Comparative Visual Performance of Diffractive Bifocal and Rotationally Asymmetric Refractive Intraocular Lenses

We compared the visual performance of a diffractive bifocal intraocular lens (IOL) with +4.0 D near addition (ZMB00 [Johnson & Johnson Surgical Vision]) and a rotationally asymmetric refractive IOL with +1.5 D near addition (LS-313 MF15 [Teleon Surgical BV]) 10 weeks after cataract patients’ last surgery for bilateral ZMB00 or LS-313 MF15 implantation, with the lenses of each eye implanted within 3 months of each other. The ZMB00 and LS-313 MF15 groups comprised 1326 eyes of 663 patients (age: 67.0±7.8 years; females/males, 518/145) and 448 eyes of 224 patients (73.6±7.0 years; females/males, 125/99) respectively; patients underwent surgery between 2011 and 2020. A linear mixed-effects model using data for both eyes, with strict adjustments for sex, age, subjective refraction spherical equivalent, subjective refraction cylinder, corneal astigmatism, axial length, corneal higher-order aberrations, and pupil diameter, ensured statistical validity. Compared to the LS-313 MF15 group, the ZMB00 group had significantly superior uncorrected near visual acuity, reduced higher-order aberrations (ocular/internal, scaled to a 4-mm pupil; WF_4_post_O_TotalHOA/Third/Fourth/Trefoil/Coma/Tetrafoil/Spherical, WF_4_post_I_Astigmatism/TotalHOA/Third/Trefoil/Coma/Tetrafoil/Spherical), and superior distance and near spectacle independence (p<0.00068, Wald test). Contrast sensitivity, measured without (6.3°/4.0°/2.5°/1.6°/1.0°/0.7°) or with glare (4.0°/2.5°/1.6°/1.0°/0.7), was significantly better in the LS-313 MF15 group than in the ZMB00 group (p<0.00068, Wald test).