.3% of the patients, and glare complaints at a level that would prevent vehicle use at night in 3.33% of the patients [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, there are also studies reporting a higher incidence of photic complaints with multifocal IOLs. Kohnen et al. reported a 93% incidence of halo complaints at 3 months postoperatively with Panoptix [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Amigo et al. reported similar halo and glare complaints for Trinova and FineVision Micro F [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eContrast sensitivity function is another important aspect that has been investigated with numerous IOLs with different materials and optical designs. Cochener et al. mentioned that EDOF IOLs could theoretically be superior to trifocal IOLs in terms of contrast sensitivity due to compensation for chromatic and spherical aberrations [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Mencucci et al. compared the EDOF Tecnis Symfony with the AT LISA Tri839MP and Acrysof IQ PanOptix trifocal diffractive IOL designs and showed that Tecnis Symfony was associated with improved contrast sensitivity under both photopic and mesopic conditions [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAssessment of improvement in patients' daily activities after cataract surgery is becoming increasingly important. One of the questionnaires developed for this purpose is VF-14, reported by Steinberg et al., and it has been validated for use in populations with cataract [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Brydon et al. found higher VF-14 values measured without glasses in the multifocal group compared to the monofocal group in their study [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Dyrda et al. compared hybrid multifocal, refractive multifocal, diffractive multifocal, and monofocal IOLs and reported statistically significantly better VF-14 values with hybrid and diffractive optic-designed IOLs compared to monofocal IOLs [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, all patients in the Trinova Pro C group achieved spectacle independence in their daily activities. In the Tecnis Eyhance group, 80% of patients reported using near glasses with varying frequency. Ceran et al. reported a spectacle independence rate of 96.6% at 6 months postoperatively with Trinova [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Amigo et al. reported that all patients implanted with Trinova were able to read unaided at near and intermediate distances without difficulty [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. \u0026Uuml;nsal and Sabur reported spectacle independence rates of 97% at distance, 84% at intermediate, and 6% at near with Tecnis Eyhance [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study has certain limitations. Firstly, it was designed retrospectively and limited to patients who completed the follow-up period. Another important limitation is the short follow-up duration and the limited number of patient groups. The absence of control groups involving IOL implantations with similar designs is another significant limitation of our study. Parameters such as reading speed, critical print size, and contrast sensitivity, which are important indicators of near vision, were not evaluated. Additionally, contrast sensitivity values were not detailed for different lighting conditions. Objective questionnaires or measurement methods to assess subjective photic complaints such as halo and glare were not used in our study. Nevertheless, we believe that if there is any bias in our study, it would affect the clinical outcomes of both IOLs, and parameters that would create different clinical outcomes are discussed in the relevant sections of our study, thus ensuring the reliability of the results.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eTrinova Pro C and Tecnis Eyhance IOLs have achieved patient expectations and clinically satisfactory outcomes. Further clinical research is needed to examine visual quality, contrast sensitivity values, and photic phenomena with these IOLs of different designs.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIOL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntraocular lens\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEDOF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eExtended depth of focus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIOP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntraocular pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMUDVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMonocular uncorrected distance visual acuity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMBCDVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMonocular best corrected distance visual acuity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOptic coherence tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBUDVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBinocular uncorrected distance visual acuity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMUIVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMonocular uncorrected intermediate (60 cm) visual acuity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBUIVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBinocular uncorrected intermediate (60 cm) visual acuity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMDCIVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMonocular distance-corrected intermediate visual acuity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMUNVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMonocular uncorrected near (40 cm) visual acuity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBUNVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBinocular uncorrected near (40 cm) visual acuity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePosterior capsule opacity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVF-14\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eThe Visual Function \u0026minus;\u0026thinsp;14 questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThis study was conducted in accordance with the tenets of the Declaration of Helsinki, and written consents were obtained from all patients. The study protocol was reviewed and approved by the Institution\u0026rsquo;s local ethics committee of Kartal Dr. Lutfi Kırdar City Hospital before the participants\u0026rsquo; enrollment with study protocol number of 2022/514/223/3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets generated and/or analysed during the current study are not publicly available due to the funding polites but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThe design of the study and collection, analysis, and interpretation of data and in writing the manuscript\u0026nbsp;were funded by VSY Biotechnology GMBH.