Analysis of Visual Quality after Implantation of Diffractive Multifocal Intraocular Lens Diff - aA in Cataract Patients

Analysis of Visual Quality after Implantation of Diffractive Multifocal Intraocular Lens Diff - aA in Cataract Patients | 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 Analysis of Visual Quality after Implantation of Diffractive Multifocal Intraocular Lens Diff - aA in Cataract Patients Jingwen Zhang, Louxun Sun, Yifan Yang, Shanshan Du, Jingzhi Shao, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8626404/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Apr, 2026 Read the published version in BMC Ophthalmology → Version 1 posted 16 You are reading this latest preprint version Abstract Objective To explore the visual quality analysis of cataract patients after implantation of the aspheric diffractive multifocal intraocular lens (IOL) Diff - aA IOL. Methods Prospective cohort study. Cataract patients who visited the Third Department of Ophthalmology of the First Affiliated Hospital of Zhengzhou University from September 2024 to September 2025 were selected as the study cohort, and a total of 93 cases (93 eyes) were included. According to the models of intraocular lenses (IOLs) implanted in the patients, they were divided into two groups: the observation group consisted of 53 cases (53 eyes) of patients who received the Diff-aA IOL (HumanOptics, Germany); the control group included 40 cases (40 eyes) of patients who received the Tecnis ZMB00 IOL (Advanced Medical Optics, USA). At 1 month and 3 months after surgery, the uncorrected far, intermediate, and near visual acuities of both eyes of the patients in the two groups were measured respectively, and the defocus curves were plotted. For objective visual quality, the Itrace was used to measure the modulation transfer function (MTF) curve, Strehl ratio (SR), and point spread function (PSF), and for subjective visual quality, the VF − 14 - CN scale was used for evaluation. Results The uncorrected near vision of the observation group was slightly lower than that of the control group (P < 0.05), while the uncorrected intermediate vision of the observation group was better than that of the control group (P < 0.001). The fitted defocus curve at 1 month after surgery showed that at the defocus levels of 0.00D and − 3.50D, the visual acuity of the control group was better than that of the observation group (P = 0.003, P < 0.001); at the defocus levels of -1.50D to -2.50D, the visual acuity of the observation group was better than that of the control group (P < 0.001, P < 0.001, P = 0.004). The fitted defocus curve at 3 months after surgery indicated that at the defocus levels of -1.50D to -2.50D, the visual acuity of the observation group was better than that of the control group (P < 0.001, P < 0.001, P < 0.001). At 3 months after surgery, the AUDOC of the observation group was better than that of the control group, suggesting that the overall visual performance of the observation group was better (P 0.05). There was no statistically significant difference in the average VF − 14 scores between the two groups (P = 0.667). In terms of the incidence of optical interference phenomena, halos were the most common, reported by 45.45% of patients in the Diff - aA group and 45.16% of patients in the ZMB00 group. Followed by glare (reported by 27.27% in the Diff - aA group and 35.48% in the ZMB00 group) and starburst (reported by 18.18% in the Diff - aA group and 22.58% in the ZMB00 group). The report rate of diplopia was relatively low, with only one patient in the ZMB00 group reporting it. Conclusion The aspheric diffractive multifocal intraocular lens Diff - aA IOL can provide excellent far and near visual acuities and satisfactory intermediate visual acuity, achieve a relatively continuous visual range after surgery, and at the same time obtain a satisfactory spectacle - independence rate and a low incidence of adverse visual phenomena. Multifocal intraocular lens Cataract Visual quality Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1 Introduction With the acceleration of the global aging process, the prevalence of cataracts has shown a significant upward trend [ 1 ]. Meanwhile, the rapid development of technology has also changed people's lifestyles. Intermediate vision has become an important requirement in modern life due to the use of tablets and computers. These changes brought about by the population structure and technological development highlight the importance of effective management and correction of presbyopia for the elderly to maintain their independence and complete daily tasks smoothly [ 2 ]. Currently, cataract extraction combined with intraocular lens (IOL) implantation is the standard method for treating age-related cataracts. When it comes to IOL selection, monofocal intraocular lens (Mo-IOL) and multifocal intraocular lens (MIOL) are the two main types. Globally, approximately 86% of patients choose to have monofocal intraocular lenses implanted during cataract surgery [ 3 ]. Although monofocal intraocular lenses are relatively technically mature and have high safety, they cannot meet patients' intermediate and near vision needs, bringing many inconveniences to their daily lives. Multifocal intraocular lenses split light into different focal points, which helps reduce patients' dependence on glasses for near and far tasks [ 4 ]. However, some patients may experience problems such as reduced contrast sensitivity and visual disturbances, like glare and halos, after having multifocal intraocular lenses implanted [ 5 , 6 ]. Given that patients hope to be free from glasses after cataract surgery [ 7 ], intraocular lenses that can provide continuous vision at all focal lengths with low visual disturbances have become a research hotspot. Diff-aA IOL (HumanOpitics, Germany), as a new type of intraocular lens, offers a new approach to solving this problem. Diff-aA IOL is a one-piece biconvex hydrophilic acrylic progressive diffractive multifocal IOL. It consists of a central diffractive zone with a diameter of 3.0 mm and a peripheral refractive zone. Its near addition power is + 3.5 D. It adopts the DOLA technology (diffractive optic local asphericity), that is, a local aspherical design in the diffractive zone [ 8 ]. By using the principle of aspherical diffractive rings, it achieves a smooth transition from near vision to far vision [ 9 ] and reduces optical interference phenomena. Clinical studies have shown that Diff-aA IOL can provide patients with full-range vision after surgery, and patients' satisfaction is relatively high [ 10 ]. However, there are relatively few domestic clinical studies on this intraocular lens at present, especially in terms of relevant literature on postoperative visual quality. A comprehensive evaluation of the clinical effects of the aspherical diffractive-refractive multifocal intraocular lens Diff-aA IOL is of great significance for providing more scientific basis for clinicians to select intraocular lenses and meeting patients' needs for high-quality visual experience. This study aims to conduct an in-depth investigation into the visual effects of patients with cataracts after Diff-aA IOL implantation, providing a comprehensive and complete reference for clinical practice, with the hope of promoting further development in refractive correction and visual quality improvement in cataract surgery. 2 Materials and Methods 2.1 Research Method and Subjects A prospective cohort study was conducted. The clinical data of 93 cataract patients (93 eyes) who underwent phacoemulsification combined with intraocular lens (IOL) implantation in the Third Department of Ophthalmology of the First Affiliated Hospital of Zhengzhou University from September 2024 to September 2025 were collected. According to the model of the IOL implanted, the patients were divided into two groups: the observation group consisted of 53 patients (53 eyes) who received the Diffractiva - aA IOL (hereinafter referred to as Diff - aA IOL, HumanOptics, Germany); the control group consisted of 40 patients (40 eyes) who received the Tecnis ZMB00 IOL (hereinafter referred to as ZMB00 IOL, Advanced Medical Optics, USA). Inclusion criteria: (1) Patients with simple age - related cataract; (2) Axial length between 22 mm and 26 mm; (3) Photopic pupil diameter between 2.75 mm and 4.00 mm; (4) Kappa angle ≤ 0.5, Alpha angle ≤ 0.5, and corneal higher - order aberration (HOA) ≤ 0.3 µm in corneal biometry; (5) Predicted postoperative corneal astigmatism ≤ 1.0 D; (6) Patients with near - vision and glasses - free needs, and with high requirements for postoperative full - range visual acuity and visual quality. Exclusion criteria: (1) Patients with preoperative ocular surface inflammation or unstable tear film that affected the measurement of IOL biological parameters; (2) Patients with a pupil diameter 6 mm in dim light; (3) Patients with intraoperative complications such as zonular laxity, anterior capsule tear, or posterior capsule rupture; (4) Patients with IOL decentration, tilt, obvious capsular bag shrinkage, endophthalmitis, cystoid macular edema, and other related complications after surgery; (5) Patients with excessively high expectations for postoperative visual acuity or poor compliance during postoperative follow - up; (6) Patients with unexpected postoperative refraction (the difference between the actual postoperative refraction and the reserved refraction > 1 D); (7) Patients with organic eye diseases such as corneal diseases, glaucoma, vitreoretinal diseases, strabismus, and amblyopia. This research protocol followed the Declaration of Helsinki on biomedical research involving human participants and was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University(Ethical Review Number: 2022-KY-0006-001). Informed consent forms for surgery were obtained from all patients and their families before enrollment. 2.2 Preoperative Evaluation 2.2.1 Ocular Examination All patients were required to undergo routine ophthalmic examinations before surgery, including: visual acuity examination (all visual acuity data in this study were converted to the corresponding Logarithm of the Minimum Angle of Resolution (LogMAR)), intraocular pressure examination, slit - lamp examination, visual quality examination (using iTrace to measure biological parameters such as wavefront aberration, Kappa angle, and alpha angle before and after surgery), and corneal topography examination. 2.2.2 Intraocular Lens The Diff - aA IOL is an aspheric diffractive multifocal intraocular lens. It is a one - piece biconvex hydrophilic acrylate progressive diffractive IOL with a total diameter of 12.5 mm and an optical diameter of 6.0 mm. The optical zone structure consists of a central diffractive zone with a diameter of 3.0 mm and a peripheral refractive zone with a zero - spherical - aberration design. There are a total of 9 annular diffractive steps in the diffractive zone. The first 3 steps have the same height, and the height of the latter 6 steps gradually decreases, allowing for a smooth transition to distance - dominant vision when the pupil dilates. The near - addition power of the Diff - aA IOL is + 3.50 D, and the refractive power ranges from + 10.0 D to + 30.0 D. The TECNIS ZMB00 IOL is a diffractive multifocal intraocular lens with a total diameter of 13.0 mm and an optical diameter of 6.0 mm. Its refractive index is 1.46, the spherical aberration is − 0.27 um, and the Abbe number is 55.5. It uses a stepped progressive diffractive grating and a negative - spherical - aberration design to compensate for corneal aberrations, providing distance to near vision while maintaining high contrast sensitivity. The near - addition refractive power of the ZMB00 IOL is + 4.00 D, and the refractive power ranges from + 5.0 D to + 34.0 D [ 11 – 12 ]. 2.2.3 Calculation of Intraocular Lens Refractive Power and Refractive Target Strategy The IOL Master 700 measuring instrument was used to measure the biological parameters of the patients before surgery, including axial length, corneal curvature, anterior chamber depth, and white - to - white distance. The Holladay 2 formula or Kane formula was used to calculate the refractive power of the IOL for all eyes. In this study, the optimized A - constant for multifocal intraocular lenses was applied. The postoperative target refractive power was the positive value closest to zero. In addition, patients were informed of the risk of postoperative refractive error and refractive drift before surgery. 2.3 Surgical Method All surgical operations were performed by the same experienced doctor under local anesthesia. All patients underwent phacoemulsification combined with IOL implantation. A 3.0 - mm clear corneal tunnel main incision was made at the 10:30 position of the operative eye, with a tunnel length of approximately 2.0 mm. Sodium hyaluronate was injected into the anterior chamber to maintain the anterior chamber depth and protect the corneal endothelium. A 1.0 - mm auxiliary incision was made at the limbus at the 2:00 position. Then, a continuous circular capsulorhexis of 5.3–5.5 mm was performed with reference to the corneal center. After sufficient hydro - dissection, phacoemulsification was used to aspirate the lens nucleus, and the residual lens cortex was aspirated by I/A. The posterior capsule was polished with a blunt needle, and viscoelastic agent was injected into the capsular bag again. Subsequently, the IOLs in both groups were implanted into the capsular bag using an IOL injector and adjusted to the correct position. The viscoelastic agent was replaced with an aspiration - irrigation device, and the incision was hydrated to ensure closure. The patient was asked to look at a light to observe the position of the IOL relative to the visual axis. After ensuring a normal anterior chamber depth, tobramycin and dexamethasone eye ointment was applied to the conjunctival sac. For highly myopic patients, gatifloxacin ophthalmic gel was applied. The operative eye was covered with a sterile dressing, and the patient was sent back to the ward after the vital signs were stable. 2.4 Follow - up and observation indicators 2.4.1 Follow - up time Follow - up and collection of relevant data were conducted at 2 weeks, 1 month, and 3 months after surgery. The uncorrected visual acuity, refraction results, objective and subjective visual quality of the patients were recorded. 2.4.2 Visual acuity and refraction At 3 months after surgery, computerized refraction and subjective refraction were performed. The best - corrected distance visual acuity (BCDVA) of the patients was examined and recorded. At the same time, the static visual acuity (SVA) of the patients was examined and recorded, including the uncorrected distance visual acuity (UDVA) measured at 5m, the uncorrected intermediate visual acuity (UIVA) measured at 80cm, and the uncorrected near visual acuity (UNVA) measured at 40cm. All data results were expressed in LogMAR. 