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003eConception or design of the work: MT, AP, GA. Data collection: MT, AP. Data analysis and interpretation: MT, AP, GA. Drafting the article: MT, AP, GA. Critical revision of the article: MT, AP.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements: \u003c/strong\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDavis G. The Evolution of Cataract Surgery. \u003cem\u003eMo Med\u003c/em\u003e. 2016;113(1):58-62.\u003c/li\u003e\n\u003cli\u003eMencucci R, Cennamo M, Venturi D, Vignapiano R, Favuzza E. Visual outcome, optical quality, and patient satisfaction with a new monofocal IOL, enhanced for intermediate vision: preliminary results. \u003cem\u003eJ Cataract Refract Surg\u003c/em\u003e. 2020;46(3):378-387. doi:10.1097/j.jcrs.0000000000000061\u003c/li\u003e\n\u003cli\u003eRampat R, Gatinel D. 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A More Natural Way of Seeing: Visual Performance of Three Presbyopia Correcting Intraocular Lenses. \u003cem\u003eOpen J Ophthalmol\u003c/em\u003e. 2016;06(03):176-183. doi:10.4236/ojoph.2016.63025\u003c/li\u003e\n\u003cli\u003eKohnen T, Herzog M, Hemkeppler E, et al. Visual Performance of a Quadrifocal (Trifocal) Intraocular Lens Following Removal of the Crystalline Lens. \u003cem\u003eAm J Ophthalmol\u003c/em\u003e. 2017;184:52-62. doi:10.1016/j.ajo.2017.09.016\u003c/li\u003e\n\u003cli\u003eCochener B, Boutillier G, Lamard M, Auberger-Zagnoli C. A Comparative Evaluation of a New Generation of Diffractive Trifocal and Extended Depth of Focus Intraocular Lenses. \u003cem\u003eJ Refract Surg\u003c/em\u003e. 2018;34(8):507-514. doi:10.3928/1081597X-20180530-02\u003c/li\u003e\n\u003cli\u003eMencucci R, Favuzza E, Caporossi O, Savastano A, Rizzo S. Comparative analysis of visual outcomes, reading skills, contrast sensitivity, and patient satisfaction with two models of trifocal diffractive intraocular lenses and an extended range of vision intraocular lens. \u003cem\u003eGraefes Arch Clin Exp Ophthalmol\u003c/em\u003e. 2018;256(10):1913-1922. doi:10.1007/s00417-018-4052-3\u003c/li\u003e\n\u003cli\u003eCassard SD. Reproducibility and Responsiveness of the VF-14: An Index of Functional Impairment in Patients With Cataracts. \u003cem\u003eArch Ophthalmol\u003c/em\u003e. 1995;113(12):1508. doi:10.1001/archopht.1995.01100120038005\u003c/li\u003e\n\u003cli\u003eBrydon KW, Tokarewicz AC, Nichols BD. AMO array multifocal lens versus monofocal correction in cataract surgery. \u003cem\u003eJ Cataract Refract Surg\u003c/em\u003e. 2000;26(1):96-100. doi:10.1016/S0886-3350(99)00335-1\u003c/li\u003e\n\u003cli\u003eDyrda A, Mart\u0026iacute;nez-Palmer A, Mart\u0026iacute;n-Moral D, et al. Clinical Results of Diffractive, Refractive, Hybrid Multifocal, and Monofocal Intraocular Lenses. \u003cem\u003eJ Ophthalmol\u003c/em\u003e. 2018;2018:1-12. doi:10.1155/2018/8285637\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cataract, presbyopia, trifocal intraocular lens, extended depth of focus","lastPublishedDoi":"10.21203/rs.3.rs-3104554/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3104554/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe aim of this study was to investigate the effects of trifocal and monofocal intraocular lens with enhanced depth of focus implantations\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e40 patients who had bilateral implantation of the trifocal or monofocal extended depth of focus intaocular lenses after phacoemulsification were included in the study. The preoperative and postoperative examination findings were analyzed. At the 6th postoperative month, binocular defocus curves, contrast sensitivity measurements, subjective complaints, spectacles independence, and the quality of life questionnaire results of the VF-14 questionnaire were also examined.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWhile distance and intermediate visual acuities were similar at 6 months postoperatively, near visual acuities were found to be statistically significantly better in the trifocal group. The contrast sensitivity values were found to be statistically better in the edof group. In the trifocal group, 25% of the patients had low-intensity and 5% of the patients had moderate intensity of photopic complaints respectively, while 10% of the patients in the edof group had low-intensity photopic complaints. While spectacles independence could be achieved in all patients in the trifocal group, in the edof group, 80% of patients needed spectacles. When examining VF-14 test values without spectacles, it was found that the values of the trifocal group were significantly higher.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eTrifocal group performed better at near, although far and intermediate vision was comparable between the groups. On the other hand, a higher rate of photic phenomena was observed in the trifocal group.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003eRetrospectively registered\u003c/p\u003e","manuscriptTitle":"Comparision of a Novel Trifocal Intraocular Lens and a Monofocal Enhanced Depth of Focus Intraocular Lens in Visual Performance and Quality of Life Scores","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-06-26 14:18:32","doi":"10.21203/rs.3.rs-3104554/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b050811d-daf6-4636-a691-3307006dda4a","owner":[],"postedDate":"June 26th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-01-12T04:30:08+00:00","versionOfRecord":[],"versionCreatedAt":"2023-06-26 14:18:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3104554","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3104554","identity":"rs-3104554","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}