2.4.3 Defocus curve The defocus curves of the patients were collected and plotted at 1 month and 3 months after surgery. The measurement was taken at intervals of 0.50D, with a measurement range from + 1.00D to − 4.00D. The measurement distance was 5m, and the measurement tool was the international standard logarithmic visual acuity chart. The results were all converted to LogMAR units. 2.4.4 Objective visual quality At 1 month and 3 months after surgery, the Itrace device was used to collect the wavefront aberration (WA), modulation transfer function (MTF), strehl ratio (SR), and point - spread function (PSF) of the patients. The Itrace device simulated the shape of the point - spread function and introduced the types and degrees of Itrace optical indicators and the occurrence of wavefront aberration [ 13 ]. For example, when coma occurs alone, a comet tail appears in the image, which is described as "blur" or "diplopia"; when spherical aberration occurs alone, concentric circles appear in the image, which is described as "glare" or "halo"; when trefoil aberration occurs alone, the image seems to be a star, which is described as "starburst"; when second - order astigmatic aberration occurs alone, multiple focal points appear in the image, which is described as "mixed focus". The severity of the Itrace optical indicators was divided into four grades: none (-), mild (+), moderate (++), and severe (+++). All examinations were completed by the same technician. 2.4.5 Subjective visual quality At 3 months after surgery, the satisfaction and spectacle independence degree of the two groups of patients were evaluated. The visual function index scale (VF − 14 - CN scale) was used to evaluate the patients' satisfaction with visual quality. The VF − 14 was published by American scholars Steinberg et al. [ 14 ] in 1994 and was designed based on 14 vision - dependent daily activities. The difficulty of completing each activity was scored on a 5 - level scale from 0 to 4 points, namely: (0) impossible to complete; (1) very difficult; (2) moderately difficult; (3) slightly difficult; (4) no difficulty. The results of the VF − 14 scale of 766 cataract patients in three cities in the United States showed that the VF − 14 is a reliable and effective tool for measuring the visual function impairment of cataract patients [ 15 ]. Patients for whom all scores were not applicable were not included in the final items of the statistical scope of this study. After calculating the mean value, the score was recorded as 0–100 points. A higher score reflected a higher satisfaction of the patients after surgery. In addition to the VF − 14 questionnaire survey, this study also added questions about the occurrence of glare, halo, starburst, and diplopia to evaluate the incidence of optical interference of visual impairment. 2.5 Statistical analysis The SPSS Statistics for Windows software (version 29.0, IBM Corp, USA) was used as the statistical analysis software for statistical analysis. Normality and homogeneity of variance tests were performed on all the collected data. The Kolmogorov - Smirnov test ( K - S test) was used to evaluate the consistency of the sample with the normal distribution. If the data conformed to the normal distribution, the mean ± standard deviation (‾x ± s) was used for representation. For skewed - distributed data, the median and inter - quartile range M ( P 25, P 75) were used. Considering that the deviation of the area under the defocus curve from + 1.00D to − 4.00D was 0.24 logMAR and the maximum tolerable error was 0.20 logMAR, a sample of at least 46 patients was required. For the comparison of two groups of independent data, the t - test, Welch’s t - test, or Mann - Whitney U test was used for analysis according to whether the data conformed to the normal distribution and homogeneity of variance. For the comparison of multiple groups of independent samples, one - way analysis of variance was used if the data met the normality requirement, and the Kruskal - Wallis H test was used if not. To evaluate the association between the Itrace optical indicators and BCDVA of the two groups, the Spearman rank correlation test was performed. A P - value less than 0.05 was considered statistically significant. 3 Results 3.1 Comparison of general data A total of 93 cataract patients with 93 eyes were included in this study. According to the type of intraocular lens (IOL) implanted in the patients, they were divided into an observation group (implanted with Diff - aA IOL) and a control group (implanted with ZMB00 IOL). Among them, there were 53 cases (53 eyes) in the Diff - aA IOL group and 40 cases (40 eyes) in the ZMB00 IOL group. The ocular data of the two groups of patients are shown in Table 3.1 . Table 3.1 General baseline data of the two groups of patients Parameters Observation Group Control Group t / X 2 P Number of implanted Eyes, n 53 40 Age, years 61.64 ± 11.23 57.85 ± 14.08 -1.153 0.253 UDVA, LogMAR 0.699(0.398,0.980) 0.899(0.495,0.980) 0.502 0.616 CDVA, LogMAR 0.398(0.221,0.698) 0.450(0.225,0.597) 0.716 0.474 Sphere, D -0.5(-2.31,0.00) 0(-2.50,1.31) 0.058 0.954 Cylinder, D -0.5(-0.68,0.00) -0.375(-1.00,0.00) 0.795 0.427 Spherical equivalent, D -0.625(-2.71,0.00) 0(-2.93,1.31) 0.094 0.925 ACD, mm 3.2(2.88,3.51) 2.89(2.77,3.15) -1.862 0.063 AL, mm 23.18(22.82,23.99) 23.51(22.13,24.92) -0.384 0.701 Note: For the observation group and the control group, data conforming to the normal distribution are expressed as ‾x ± s; data that do not meet the normal distribution are expressed as M ( P 25, P 75). Independent - sample t - test is used for data with normal distribution, and non - parametric test is used for non - normally distributed data; chi - square test is used for count data. P < 0.05 is considered to be statistically significant. 3.2 Postoperative visual acuity Three months after the operation, there was no statistically significant difference in the best - corrected distance visual acuity between the observation group and the control group. The uncorrected visual acuity performance at 5m, 80cm and 40cm is shown in Table 3.2 .1 and Table 3.2 .2 Three months after the operation, there was no statistically significant difference in the best - corrected distance visual acuity between the observation group and the control group ( P > 0.05). Three months after the operation, both groups had good uncorrected distance visual acuity. The uncorrected distance visual acuity of the observation group was 0 LogMAR, and that of the control group was also 0 LogMAR, with no statistically significant difference ( P > 0.05). The uncorrected near - distance visual acuity of the observation group was slightly lower than that of the control group, and the difference was statistically significant ( P < 0.05). The uncorrected intermediate - distance visual acuity of the observation group was better than that of the control group, and the difference was statistically significant ( P < 0.001). Table 3.2 .1 Comparison of the best - corrected distance visual acuity between the two groups three months after the operation VA(LogMAR) Observation Group Control Group Z P BCVDA 0.00(-0.01,0.00) 0.00(-0.01,0.01) 0.161 0.972 Note: Since the normality test was not passed, the Mann-Whitney U test was used. A P value < 0.05 was considered statistically significant. Table 3.2 .2 Comparison of uncorrected visual acuity between the two groups at 3 months after surgery VA(LogMAR) Observation Group Control Group Z P UNVA 0.15(0.15,0.22) 0.15(0.10, 0.20) -2.333 0.02 UIVA 0.10(0.09, 0.20) 0.20(0.20, 0.30) 4.722 < 0.001 UDVA 0(-0.07,0.09) 0(-0.07,0.03) 0.437 0.662 Note: None of them passed the normality test, so the Mann-Whitney U test was used. P < 0.05 was considered statistically significant. 3.3 Defocus curve The defocus curves of the two groups were plotted at 1 month and 3 months after surgery respectively. (Fig. 3.3 .1, Fig. 3.3 .2) The area formed by the defocus curve better than 0.3 LogMAR was quantified, which was called the area under the defocus curve (AoF, Area - of - Focus) and expressed as LogMAR/m. The AoFs of the two groups were compared and presented in the form of a histogram. (Fig. 3.3 .3, Fig. 3.3 .4) The fitted defocus curve at 1 month after surgery showed that the visual acuity of both groups was better than 0.3 LogMAR at the defocus level of + 1.00D to − 4.00D; at the defocus levels of 0.00D and − 3.50D, the visual acuity of the control group was better than that of the observation group, and the differences were statistically significant ( P = 0.003, P < 0.001); at the defocus level of − 1.50D to − 2.50D, the visual acuity of the observation group was better than that of the control group, and the differences were statistically significant ( P < 0.001, P < 0.001, P = 0.004). (Fig. 3.3 .1) The fitted defocus curves at 3 months after surgery showed that at the defocus levels from + 1.00D to -4.00D, the visual acuity of both groups was better than 0.3 LogMAR. At the defocus levels from − 1.50D to -2.50D, the visual acuity of the observation group was better than that of the control group, and the differences were statistically significant ( P < 0.001, P < 0.001, P < 0.001). (Fig. 3.3 .2) There was no statistically significant difference in the AoF between the two groups at 1 month after surgery (Fig. 3.3 .3). At 3 months after surgery, the AoF of the observation group was better than that of the control group, suggesting that the overall visual performance of the observation group was better, which was statistically significant ( P < 0.001) (Fig. 3.3 .4). 3.4 Analysis of objective visual quality After the surgery, the Itrace instrument was used to collect the objective visual quality data of the patients, including the total high - order aberrations (THOA) in wavefront aberrations, the average height of the modulation transfer function (MTF Avg Height), the Strehl ratio (SR), and the point spread function (PSF). Comparisons were made at 3 months after the surgery. Correlation analysis was also conducted between these parameters and the BCDVA at 3 months after the surgery. At 3 months after the surgery, there were no statistically significant differences in THOA, MTF Avg Height, and SR between the two groups. (Table 3.4 .1) Table 3.4 .1 Comparison of Itrace optical quality indicators between the two groups at 3 months after surgery 观察组 对照组 t / Z P THOA 0.131(0.102,0.186) 0.155(0.098,0.26) 0.622 0.534 MTF Avg Height 0.331 ± 0.124 0.318 ± 0.129 0.512 0.610 SR 0.096(0.004,0.218) 0.092(0.063,0.151) -0.276 0.783 Note: The THOA and SR in the observation group and the control group both passed the normality test, and non-parametric tests were used; the MTF Avg Height showed a normal distribution, and an independent samples t-test was used. The postoperative PSF indicators of the two groups were analyzed. At 3 months after surgery, there were no statistically significant differences between the two groups in terms of blurring/diplopia, glare/halo, mixed focus, night myopia or night hyperopia, with all P > 0.05 (Table 3.4 .2). Table 3.4 .2 Comparison of PSF indicators between the two groups at 3 months after surgery Diff-aA IOL ZMB00 IOL P blur/double vision 0.950 0 37 28 + 9 6 ++ 2 1 +++ 5 5 glare/halo 0.686 0 48 35 + 2 4 ++ 1 0 +++ 2 1 starburst 0.622 0 30 22 + 15 8 ++ 1 2 +++ 7 8 mixed focus 0.780 0 47 34 + 0 0 ++ 0 6 +++ 6 0 night myopia 0.690 0 49 36 + 1 0 ++ 0 2 +++ 3 2 Note: The data in this table are count data, and the rank-sum test is used for analysis. Spearman's rank correlation analysis was used to investigate the relationships between the iTrace optical indicators and BCDVA in the observation group and the control group. The Strehl ratio and the average height of the modulation transfer function in the control group (ZMB00 IOL) were the only two iTrace optical indicators that showed a statistical correlation with BCDVA ( P < 0.05). Table 3.4 .3 Correlation analysis between BCDVA and various optical indicators in the two groups 3 months after surgery BCDVA Diff-aA IOL ZMB00 IOL CC( r ) P CC( r ) P THOA -0.05689 0.6714 -0.1733 0.2914 MTF Avg Height -0.04556 0.7342 0.3199 0.0471* SR -0.03525 0.7928 0.3203 0.0468* * P < 0.05 CC: Correlation coefficient; BCDVA: Best corrected distance visual acuity; THOA: Total high-order wavefront aberration; MTF: Modulation transfer function; SR: Strehl ratio; IOL: Intraocular lens; 3.5 Subjective visual quality analysis In this study, the VF-14-CN questionnaire was used to evaluate the daily lives of patients. Table 3.5 outlines the VF-14 items and the average scores reported by patients for each item. The average VF-14 score for the group implanted with the Diff-aA IOL was 98.34 ± 0.98, and that for the group implanted with the ZMB00 IOL was 98.40 ± 1.45. There was no statistically significant difference in the average scores between the two groups ( P = 0.667). In terms of the incidence of optical interference phenomena, halos were the most common, with 45.45% of patients in the Diff-aA group and 45.16% in the ZMB00 group reporting them. This was followed by glare (reported by 27.27% in the Diff-aA group and 35.48% in the ZMB00 group) and starbursts (reported by 18.18% in the Diff-aA group and 22.58% in the ZMB00 group). The reporting rate of diplopia was relatively low, with only one patient in the ZMB00 group reporting it. In the observation group, 93.18% of patients reported not relying on glasses after surgery, while in the control group, 93.54% of patients reported the same. In terms of satisfaction with the surgical results, 95.45% in the observation group and 96.77% in the control group were satisfied with the surgical outcomes. Table 3.5 Comparison of VF − 14 scores at 3 months after phacoemulsification and intraocular lens implantation between the two groups of patients Question observation group control group Z P Do you have any difficulty reading small print (such as labels on medicine bottles, phone books, or food labels)? 3.00(3.00,4.00) 3.00(3.00,4.00) -0.460 0.646 Do you also have difficulty reading newspapers or books? 3.00(3.00,4.00) 3.00(3.00,3.00) -1.038 0.299 Do you also have any difficulty reading large-print books, newspapers, or the numbers on the phone? 4.00(4.00,4.00) 4.00(4.00,4.00) -0.245 0.807 Do you have any difficulties when people approach you? 4.00(4.00,4.00) 4.00(4.00,4.00) -0.525 0.599 Do you also have any difficulty in seeing clearly the steps, stairs or curbs? 4.00(4.00,4.00) 4.00(4.00,4.00) -0.765 0.444 Do you also have any difficulties in reading traffic signs, road signs, or store signs? 4.00(4.00,4.00) 4.00(4.00,4.00) -0.525 0.599 Do you also have any difficulties in sewing, knitting, crocheting, or woodworking? 4.00(4.00,4.00) 4.00(3.00,4.00) -0.759 0.448 Do you also have any difficulties writing checks or filling out forms? 4.00(4.00,4.00) 4.00(4.00,4.00) -1.688 0.091 Do you have any difficulties in playing games such as mahjong, card games, and chess? 4.00(4.00,4.00) 4.00(3.00,4.00) -1.569 0.117 Do you encounter any difficulties when participating in sports such as badminton, croquet, table tennis, basketball, walking, doing exercise, and Tai Chi? 4.00(4.00,4.00) 4.00(4.00,4.00) -1.311 0.190 Do you have any difficulties in cooking due to vision problems? 4.00(4.00,4.00) 4.00(4.00,4.00) -1.407 0.160 Do you have any difficulties watching TV because of your vision problem? 4.00(4.00,4.00) 4.00(4.00,4.00) -1.102 0.271 Due to vision problems, how difficult is it for you to drive during the day? 4.00(4.00,4.00) 4.00(3.00,4.00) -1.241 0.215 Due to vision problems, how difficult is it for you to drive at night? 4.00(3.50,4.00) 4.00(3.00,4.00) -1.153 0.249 Note: The single-item scores do not follow a normal distribution and are represented by M ( P 25, P 75). Non-parametric tests were used. P < 0.05 was considered statistically significant. 4 Discussion Generally, diffractive intraocular lenses (IOLs) create focal points for both distance and near vision, but the image quality at intermediate distances may be affected [ 16 ]. To improve distance vision under conditions of dilated pupils or low illumination (when halos and aberrations are most prominent), many modern designs employ a gradient diffractive profile, where the height of the diffractive steps gradually and smoothly decreases from the center to the periphery [ 17 ]. When the pupil dilates, this gradient profile directs more light towards the distance focal point, resulting in a clearer distance image and reducing the occurrence of halos. The Diff - aA IOL is a gradient diffractive multifocal IOL that provides a certain level of intermediate vision while ensuring good distance and near vision, and reduces optical interference phenomena. However, from a clinical perspective, there is currently a lack of validation for the advantages of the Diff - aA IOL in intermediate vision, and there are relatively few studies on its long - term effectiveness and safety when applied to the Chinese population. Therefore, in this study, patients who had received the Diff - aA IOL implantation were followed up for 3 months after the surgery, taking into account both objective optical indicators and the patients' subjective visual experiences. 4.1 Visual Acuity In both the Diff - aA IOL group and the ZMB00 IOL group, the best - corrected visual acuity (BCVA) was improved compared with that before surgery, which is in line with the general perception that cataract surgery can improve visual acuity [ 18 ]. In terms of distance visual acuity, the uncorrected distance visual acuity of both groups reached a good level (P = 0.662), indicating that the improvement effects of the two were comparable and could meet the patients' needs for distance vision. In terms of uncorrected intermediate visual acuity, the Diff - aA IOL group performed better (P < 0.001). The advantage of the Diff - aA IOL may be attributed to its local aspheric design in the diffractive zone, which can meet the needs of intermediate - range vision while ensuring distance and near vision, and has a positive significance for improving the patients' quality of life. In terms of uncorrected near visual acuity, the ZMB00 IOL group performed better, but the mean values of the two groups were similar. Although there was a significant statistical difference, the actual clinical difference was not large. This result was similar to the study by Wang J et al. [ 19 ]. This may be related to the near - addition powers of the IOLs in the two groups. The near - addition power of the ZMB00 IOL was + 4.00D, while that of the Diff - aA IOL was + 3.50D. In addition, the distances for near and intermediate vision vary depending on the content the patients are looking at. Cardona and López [ 20 ] found that the working distances for presbyopic patients using computers and reading were 40 to 60 cm and 30 to 50 cm respectively. Long [ 21 ] et al. pointed out that the reading distance for smartphones was even closer. Bababekova [ 22 ] et al. reported that the average working distances for reading text messages and surfing the Internet on smartphones were 36.2 cm and 32.2 cm respectively, both less than the typical distance of 40 cm. Therefore, it is recommended that ophthalmologists understand in detail the working distances of the patients' habitual tasks to select intraocular lenses that can cover a wide range of distances and provide good visual performance. 4.2 Defocus Curve The defocus curve is a core tool for evaluating the visual quality of intraocular lenses (IOLs) at different depths of focus. It is particularly significant in the analysis of the effects of multifocal IOLs and extended - depth - of - focus IOLs [ 23 ]. The defocus curve helps to identify refractive errors, determine the position of the peak far - vision, and guide decisions to improve the correction effect for presbyopia [ 24 ]. At 1 month after surgery, the visual acuity of the ZMB00 IOL group was better than that of the Diff - aA IOL group at the defocus levels of 0D and − 3.5D. However, the Diff - aA IOL group outperformed at the defocus levels from − 1.50D to − 2.50D. At 3 months after surgery, the Diff - aA IOL group still had better visual acuity at the defocus levels from − 1.50D to − 2.50D. This result suggests that the Diff - aA IOL can provide a certain degree of intermediate vision, which is consistent with the results of uncorrected intermediate - distance vision. Meanwhile, we compared and quantified the area - of - focus (AoF) of the defocus curves between the two groups. The area - of - focus is a core index that quantifies the defocus curve into a single value, used to comprehensively evaluate the overall performance of the visual system within the dynamic defocus range. The defocus curve is divided into far - distance (–0.50 D to + 0.50 D), intermediate (–2.00 D to − 0.50 D), and near - distance (–4.00 D to − 2.00 D) parts. For each of these parts, the entire AoF below 0.30 logMAR is calculated and expressed as logMAR/m. The larger the AoF, the better the visual acuity in that part. In studies where the focal analysis method is not sensitive enough to identify the differences in visual performance between different multifocal IOLs, the AoF can detect significant differences in intermediate - and near - distance visual acuity [ 25 ]. This study found that the AoF of both groups continued to increase from 1 month to 3 months after surgery, suggesting that there is a process of neural adaptation and remodeling for the IOLs in both groups. To enable patients to adapt to multifocal IOLs, the brain must undergo “neural adaptation” to process new visual information. Previous studies have indicated that the neural adaptation of multifocal IOLs is initially achieved through visual, attention, and brain program - learning networks [ 26 ]. However, some literature also points out that the reduction of objective glare may be related to wound healing and suggests that the previous reports of glare reduction over time after surgery are due to optical changes rather than neural adaptation [ 27 ]. 4.3 Analysis of Objective Visual Quality In this study, iTrace was used to examine the objective visual performance after surgery. The important analysis parameters of iTrace in this study include wavefront aberration, Modulation Transfer Function (MTF), Strehl ratio (SR), and Point - Spread Function (PSF). iTrace quantitatively measures the wavefront aberration of the eye. Wavefront aberration is one of the indicators for evaluating the imaging effect of an optical system. Among wavefront aberrations, the aberrations that cannot be corrected by refraction are called Total Higher - Order Aberrations (THOA). Even under good refractive conditions, the magnitude of its value and the combination of different fractional - order aberrations can still have a significant adverse impact on visual performance [ 28 – 29 ]. MTF is the core indicator for evaluating the imaging quality of an optical system, which describes the system's ability to transfer contrast at different spatial frequencies (e.g., 30 cycles/degree, c/d). MTF Avg Height is the average height of the MTF curve within a specific frequency range (e.g., 5–30 c/d), reflecting the average level of the optical system's ability to transfer contrast at different spatial frequencies, and it represents the comprehensive performance of the optical system in multiple frequency bands. SR represents the ratio of the light intensity of the actual optical system of the human eye to that of an aberration - free optical system, and it is used to measure the imaging quality of the optical system. The closer it is to 1, the better the imaging quality [ 30 ]. PSF is used to describe the imaging situation of an optical system for a point light source. In an ideal state, a point light source should be imaged as a point through a perfect optical system. However, in the actual optical system of the eye (including structures such as the cornea and lens) and implants such as intraocular lenses, due to factors such as aberration and diffraction, the point light source will be diffused into a light spot of a specific shape. The shape and intensity distribution of this light spot are the point - spread function. It is one of the important indicators for evaluating the imaging quality of an optical system. PSF can reflect the ability of an intraocular lens to image a point light source and is closely related to visual clarity, contrast, etc. This study showed that there were no significant differences between the two groups of IOLs in terms of THOA, average height of MTF, SR, and PSF, and all differences were not statistically significant (P > 0.05). These results confirm that the two IOLs perform similarly in contrast transfer ability and overall optical imaging quality and can both provide stable visual effects. In this study, a weak positive correlation was observed between the MTF Avg Height and BCDVA in the ZMB00 group (r = 0.32), which is consistent with the conclusion of the defocus curve study by Vargas et al., that is, the distant vision performance of diffractive multifocal IOLs highly depends on the stability of the MTF curve. In contrast, there was no significant correlation between all optical parameters and BCDVA in the Diff - aA IOL group (|r| < 0.06). This suggests that the postoperative visual acuity of this IOL may mainly depend on the accuracy of refractive correction rather than wavefront aberrations. The underlying reason may be related to the optical design of the Diff - aA IOL. The optical center consists of a central diffractive zone with a diameter of 3.0 mm and a peripheral refractive zone with a zero - spherical - aberration design. The astigmatism caused by HOA can be partially offset by the peripheral refraction compensation. In this study, one of the reasons why the Diff - aA IOL and ZMB00 IOL have similar visual quality may be that we measured the objective visual quality under a pupil diameter of 4.0 mm. Under a 4 - mm pupil, corneal aberrations do not have a significant impact on the results, which can be similar to the real optical quality of the IOL [ 31 ]. 4.4 Relationship between subjective visual quality and optical interference In ophthalmic research, evaluating the subjective visual quality of patients is crucial for understanding visual function and the effects of different treatment methods or interventions. First, looking at the scores of the VF − 14 items, the average scores of the Diff - aA group and the ZMB00 group for tasks such as reading small print and doing handicrafts were both below 4.00. In contrast, the scores of the two groups in other VF − 14 items generally reached 4.00. The results of the VF − 14 items showed a similar trend to those of visual acuity. Secondly, optical interference phenomena can also affect patient satisfaction after multifocal intraocular lens (IOL) implantation [ 32 ], including positive and negative optical interferences. Positive optical interference refers to the extra bright lights seen by patients, such as light streaks, halos, glare, and starbursts, which usually appear at the edge or center of the visual field, especially more obvious at night or in low - light environments. Negative optical interference is the crescent - shaped or bracket - shaped shadows in the temporal visual field complained by patients, similar to visual field occlusion, which are aggravated under strong light or when the pupils constrict [ 33 ]. The full - vision - zone diffractive rings of ZMB00 can induce more positive optical interference than single - focal IOLs. The diffractive rings on the posterior surface may be partly responsible for the scattering that causes moderate glare. Glare and halos, the main optical phenomena complained by 38.2% of patients after MIOL implantation [ 34 ], and diffractive MIOLs may have more optical interference phenomena [ 35 , 36 ]. In this study, halos were the most commonly encountered light phenomenon, affecting nearly half of the patients. However, most patients were satisfied with their postoperative visual quality. In the Diff - aA group and the ZMB00 group, night driving was a problem for some patients. Previous studies have shown that this is due to night - time aberrations such as halos and glare [ 37 , 38 ], and this result may be related to neural adaptation. Adverse visual symptoms are visual phenomena or visual functions unrelated to visual acuity [ 39 ], which to some extent reflect the brain function of the visual cortex [ 40 ]. However, neural adaptation is a variable process that depends on individual patients and may not be easily predicted [ 41 ]. 4.5 Innovation and Limitations of the Study The advantages of this study include a prospective design, comprehensive pre - and post - operative evaluations, and the use of advanced imaging techniques for accurate measurements. However, there are some limitations to be considered. First, only one eye of each patient was included, thus ignoring the correlation of binocular parameters. Therefore, binocular visual quality indicators such as stereopsis were not evaluated. Second, there was no long - term evaluation. The third limitation is the relatively small sample size, which is related to the strict inclusion criteria. Since myopia is closely related to other vision - affecting diseases such as myopic maculopathy [ 42 ], great caution must be exercised when implanting IOLs in myopic patients. The risk of surgical complications is also higher, such as IOL decentration. 5 Conclusion The aspheric diffractive multifocal intraocular lens Diff - aA IOL can provide excellent far and near vision and satisfactory intermediate vision, achieving a relatively continuous visual range after surgery. At the same time, it has a satisfactory spectacle independence rate, good visual satisfaction, and a low incidence of adverse visual phenomena. Declarations Funding No funds Author information Zhang Jingwen1,2, Sun Louxun3, Yang Yifan2, Du Shanshan1, Shao Jingzhi1, Zhang Fengyan1 Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University Zhengzhou 450000, Henan, China Affiliations of the authors: 1 (450000) Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China; 2 (450000) Zhengzhou University, Zhengzhou, Henan, China; 3 (410000) The Third Xiangya Hospital of Central South University, Changsha, Hunan, China Author profiles: Zhang Jingwen, a postgraduate student for a master's degree, a resident physician. Research direction: cataract. Sun Louxun, a resident physician. Research direction: basic research on surgical oncology and related diseases. Yang Yifan, a resident physician. Research direction: cataract. Du Shanshan, a doctor, an associate chief physician. Research direction: cataract. Shao Jingzhi, a doctor, an associate chief physician. Research direction: cataract. Corresponding author: Zhang Fengyan, a doctor, a chief physician, a doctoral supervisor. Research direction: cataract. Email: [email protected] Data availability All data generated or analyzed during this study are included in this published article. Competing interests The authors declare no competing interests. Ethics approval and consent to participants Written informed consent was obtained from all participants before their inclusion in the study. This trial was conducted in accordance with the guidelines for clinical trials involving human participants and the Declaration of Helsinki. The research protocol was approved by the Ethics Committee of Zhengzhou University. (Ethical Review Number: 2022-KY-0006-001) Consent for publication Before the participant enters the study, written informed consent was obtained from all participants for the publication of results that will be used in a completely confidential manner and solely for research purposes, and the participants’ identity will remain confidential within the framework of the law. References Hashemi H, Pakzad R, Yekta A, et al. Global and regional prevalence of age-related cataract: a comprehensive systematic review and meta-analysis[J]. Eye (Lond). 2020;34(8):1357–70. 10.1038/s41433-020-0806-3 . Stern B, Gatinel D. Presbyopia Correction in Lens Replacement Surgery: A Review[J]. Clin Exp Ophthalmol. 2025;53(6):668–81. 10.1111/ceo.14535 . Howes F, Rementeria-Capelo LA, Poyales F, Borovik A, et al. Visual Performance and Patient Satisfaction of Bilaterally Implanted Extended Depth of Focus Intraocular Lens: Outcomes of a Multicenter Registry[J]. 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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-8626404","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":578562703,"identity":"348f9e8d-e9d8-4da8-876a-5b324be2aac8","order_by":0,"name":"Jingwen Zhang","email":"","orcid":"","institution":"Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"Jingwen","middleName":"","lastName":"Zhang","suffix":""},{"id":578562704,"identity":"666fdd0b-c4c1-4f40-b852-3f9a816c64c8","order_by":1,"name":"Louxun Sun","email":"","orcid":"","institution":"Central South 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University","correspondingAuthor":false,"prefix":"","firstName":"Jingzhi","middleName":"","lastName":"Shao","suffix":""},{"id":578562708,"identity":"24a90c7f-17ff-4a41-b9c8-2d0f0cb95444","order_by":5,"name":"Fengyan Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYBACNmbmg4//VPyTY2w4fIA4LXzsbMkGPGcOGDM3HksgToscP4+ZAG/bgcT25jMGxDqMx4xBgu0OY2/bmY833jDYyek2ENTCVvbAgOcZs2TP2c2WcxiSjc0OENTCvN0gQYKZzXDG2W3SPAwHErcR1sJgJnHAgJnH/v6bZ8RqYTGTbEg4LMHYcIaNWC1sycYMB9IMGBuOGVvOMSDCL/L9hw8+ZvxnU9/YcPjhjTcVdnIEtaAACR4iowZZC6k6RsEoGAWjYEQAAIp0Qb4qKQQkAAAAAElFTkSuQmCC","orcid":"","institution":"the First Affiliated Hospital of Zhengzhou University","correspondingAuthor":true,"prefix":"","firstName":"Fengyan","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2026-01-17 13:53:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8626404/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8626404/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12886-026-04820-x","type":"published","date":"2026-04-14T15:59:49+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":101170235,"identity":"0f8da818-5070-42d7-9852-74ab44b69c46","added_by":"auto","created_at":"2026-01-27 00:01:51","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":202624,"visible":true,"origin":"","legend":"","description":"","filename":"BMC1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8626404/v1/aae378f27dc5a6a07ab7178a.docx"},{"id":101170226,"identity":"3fc64500-7f28-4f71-ad1e-2ff044c9a39f","added_by":"auto","created_at":"2026-01-27 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00:01:51","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":164271,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8626404/v1/a1eed59ebcd0284d6b76fabd.html"},{"id":101170229,"identity":"af0e7ef2-0296-497c-8b53-919d2a5f81d6","added_by":"auto","created_at":"2026-01-27 00:01:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":44222,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.3.1 Comparison of defocus curves between the two implantation schemes at 1 month after surgery.\u003c/p\u003e\n\u003cp\u003eNote: Error bars are expressed as standard deviations. * indicates \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05, ** indicates \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01, and *** indicates \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8626404/v1/9dd42d3189a2f7cd31646c31.png"},{"id":101170227,"identity":"0f8ab2c4-a819-400b-9f95-8008cdc7b731","added_by":"auto","created_at":"2026-01-27 00:01:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":45152,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.3.2 Comparison of defocus curves between the two implantation schemes at 3 months after surgery.\u003c/p\u003e\n\u003cp\u003eNote: Error bars are all expressed as standard deviations. * indicates \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05, ** indicates \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01, and *** indicates \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8626404/v1/4a0de374ae32e0e5c2d46a71.png"},{"id":101206422,"identity":"8d724402-a4db-4ddd-add2-c2c12ec5232f","added_by":"auto","created_at":"2026-01-27 09:56:12","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":23153,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.3.3 Comparison of the area under the defocus curve (AoF) between the two groups at 1 month after surgery.\u003c/p\u003e\n\u003cp\u003eNote: Error bars are presented as standard deviations. ns indicates no statistical significance, * indicates \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05, ** indicates \u003cem\u003eP\u003c/em\u003e\u0026lt; 0.01, and *** indicates \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8626404/v1/491f76a18d004bb769d9b703.png"},{"id":101206159,"identity":"733343f8-6508-4a45-b813-3afe802747f0","added_by":"auto","created_at":"2026-01-27 09:55:29","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":22528,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.3.4 Comparison of the area under the defocus curve (AoF) between the two groups at 3 month after surgery.\u003c/p\u003e\n\u003cp\u003eNote: Error bars are presented as standard deviations. ns indicates no statistical significance, * indicates \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05, ** indicates \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01, and *** indicates \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8626404/v1/da6306e839f18e2056bce9b2.png"},{"id":101206173,"identity":"817487c4-4aae-4545-a3f1-70d76eafe78f","added_by":"auto","created_at":"2026-01-27 09:55:32","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":27966,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.5 Visual disturbances reported by patients 3 months after surgery\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-8626404/v1/e419155f83b58a597850b9ff.png"},{"id":107351072,"identity":"70283dd2-2402-4968-b788-d261432cc29c","added_by":"auto","created_at":"2026-04-20 16:08:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":896516,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8626404/v1/d123a430-ed96-40b9-a1a2-e63d730adb63.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of Visual Quality after Implantation of Diffractive Multifocal Intraocular Lens Diff - aA in Cataract Patients","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eWith the acceleration of the global aging process, the prevalence of cataracts has shown a significant upward trend [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Meanwhile, the rapid development of technology has also changed people's lifestyles. Intermediate vision has become an important requirement in modern life due to the use of tablets and computers. These changes brought about by the population structure and technological development highlight the importance of effective management and correction of presbyopia for the elderly to maintain their independence and complete daily tasks smoothly [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCurrently, cataract extraction combined with intraocular lens (IOL) implantation is the standard method for treating age-related cataracts. When it comes to IOL selection, monofocal intraocular lens (Mo-IOL) and multifocal intraocular lens (MIOL) are the two main types.\u003c/p\u003e \u003cp\u003eGlobally, approximately 86% of patients choose to have monofocal intraocular lenses implanted during cataract surgery [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Although monofocal intraocular lenses are relatively technically mature and have high safety, they cannot meet patients' intermediate and near vision needs, bringing many inconveniences to their daily lives. Multifocal intraocular lenses split light into different focal points, which helps reduce patients' dependence on glasses for near and far tasks [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, some patients may experience problems such as reduced contrast sensitivity and visual disturbances, like glare and halos, after having multifocal intraocular lenses implanted [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven that patients hope to be free from glasses after cataract surgery [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], intraocular lenses that can provide continuous vision at all focal lengths with low visual disturbances have become a research hotspot. Diff-aA IOL (HumanOpitics, Germany), as a new type of intraocular lens, offers a new approach to solving this problem.\u003c/p\u003e \u003cp\u003eDiff-aA IOL is a one-piece biconvex hydrophilic acrylic progressive diffractive multifocal IOL. It consists of a central diffractive zone with a diameter of 3.0 mm and a peripheral refractive zone. Its near addition power is +\u0026thinsp;3.5 D. It adopts the DOLA technology (diffractive optic local asphericity), that is, a local aspherical design in the diffractive zone [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. By using the principle of aspherical diffractive rings, it achieves a smooth transition from near vision to far vision [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and reduces optical interference phenomena.\u003c/p\u003e \u003cp\u003eClinical studies have shown that Diff-aA IOL can provide patients with full-range vision after surgery, and patients' satisfaction is relatively high [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, there are relatively few domestic clinical studies on this intraocular lens at present, especially in terms of relevant literature on postoperative visual quality. A comprehensive evaluation of the clinical effects of the aspherical diffractive-refractive multifocal intraocular lens Diff-aA IOL is of great significance for providing more scientific basis for clinicians to select intraocular lenses and meeting patients' needs for high-quality visual experience.\u003c/p\u003e \u003cp\u003eThis study aims to conduct an in-depth investigation into the visual effects of patients with cataracts after Diff-aA IOL implantation, providing a comprehensive and complete reference for clinical practice, with the hope of promoting further development in refractive correction and visual quality improvement in cataract surgery.\u003c/p\u003e"},{"header":"2 Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 \u003cb\u003eResearch Method and Subjects\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eA prospective cohort study was conducted. The clinical data of 93 cataract patients (93 eyes) who underwent phacoemulsification combined with intraocular lens (IOL) implantation in the Third Department of Ophthalmology of the First Affiliated Hospital of Zhengzhou University from September 2024 to September 2025 were collected. According to the model of the IOL implanted, the patients were divided into two groups: the observation group consisted of 53 patients (53 eyes) who received the Diffractiva - aA IOL (hereinafter referred to as Diff - aA IOL, HumanOptics, Germany); the control group consisted of 40 patients (40 eyes) who received the Tecnis ZMB00 IOL (hereinafter referred to as ZMB00 IOL, Advanced Medical Optics, USA). Inclusion criteria: (1) Patients with simple age - related cataract; (2) Axial length between 22 mm and 26 mm; (3) Photopic pupil diameter between 2.75 mm and 4.00 mm; (4) Kappa angle\u0026thinsp;\u0026le;\u0026thinsp;0.5, Alpha angle\u0026thinsp;\u0026le;\u0026thinsp;0.5, and corneal higher - order aberration (HOA)\u0026thinsp;\u0026le;\u0026thinsp;0.3 \u0026micro;m in corneal biometry; (5) Predicted postoperative corneal astigmatism\u0026thinsp;\u0026le;\u0026thinsp;1.0 D; (6) Patients with near - vision and glasses - free needs, and with high requirements for postoperative full - range visual acuity and visual quality. Exclusion criteria: (1) Patients with preoperative ocular surface inflammation or unstable tear film that affected the measurement of IOL biological parameters; (2) Patients with a pupil diameter\u0026thinsp;\u0026lt;\u0026thinsp;2 mm in natural light or \u0026gt;\u0026thinsp;6 mm in dim light; (3) Patients with intraoperative complications such as zonular laxity, anterior capsule tear, or posterior capsule rupture; (4) Patients with IOL decentration, tilt, obvious capsular bag shrinkage, endophthalmitis, cystoid macular edema, and other related complications after surgery; (5) Patients with excessively high expectations for postoperative visual acuity or poor compliance during postoperative follow - up; (6) Patients with unexpected postoperative refraction (the difference between the actual postoperative refraction and the reserved refraction\u0026thinsp;\u0026gt;\u0026thinsp;1 D); (7) Patients with organic eye diseases such as corneal diseases, glaucoma, vitreoretinal diseases, strabismus, and amblyopia.\u003c/p\u003e \u003cp\u003e This research protocol followed the Declaration of Helsinki on biomedical research involving human participants and was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University(Ethical Review Number: 2022-KY-0006-001). Informed consent forms for surgery were obtained from all patients and their families before enrollment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 \u003cb\u003ePreoperative Evaluation\u003c/b\u003e\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Ocular Examination\u003c/h2\u003e \u003cp\u003eAll patients were required to undergo routine ophthalmic examinations before surgery, including: visual acuity examination (all visual acuity data in this study were converted to the corresponding Logarithm of the Minimum Angle of Resolution (LogMAR)), intraocular pressure examination, slit - lamp examination, visual quality examination (using iTrace to measure biological parameters such as wavefront aberration, Kappa angle, and alpha angle before and after surgery), and corneal topography examination.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 \u003cb\u003eIntraocular Lens\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eThe Diff - aA IOL is an aspheric diffractive multifocal intraocular lens. It is a one - piece biconvex hydrophilic acrylate progressive diffractive IOL with a total diameter of 12.5 mm and an optical diameter of 6.0 mm. The optical zone structure consists of a central diffractive zone with a diameter of 3.0 mm and a peripheral refractive zone with a zero - spherical - aberration design. There are a total of 9 annular diffractive steps in the diffractive zone. The first 3 steps have the same height, and the height of the latter 6 steps gradually decreases, allowing for a smooth transition to distance - dominant vision when the pupil dilates. The near - addition power of the Diff - aA IOL is +\u0026thinsp;3.50 D, and the refractive power ranges from +\u0026thinsp;10.0 D to +\u0026thinsp;30.0 D.\u003c/p\u003e \u003cp\u003eThe TECNIS ZMB00 IOL is a diffractive multifocal intraocular lens with a total diameter of 13.0 mm and an optical diameter of 6.0 mm. Its refractive index is 1.46, the spherical aberration is \u0026minus;\u0026thinsp;0.27 um, and the Abbe number is 55.5. It uses a stepped progressive diffractive grating and a negative - spherical - aberration design to compensate for corneal aberrations, providing distance to near vision while maintaining high contrast sensitivity. The near - addition refractive power of the ZMB00 IOL is +\u0026thinsp;4.00 D, and the refractive power ranges from +\u0026thinsp;5.0 D to +\u0026thinsp;34.0 D [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3 \u003cb\u003eCalculation of Intraocular Lens Refractive Power and Refractive Target Strategy\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eThe IOL Master 700 measuring instrument was used to measure the biological parameters of the patients before surgery, including axial length, corneal curvature, anterior chamber depth, and white - to - white distance. The Holladay 2 formula or Kane formula was used to calculate the refractive power of the IOL for all eyes. In this study, the optimized A - constant for multifocal intraocular lenses was applied. The postoperative target refractive power was the positive value closest to zero. In addition, patients were informed of the risk of postoperative refractive error and refractive drift before surgery.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.3 \u003cb\u003eSurgical Method\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eAll surgical operations were performed by the same experienced doctor under local anesthesia.\u003c/p\u003e \u003cp\u003eAll patients underwent phacoemulsification combined with IOL implantation. A 3.0 - mm clear corneal tunnel main incision was made at the 10:30 position of the operative eye, with a tunnel length of approximately 2.0 mm. Sodium hyaluronate was injected into the anterior chamber to maintain the anterior chamber depth and protect the corneal endothelium. A 1.0 - mm auxiliary incision was made at the limbus at the 2:00 position. Then, a continuous circular capsulorhexis of 5.3\u0026ndash;5.5 mm was performed with reference to the corneal center. After sufficient hydro - dissection, phacoemulsification was used to aspirate the lens nucleus, and the residual lens cortex was aspirated by I/A. The posterior capsule was polished with a blunt needle, and viscoelastic agent was injected into the capsular bag again. Subsequently, the IOLs in both groups were implanted into the capsular bag using an IOL injector and adjusted to the correct position. The viscoelastic agent was replaced with an aspiration - irrigation device, and the incision was hydrated to ensure closure. The patient was asked to look at a light to observe the position of the IOL relative to the visual axis. After ensuring a normal anterior chamber depth, tobramycin and dexamethasone eye ointment was applied to the conjunctival sac. For highly myopic patients, gatifloxacin ophthalmic gel was applied. The operative eye was covered with a sterile dressing, and the patient was sent back to the ward after the vital signs were stable.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.4 \u003cb\u003eFollow - up and observation indicators\u003c/b\u003e\u003c/h2\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1 Follow - up time\u003c/h2\u003e \u003cp\u003eFollow - up and collection of relevant data were conducted at 2 weeks, 1 month, and 3 months after surgery. The uncorrected visual acuity, refraction results, objective and subjective visual quality of the patients were recorded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e2.4.2 Visual acuity and refraction\u003c/h2\u003e \u003cp\u003eAt 3 months after surgery, computerized refraction and subjective refraction were performed. The best - corrected distance visual acuity (BCDVA) of the patients was examined and recorded. At the same time, the static visual acuity (SVA) of the patients was examined and recorded, including the uncorrected distance visual acuity (UDVA) measured at 5m, the uncorrected intermediate visual acuity (UIVA) measured at 80cm, and the uncorrected near visual acuity (UNVA) measured at 40cm. All data results were expressed in LogMAR.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e2.4.3 Defocus curve\u003c/h2\u003e \u003cp\u003eThe defocus curves of the patients were collected and plotted at 1 month and 3 months after surgery. The measurement was taken at intervals of 0.50D, with a measurement range from +\u0026thinsp;1.00D to \u0026minus;\u0026thinsp;4.00D. The measurement distance was 5m, and the measurement tool was the international standard logarithmic visual acuity chart. The results were all converted to LogMAR units.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e2.4.4 Objective visual quality\u003c/h2\u003e \u003cp\u003eAt 1 month and 3 months after surgery, the Itrace device was used to collect the wavefront aberration (WA), modulation transfer function (MTF), strehl ratio (SR), and point - spread function (PSF) of the patients. The Itrace device simulated the shape of the point - spread function and introduced the types and degrees of Itrace optical indicators and the occurrence of wavefront aberration [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. For example, when coma occurs alone, a comet tail appears in the image, which is described as \"blur\" or \"diplopia\"; when spherical aberration occurs alone, concentric circles appear in the image, which is described as \"glare\" or \"halo\"; when trefoil aberration occurs alone, the image seems to be a star, which is described as \"starburst\"; when second - order astigmatic aberration occurs alone, multiple focal points appear in the image, which is described as \"mixed focus\". The severity of the Itrace optical indicators was divided into four grades: none (-), mild (+), moderate (++), and severe (+++). All examinations were completed by the same technician.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e2.4.5 Subjective visual quality\u003c/h2\u003e \u003cp\u003eAt 3 months after surgery, the satisfaction and spectacle independence degree of the two groups of patients were evaluated.\u003c/p\u003e \u003cp\u003eThe visual function index scale (VF \u0026minus;\u0026thinsp;14 - CN scale) was used to evaluate the patients' satisfaction with visual quality. The VF \u0026minus;\u0026thinsp;14 was published by American scholars Steinberg et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] in 1994 and was designed based on 14 vision - dependent daily activities. The difficulty of completing each activity was scored on a 5 - level scale from 0 to 4 points, namely: (0) impossible to complete; (1) very difficult; (2) moderately difficult; (3) slightly difficult; (4) no difficulty. The results of the VF \u0026minus;\u0026thinsp;14 scale of 766 cataract patients in three cities in the United States showed that the VF \u0026minus;\u0026thinsp;14 is a reliable and effective tool for measuring the visual function impairment of cataract patients [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Patients for whom all scores were not applicable were not included in the final items of the statistical scope of this study. After calculating the mean value, the score was recorded as 0\u0026ndash;100 points. A higher score reflected a higher satisfaction of the patients after surgery. In addition to the VF \u0026minus;\u0026thinsp;14 questionnaire survey, this study also added questions about the occurrence of glare, halo, starburst, and diplopia to evaluate the incidence of optical interference of visual impairment.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e2.5 \u003cb\u003eStatistical analysis\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eThe SPSS Statistics for Windows software (version 29.0, IBM Corp, USA) was used as the statistical analysis software for statistical analysis. Normality and homogeneity of variance tests were performed on all the collected data. The Kolmogorov - Smirnov test (\u003cem\u003eK\u003c/em\u003e - \u003cem\u003eS\u003c/em\u003e test) was used to evaluate the consistency of the sample with the normal distribution. If the data conformed to the normal distribution, the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (\u0026oline;x\u0026thinsp;\u0026plusmn;\u0026thinsp;s) was used for representation. For skewed - distributed data, the median and inter - quartile range \u003cem\u003eM\u003c/em\u003e (\u003cem\u003eP\u003c/em\u003e25, \u003cem\u003eP\u003c/em\u003e75) were used. Considering that the deviation of the area under the defocus curve from +\u0026thinsp;1.00D to \u0026minus;\u0026thinsp;4.00D was 0.24 logMAR and the maximum tolerable error was 0.20 logMAR, a sample of at least 46 patients was required. For the comparison of two groups of independent data, the \u003cem\u003et\u003c/em\u003e - test, Welch\u0026rsquo;s \u003cem\u003et\u003c/em\u003e - test, or Mann - Whitney \u003cem\u003eU\u003c/em\u003e test was used for analysis according to whether the data conformed to the normal distribution and homogeneity of variance. For the comparison of multiple groups of independent samples, one - way analysis of variance was used if the data met the normality requirement, and the Kruskal - Wallis \u003cem\u003eH\u003c/em\u003e test was used if not. To evaluate the association between the Itrace optical indicators and BCDVA of the two groups, the Spearman rank correlation test was performed. A P - value less than 0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 Comparison of general data\u003c/h2\u003e\n \u003cp\u003eA total of 93 cataract patients with 93 eyes were included in this study. According to the type of intraocular lens (IOL) implanted in the patients, they were divided into an observation group (implanted with Diff - aA IOL) and a control group (implanted with ZMB00 IOL). Among them, there were 53 cases (53 eyes) in the Diff - aA IOL group and 40 cases (40 eyes) in the ZMB00 IOL group. The ocular data of the two groups of patients are shown in Table \u003cspan class=\"InternalRef\"\u003e3.1\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3.1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eGeneral baseline data of the two groups of patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParameters\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eObservation Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e/\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of implanted Eyes, n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61.64\u0026thinsp;\u0026plusmn;\u0026thinsp;11.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.85\u0026thinsp;\u0026plusmn;\u0026thinsp;14.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.253\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUDVA, LogMAR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.699(0.398,0.980)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.899(0.495,0.980)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.502\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.616\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCDVA, LogMAR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.398(0.221,0.698)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.450(0.225,0.597)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.716\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.474\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSphere, D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.5(-2.31,0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(-2.50,1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.954\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCylinder, D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.5(-0.68,0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.375(-1.00,0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.795\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.427\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpherical equivalent, D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.625(-2.71,0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(-2.93,1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.925\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eACD, mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.2(2.88,3.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.89(2.77,3.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.862\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAL, mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.18(22.82,23.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.51(22.13,24.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.701\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eNote: For the observation group and the control group, data conforming to the normal distribution are expressed as \u0026oline;x\u0026thinsp;\u0026plusmn;\u0026thinsp;s; data that do not meet the normal distribution are expressed as \u003cem\u003eM\u003c/em\u003e (\u003cem\u003eP\u003c/em\u003e25, \u003cem\u003eP\u003c/em\u003e75). Independent - sample t - test is used for data with normal distribution, and non - parametric test is used for non - normally distributed data; chi - square test is used for count data. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 is considered to be statistically significant.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 \u003cstrong\u003ePostoperative visual acuity\u003c/strong\u003e\u003c/h2\u003e\n \u003cp\u003eThree months after the operation, there was no statistically significant difference in the best - corrected distance visual acuity between the observation group and the control group. The uncorrected visual acuity performance at 5m, 80cm and 40cm is shown in Table \u003cspan class=\"InternalRef\"\u003e3.2\u003c/span\u003e.1 and Table \u003cspan class=\"InternalRef\"\u003e3.2\u003c/span\u003e.2\u003c/p\u003e\n \u003cp\u003eThree months after the operation, there was no statistically significant difference in the best - corrected distance visual acuity between the observation group and the control group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Three months after the operation, both groups had good uncorrected distance visual acuity. The uncorrected distance visual acuity of the observation group was 0 LogMAR, and that of the control group was also 0 LogMAR, with no statistically significant difference (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The uncorrected near - distance visual acuity of the observation group was slightly lower than that of the control group, and the difference was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The uncorrected intermediate - distance visual acuity of the observation group was better than that of the control group, and the difference was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable \u003cspan class=\"InternalRef\"\u003e3.2\u003c/span\u003e.1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of the best - corrected distance visual acuity between the two groups three months after the operation\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVA(LogMAR)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eObservation Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBCVDA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00(-0.01,0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00(-0.01,0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.972\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eNote: Since the normality test was not passed, the Mann-Whitney U test was used. A P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable \u003cspan class=\"InternalRef\"\u003e3.2\u003c/span\u003e.2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of uncorrected visual acuity between the two groups at 3 months after surgery\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVA(LogMAR)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eObservation Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUNVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.15(0.15,0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.15(0.10, 0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUIVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.10(0.09, 0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.20(0.20, 0.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.722\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUDVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0(-0.07,0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0(-0.07,0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.437\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.662\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eNote: None of them passed the normality test, so the Mann-Whitney \u003cem\u003eU\u003c/em\u003e test was used. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3 \u003cstrong\u003eDefocus curve\u003c/strong\u003e\u003c/h2\u003e\n \u003cp\u003eThe defocus curves of the two groups were plotted at 1 month and 3 months after surgery respectively. (Fig. \u003cspan class=\"InternalRef\"\u003e3.3\u003c/span\u003e.1, Fig. \u003cspan class=\"InternalRef\"\u003e3.3\u003c/span\u003e.2)\u003c/p\u003e\n \u003cp\u003eThe area formed by the defocus curve better than 0.3 LogMAR was quantified, which was called the area under the defocus curve (AoF, Area - of - Focus) and expressed as LogMAR/m. The AoFs of the two groups were compared and presented in the form of a histogram. (Fig. \u003cspan class=\"InternalRef\"\u003e3.3\u003c/span\u003e.3, Fig. \u003cspan class=\"InternalRef\"\u003e3.3\u003c/span\u003e.4)\u003c/p\u003e\n \u003cp\u003eThe fitted defocus curve at 1 month after surgery showed that the visual acuity of both groups was better than 0.3 LogMAR at the defocus level of +\u0026thinsp;1.00D to \u0026minus;\u0026thinsp;4.00D; at the defocus levels of 0.00D and \u0026minus;\u0026thinsp;3.50D, the visual acuity of the control group was better than that of the observation group, and the differences were statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001); at the defocus level of \u0026minus;\u0026thinsp;1.50D to \u0026minus;\u0026thinsp;2.50D, the visual acuity of the observation group was better than that of the control group, and the differences were statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004). (Fig. \u003cspan class=\"InternalRef\"\u003e3.3\u003c/span\u003e.1)\u003c/p\u003e\n \u003cp\u003eThe fitted defocus curves at 3 months after surgery showed that at the defocus levels from +\u0026thinsp;1.00D to -4.00D, the visual acuity of both groups was better than 0.3 LogMAR. At the defocus levels from \u0026minus;\u0026thinsp;1.50D to -2.50D, the visual acuity of the observation group was better than that of the control group, and the differences were statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). (Fig. \u003cspan class=\"InternalRef\"\u003e3.3\u003c/span\u003e.2)\u003c/p\u003e\n \u003cp\u003eThere was no statistically significant difference in the AoF between the two groups at 1 month after surgery (Fig. \u003cspan class=\"InternalRef\"\u003e3.3\u003c/span\u003e.3). At 3 months after surgery, the AoF of the observation group was better than that of the control group, suggesting that the overall visual performance of the observation group was better, which was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig. \u003cspan class=\"InternalRef\"\u003e3.3\u003c/span\u003e.4).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4 \u003cstrong\u003eAnalysis of objective visual quality\u003c/strong\u003e\u003c/h2\u003e\n \u003cp\u003eAfter the surgery, the Itrace instrument was used to collect the objective visual quality data of the patients, including the total high - order aberrations (THOA) in wavefront aberrations, the average height of the modulation transfer function (MTF Avg Height), the Strehl ratio (SR), and the point spread function (PSF). Comparisons were made at 3 months after the surgery. Correlation analysis was also conducted between these parameters and the BCDVA at 3 months after the surgery.\u003c/p\u003e\n \u003cp\u003eAt 3 months after the surgery, there were no statistically significant differences in THOA, MTF Avg Height, and SR between the two groups. (Table \u003cspan class=\"InternalRef\"\u003e3.4\u003c/span\u003e.1)\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u0026nbsp;\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable \u003cspan class=\"InternalRef\"\u003e3.4\u003c/span\u003e.1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of Itrace optical quality indicators between the two groups at 3 months after surgery\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e观察组\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e对照组\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e/\u003cem\u003eZ\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTHOA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.131(0.102,0.186)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.155(0.098,0.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.622\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.534\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMTF Avg Height\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.331\u0026thinsp;\u0026plusmn;\u0026thinsp;0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.318\u0026thinsp;\u0026plusmn;\u0026thinsp;0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.610\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.096(0.004,0.218)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.092(0.063,0.151)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.783\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eNote: The THOA and SR in the observation group and the control group both passed the normality test, and non-parametric tests were used; the MTF Avg Height showed a normal distribution, and an independent samples t-test was used.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003eThe postoperative PSF indicators of the two groups were analyzed. At 3 months after surgery, there were no statistically significant differences between the two groups in terms of blurring/diplopia, glare/halo, mixed focus, night myopia or night hyperopia, with all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05 (Table \u003cspan class=\"InternalRef\"\u003e3.4\u003c/span\u003e.2).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable \u003cspan class=\"InternalRef\"\u003e3.4\u003c/span\u003e.2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of PSF indicators between the two groups at 3 months after surgery\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDiff-aA IOL\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eZMB00 IOL\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eblur/double vision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.950\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e++\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e+++\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eglare/halo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.686\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e++\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e+++\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003estarburst\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.622\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e++\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e+++\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emixed focus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.780\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e++\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e+++\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003enight myopia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.690\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e++\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e+++\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eNote: The data in this table are count data, and the rank-sum test is used for analysis.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003eSpearman\u0026apos;s rank correlation analysis was used to investigate the relationships between the iTrace optical indicators and BCDVA in the observation group and the control group. The Strehl ratio and the average height of the modulation transfer function in the control group (ZMB00 IOL) were the only two iTrace optical indicators that showed a statistical correlation with BCDVA (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable \u003cspan class=\"InternalRef\"\u003e3.4\u003c/span\u003e.3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCorrelation analysis between BCDVA and various optical indicators in the two groups 3 months after surgery\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eBCDVA\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eDiff-aA IOL\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eZMB00 IOL\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCC(\u003cem\u003er\u003c/em\u003e)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCC(\u003cem\u003er\u003c/em\u003e)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTHOA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.05689\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.6714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.1733\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.2914\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMTF Avg Height\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.04556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.7342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.3199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.0471*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.03525\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.7928\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.3203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.0468*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e*\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eCC: Correlation coefficient; BCDVA: Best corrected distance visual acuity; THOA: Total high-order wavefront aberration; MTF: Modulation transfer function; SR: Strehl ratio; IOL: Intraocular lens;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n \u003ch2\u003e3.5 \u003cstrong\u003eSubjective visual quality analysis\u003c/strong\u003e\u003c/h2\u003e\n \u003cp\u003eIn this study, the VF-14-CN questionnaire was used to evaluate the daily lives of patients. Table \u003cspan class=\"InternalRef\"\u003e3.5\u003c/span\u003e outlines the VF-14 items and the average scores reported by patients for each item. The average VF-14 score for the group implanted with the Diff-aA IOL was 98.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98, and that for the group implanted with the ZMB00 IOL was 98.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45. There was no statistically significant difference in the average scores between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.667). In terms of the incidence of optical interference phenomena, halos were the most common, with 45.45% of patients in the Diff-aA group and 45.16% in the ZMB00 group reporting them. This was followed by glare (reported by 27.27% in the Diff-aA group and 35.48% in the ZMB00 group) and starbursts (reported by 18.18% in the Diff-aA group and 22.58% in the ZMB00 group). The reporting rate of diplopia was relatively low, with only one patient in the ZMB00 group reporting it. In the observation group, 93.18% of patients reported not relying on glasses after surgery, while in the control group, 93.54% of patients reported the same. In terms of satisfaction with the surgical results, 95.45% in the observation group and 96.77% in the control group were satisfied with the surgical outcomes.\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003ctable id=\"Tab7\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3.5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of VF \u0026minus;\u0026thinsp;14 scores at 3 months after phacoemulsification and intraocular lens implantation between the two groups of patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eQuestion\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eobservation group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003econtrol group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDo you have any difficulty reading small print (such as labels on medicine bottles, phone books, or food labels)?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.00(3.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.00(3.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.460\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.646\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDo you also have difficulty reading newspapers or books?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.00(3.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.00(3.00,3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.299\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDo you also have any difficulty reading large-print books, newspapers, or the numbers on the phone?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.245\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.807\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDo you have any difficulties when people approach you?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.525\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.599\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDo you also have any difficulty in seeing clearly the steps, stairs or curbs?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.765\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.444\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDo you also have any difficulties in reading traffic signs, road signs, or store signs?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.525\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.599\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDo you also have any difficulties in sewing, knitting, crocheting, or woodworking?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(3.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.759\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.448\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDo you also have any difficulties writing checks or filling out forms?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDo you have any difficulties in playing games such as mahjong, card games, and chess?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(3.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.569\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDo you encounter any difficulties when participating in sports such as badminton, croquet, table tennis, basketball, walking, doing exercise, and Tai Chi?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.190\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDo you have any difficulties in cooking due to vision problems?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.407\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.160\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDo you have any difficulties watching TV because of your vision problem?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.271\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDue to vision problems, how difficult is it for you to drive during the day?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(4.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(3.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.215\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDue to vision problems, how difficult is it for you to drive at night?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(3.50,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00(3.00,4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.249\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eNote: The single-item scores do not follow a normal distribution and are represented by \u003cem\u003eM\u003c/em\u003e (\u003cem\u003eP\u003c/em\u003e25, \u003cem\u003eP\u003c/em\u003e75). Non-parametric tests were used. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eGenerally, diffractive intraocular lenses (IOLs) create focal points for both distance and near vision, but the image quality at intermediate distances may be affected [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. To improve distance vision under conditions of dilated pupils or low illumination (when halos and aberrations are most prominent), many modern designs employ a gradient diffractive profile, where the height of the diffractive steps gradually and smoothly decreases from the center to the periphery [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. When the pupil dilates, this gradient profile directs more light towards the distance focal point, resulting in a clearer distance image and reducing the occurrence of halos.\u003c/p\u003e \u003cp\u003eThe Diff - aA IOL is a gradient diffractive multifocal IOL that provides a certain level of intermediate vision while ensuring good distance and near vision, and reduces optical interference phenomena. However, from a clinical perspective, there is currently a lack of validation for the advantages of the Diff - aA IOL in intermediate vision, and there are relatively few studies on its long - term effectiveness and safety when applied to the Chinese population. Therefore, in this study, patients who had received the Diff - aA IOL implantation were followed up for 3 months after the surgery, taking into account both objective optical indicators and the patients' subjective visual experiences.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e4.1 \u003cb\u003eVisual Acuity\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eIn both the Diff - aA IOL group and the ZMB00 IOL group, the best - corrected visual acuity (BCVA) was improved compared with that before surgery, which is in line with the general perception that cataract surgery can improve visual acuity [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In terms of distance visual acuity, the uncorrected distance visual acuity of both groups reached a good level (P\u0026thinsp;=\u0026thinsp;0.662), indicating that the improvement effects of the two were comparable and could meet the patients' needs for distance vision.\u003c/p\u003e \u003cp\u003eIn terms of uncorrected intermediate visual acuity, the Diff - aA IOL group performed better (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The advantage of the Diff - aA IOL may be attributed to its local aspheric design in the diffractive zone, which can meet the needs of intermediate - range vision while ensuring distance and near vision, and has a positive significance for improving the patients' quality of life.\u003c/p\u003e \u003cp\u003eIn terms of uncorrected near visual acuity, the ZMB00 IOL group performed better, but the mean values of the two groups were similar. Although there was a significant statistical difference, the actual clinical difference was not large. This result was similar to the study by Wang J et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This may be related to the near - addition powers of the IOLs in the two groups. The near - addition power of the ZMB00 IOL was +\u0026thinsp;4.00D, while that of the Diff - aA IOL was +\u0026thinsp;3.50D.\u003c/p\u003e \u003cp\u003eIn addition, the distances for near and intermediate vision vary depending on the content the patients are looking at. Cardona and L\u0026oacute;pez [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] found that the working distances for presbyopic patients using computers and reading were 40 to 60 cm and 30 to 50 cm respectively. Long [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] et al. pointed out that the reading distance for smartphones was even closer. Bababekova [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] et al. reported that the average working distances for reading text messages and surfing the Internet on smartphones were 36.2 cm and 32.2 cm respectively, both less than the typical distance of 40 cm. Therefore, it is recommended that ophthalmologists understand in detail the working distances of the patients' habitual tasks to select intraocular lenses that can cover a wide range of distances and provide good visual performance.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e4.2 \u003cb\u003eDefocus Curve\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eThe defocus curve is a core tool for evaluating the visual quality of intraocular lenses (IOLs) at different depths of focus. It is particularly significant in the analysis of the effects of multifocal IOLs and extended - depth - of - focus IOLs [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The defocus curve helps to identify refractive errors, determine the position of the peak far - vision, and guide decisions to improve the correction effect for presbyopia [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. At 1 month after surgery, the visual acuity of the ZMB00 IOL group was better than that of the Diff - aA IOL group at the defocus levels of 0D and \u0026minus;\u0026thinsp;3.5D. However, the Diff - aA IOL group outperformed at the defocus levels from \u0026minus;\u0026thinsp;1.50D to \u0026minus;\u0026thinsp;2.50D. At 3 months after surgery, the Diff - aA IOL group still had better visual acuity at the defocus levels from \u0026minus;\u0026thinsp;1.50D to \u0026minus;\u0026thinsp;2.50D. This result suggests that the Diff - aA IOL can provide a certain degree of intermediate vision, which is consistent with the results of uncorrected intermediate - distance vision.\u003c/p\u003e \u003cp\u003eMeanwhile, we compared and quantified the area - of - focus (AoF) of the defocus curves between the two groups. The area - of - focus is a core index that quantifies the defocus curve into a single value, used to comprehensively evaluate the overall performance of the visual system within the dynamic defocus range. The defocus curve is divided into far - distance (\u0026ndash;0.50 D to +\u0026thinsp;0.50 D), intermediate (\u0026ndash;2.00 D to \u0026minus;\u0026thinsp;0.50 D), and near - distance (\u0026ndash;4.00 D to \u0026minus;\u0026thinsp;2.00 D) parts. For each of these parts, the entire AoF below 0.30 logMAR is calculated and expressed as logMAR/m. The larger the AoF, the better the visual acuity in that part. In studies where the focal analysis method is not sensitive enough to identify the differences in visual performance between different multifocal IOLs, the AoF can detect significant differences in intermediate - and near - distance visual acuity [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study found that the AoF of both groups continued to increase from 1 month to 3 months after surgery, suggesting that there is a process of neural adaptation and remodeling for the IOLs in both groups. To enable patients to adapt to multifocal IOLs, the brain must undergo \u0026ldquo;neural adaptation\u0026rdquo; to process new visual information. Previous studies have indicated that the neural adaptation of multifocal IOLs is initially achieved through visual, attention, and brain program - learning networks [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. However, some literature also points out that the reduction of objective glare may be related to wound healing and suggests that the previous reports of glare reduction over time after surgery are due to optical changes rather than neural adaptation [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003e4.3 \u003cb\u003eAnalysis of Objective Visual Quality\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eIn this study, iTrace was used to examine the objective visual performance after surgery. The important analysis parameters of iTrace in this study include wavefront aberration, Modulation Transfer Function (MTF), Strehl ratio (SR), and Point - Spread Function (PSF). iTrace quantitatively measures the wavefront aberration of the eye. Wavefront aberration is one of the indicators for evaluating the imaging effect of an optical system. Among wavefront aberrations, the aberrations that cannot be corrected by refraction are called Total Higher - Order Aberrations (THOA). Even under good refractive conditions, the magnitude of its value and the combination of different fractional - order aberrations can still have a significant adverse impact on visual performance [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. MTF is the core indicator for evaluating the imaging quality of an optical system, which describes the system's ability to transfer contrast at different spatial frequencies (e.g., 30 cycles/degree, c/d). MTF Avg Height is the average height of the MTF curve within a specific frequency range (e.g., 5\u0026ndash;30 c/d), reflecting the average level of the optical system's ability to transfer contrast at different spatial frequencies, and it represents the comprehensive performance of the optical system in multiple frequency bands. SR represents the ratio of the light intensity of the actual optical system of the human eye to that of an aberration - free optical system, and it is used to measure the imaging quality of the optical system. The closer it is to 1, the better the imaging quality [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. PSF is used to describe the imaging situation of an optical system for a point light source. In an ideal state, a point light source should be imaged as a point through a perfect optical system. However, in the actual optical system of the eye (including structures such as the cornea and lens) and implants such as intraocular lenses, due to factors such as aberration and diffraction, the point light source will be diffused into a light spot of a specific shape. The shape and intensity distribution of this light spot are the point - spread function. It is one of the important indicators for evaluating the imaging quality of an optical system. PSF can reflect the ability of an intraocular lens to image a point light source and is closely related to visual clarity, contrast, etc.\u003c/p\u003e \u003cp\u003eThis study showed that there were no significant differences between the two groups of IOLs in terms of THOA, average height of MTF, SR, and PSF, and all differences were not statistically significant (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). These results confirm that the two IOLs perform similarly in contrast transfer ability and overall optical imaging quality and can both provide stable visual effects.\u003c/p\u003e \u003cp\u003eIn this study, a weak positive correlation was observed between the MTF Avg Height and BCDVA in the ZMB00 group (r\u0026thinsp;=\u0026thinsp;0.32), which is consistent with the conclusion of the defocus curve study by Vargas et al., that is, the distant vision performance of diffractive multifocal IOLs highly depends on the stability of the MTF curve. In contrast, there was no significant correlation between all optical parameters and BCDVA in the Diff - aA IOL group (|r| \u0026lt; 0.06). This suggests that the postoperative visual acuity of this IOL may mainly depend on the accuracy of refractive correction rather than wavefront aberrations. The underlying reason may be related to the optical design of the Diff - aA IOL. The optical center consists of a central diffractive zone with a diameter of 3.0 mm and a peripheral refractive zone with a zero - spherical - aberration design. The astigmatism caused by HOA can be partially offset by the peripheral refraction compensation.\u003c/p\u003e \u003cp\u003eIn this study, one of the reasons why the Diff - aA IOL and ZMB00 IOL have similar visual quality may be that we measured the objective visual quality under a pupil diameter of 4.0 mm. Under a 4 - mm pupil, corneal aberrations do not have a significant impact on the results, which can be similar to the real optical quality of the IOL [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003e4.4 \u003cb\u003eRelationship between subjective visual quality and optical interference\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eIn ophthalmic research, evaluating the subjective visual quality of patients is crucial for understanding visual function and the effects of different treatment methods or interventions. First, looking at the scores of the VF \u0026minus;\u0026thinsp;14 items, the average scores of the Diff - aA group and the ZMB00 group for tasks such as reading small print and doing handicrafts were both below 4.00. In contrast, the scores of the two groups in other VF \u0026minus;\u0026thinsp;14 items generally reached 4.00. The results of the VF \u0026minus;\u0026thinsp;14 items showed a similar trend to those of visual acuity.\u003c/p\u003e \u003cp\u003eSecondly, optical interference phenomena can also affect patient satisfaction after multifocal intraocular lens (IOL) implantation [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], including positive and negative optical interferences. Positive optical interference refers to the extra bright lights seen by patients, such as light streaks, halos, glare, and starbursts, which usually appear at the edge or center of the visual field, especially more obvious at night or in low - light environments. Negative optical interference is the crescent - shaped or bracket - shaped shadows in the temporal visual field complained by patients, similar to visual field occlusion, which are aggravated under strong light or when the pupils constrict [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The full - vision - zone diffractive rings of ZMB00 can induce more positive optical interference than single - focal IOLs. The diffractive rings on the posterior surface may be partly responsible for the scattering that causes moderate glare.\u003c/p\u003e \u003cp\u003eGlare and halos, the main optical phenomena complained by 38.2% of patients after MIOL implantation [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], and diffractive MIOLs may have more optical interference phenomena [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. In this study, halos were the most commonly encountered light phenomenon, affecting nearly half of the patients. However, most patients were satisfied with their postoperative visual quality. In the Diff - aA group and the ZMB00 group, night driving was a problem for some patients. Previous studies have shown that this is due to night - time aberrations such as halos and glare [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], and this result may be related to neural adaptation. Adverse visual symptoms are visual phenomena or visual functions unrelated to visual acuity [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], which to some extent reflect the brain function of the visual cortex [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. However, neural adaptation is a variable process that depends on individual patients and may not be easily predicted [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003e4.5 \u003cb\u003eInnovation and Limitations of the Study\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eThe advantages of this study include a prospective design, comprehensive pre - and post - operative evaluations, and the use of advanced imaging techniques for accurate measurements. However, there are some limitations to be considered. First, only one eye of each patient was included, thus ignoring the correlation of binocular parameters. Therefore, binocular visual quality indicators such as stereopsis were not evaluated. Second, there was no long - term evaluation. The third limitation is the relatively small sample size, which is related to the strict inclusion criteria. Since myopia is closely related to other vision - affecting diseases such as myopic maculopathy [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], great caution must be exercised when implanting IOLs in myopic patients. The risk of surgical complications is also higher, such as IOL decentration.\u003c/p\u003e \u003c/div\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eThe aspheric diffractive multifocal intraocular lens Diff - aA IOL can provide excellent far and near vision and satisfactory intermediate vision, achieving a relatively continuous visual range after surgery. At the same time, it has a satisfactory spectacle independence rate, good visual satisfaction, and a low incidence of adverse visual phenomena.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funds\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZhang Jingwen1,2, Sun Louxun3, Yang Yifan2, Du Shanshan1, Shao Jingzhi1, Zhang Fengyan1\u003c/p\u003e\n\u003cp\u003eDepartment of Ophthalmology, the First Affiliated Hospital of Zhengzhou University\u003c/p\u003e\n\u003cp\u003eZhengzhou 450000, Henan, China\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAffiliations of the authors:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 (450000) Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China;\u003c/p\u003e\n\u003cp\u003e2 (450000) Zhengzhou University, Zhengzhou, Henan, China;\u003c/p\u003e\n\u003cp\u003e3 (410000) The Third Xiangya Hospital of Central South University, Changsha, Hunan, China\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor profiles:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZhang Jingwen, a postgraduate student for a master\u0026apos;s degree, a resident physician. Research direction: cataract.\u003c/p\u003e\n\u003cp\u003eSun Louxun, a resident physician. Research direction: basic research on surgical oncology and related diseases.\u003c/p\u003e\n\u003cp\u003eYang Yifan, a resident physician. Research direction: cataract.\u003c/p\u003e\n\u003cp\u003eDu Shanshan, a doctor, an associate chief physician. Research direction: cataract.\u003c/p\u003e\n\u003cp\u003eShao Jingzhi, a doctor, an associate chief physician. Research direction: cataract.\u003c/p\u003e\n\u003cp\u003eCorresponding author: Zhang Fengyan, a doctor, a chief physician, a doctoral supervisor. Research direction: cataract. Email: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eEthics approval and consent to participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all participants before their inclusion in the study. This trial was conducted in accordance with the guidelines for clinical trials involving human participants and the Declaration of Helsinki. The research protocol was approved by the Ethics Committee of Zhengzhou University. (Ethical Review Number: 2022-KY-0006-001)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBefore the participant enters the study, written informed consent was obtained from all participants for the publication of results that will be used in a completely confidential manner and solely for research purposes, and the participants\u0026rsquo; identity will remain confidential within the framework of the law.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHashemi H, Pakzad R, Yekta A, et al. Global and regional prevalence of age-related cataract: a comprehensive systematic review and meta-analysis[J]. 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Br J Ophthalmol. 2020;104(9):1254\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bjophthalmol-2019-315255\u003c/span\u003e\u003cspan address=\"10.1136/bjophthalmol-2019-315255\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Multifocal intraocular lens, Cataract, Visual quality","lastPublishedDoi":"10.21203/rs.3.rs-8626404/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8626404/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo explore the visual quality analysis of cataract patients after implantation of the aspheric diffractive multifocal intraocular lens (IOL) Diff - aA IOL.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eProspective cohort study. Cataract patients who visited the Third Department of Ophthalmology of the First Affiliated Hospital of Zhengzhou University from September 2024 to September 2025 were selected as the study cohort, and a total of 93 cases (93 eyes) were included. According to the models of intraocular lenses (IOLs) implanted in the patients, they were divided into two groups: the observation group consisted of 53 cases (53 eyes) of patients who received the Diff-aA IOL (HumanOptics, Germany); the control group included 40 cases (40 eyes) of patients who received the Tecnis ZMB00 IOL (Advanced Medical Optics, USA). At 1 month and 3 months after surgery, the uncorrected far, intermediate, and near visual acuities of both eyes of the patients in the two groups were measured respectively, and the defocus curves were plotted. For objective visual quality, the Itrace was used to measure the modulation transfer function (MTF) curve, Strehl ratio (SR), and point spread function (PSF), and for subjective visual quality, the VF \u0026minus;\u0026thinsp;14 - CN scale was used for evaluation.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe uncorrected near vision of the observation group was slightly lower than that of the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while the uncorrected intermediate vision of the observation group was better than that of the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The fitted defocus curve at 1 month after surgery showed that at the defocus levels of 0.00D and \u0026minus;\u0026thinsp;3.50D, the visual acuity of the control group was better than that of the observation group (P\u0026thinsp;=\u0026thinsp;0.003, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001); at the defocus levels of -1.50D to -2.50D, the visual acuity of the observation group was better than that of the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, P\u0026thinsp;=\u0026thinsp;0.004). The fitted defocus curve at 3 months after surgery indicated that at the defocus levels of -1.50D to -2.50D, the visual acuity of the observation group was better than that of the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). At 3 months after surgery, the AUDOC of the observation group was better than that of the control group, suggesting that the overall visual performance of the observation group was better (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001); at 3 months after surgery, there were no significant differences in the THOA, MTF Avg Height, SR, and PSF indicators between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). There was no statistically significant difference in the average VF \u0026minus;\u0026thinsp;14 scores between the two groups (P\u0026thinsp;=\u0026thinsp;0.667). In terms of the incidence of optical interference phenomena, halos were the most common, reported by 45.45% of patients in the Diff - aA group and 45.16% of patients in the ZMB00 group. Followed by glare (reported by 27.27% in the Diff - aA group and 35.48% in the ZMB00 group) and starburst (reported by 18.18% in the Diff - aA group and 22.58% in the ZMB00 group). The report rate of diplopia was relatively low, with only one patient in the ZMB00 group reporting it.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe aspheric diffractive multifocal intraocular lens Diff - aA IOL can provide excellent far and near visual acuities and satisfactory intermediate visual acuity, achieve a relatively continuous visual range after surgery, and at the same time obtain a satisfactory spectacle - independence rate and a low incidence of adverse visual phenomena.\u003c/p\u003e","manuscriptTitle":"Analysis of Visual Quality after Implantation of Diffractive Multifocal Intraocular Lens Diff - aA in Cataract Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-27 00:01:46","doi":"10.21203/rs.3.rs-8626404/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-12T04:08:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-09T18:32:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-09T08:55:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-08T19:21:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-04T11:14:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"258685912771681799719933328842468446339","date":"2026-02-02T12:27:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"199134275776156775005992052230969250809","date":"2026-02-01T17:42:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-01T17:39:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"256464268130763358460591471171963150389","date":"2026-02-01T07:03:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"308944614285520204222872430138704490295","date":"2026-01-31T07:16:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"193909818514729866144165271327616294033","date":"2026-01-21T19:17:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"114599937817353782418017738109734913538","date":"2026-01-21T16:22:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-21T16:13:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-20T14:06:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-20T13:59:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2026-01-17T13:36:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"74257ace-98df-484f-ac92-3df59c081fb6","owner":[],"postedDate":"January 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T16:07:04+00:00","versionOfRecord":{"articleIdentity":"rs-8626404","link":"https://doi.org/10.1186/s12886-026-04820-x","journal":{"identity":"bmc-ophthalmology","isVorOnly":false,"title":"BMC Ophthalmology"},"publishedOn":"2026-04-14 15:59:49","publishedOnDateReadable":"April 14th, 2026"},"versionCreatedAt":"2026-01-27 00:01:46","video":"","vorDoi":"10.1186/s12886-026-04820-x","vorDoiUrl":"https://doi.org/10.1186/s12886-026-04820-x","workflowStages":[]},"version":"v1","identity":"rs-8626404","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8626404","identity":"rs-8626404","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}