Trifocal intraocular lenses versus bifocal intraocular lenses after cataract extraction among participants with presbyopia

Patient or population: people (> 30 years) with cataract and presbyopia 
Setting: eye clinic
Intervention: trifocal IOL
Comparison: bifocal IOL

Mean uncorrected distance visual acuity (LogMAR

(1 year)

‐

107
(2 RCTs)

⊕⊕⊝⊝
LOW ^{1 2}

Mean uncorrected near visual acuity (LogMAR)

(1 year)

‐

107
(2 RCTs)

⊕⊕⊝⊝
LOW ^{1 2}

Mean uncorrected intermediate visual acuity (LogMAR)

(1 year)

‐

107
(2 RCTs)

⊕⊕⊝⊝
LOW ^{1 2}

Mean best‐corrected distance acuity (LogMAR)

(1 year)

‐

107
(2 RCTs)

⊕⊕⊝⊝
LOW ^{1 2}

Mean contrast sensitivity

(1 year)

‐

‐

1 study reported that contrast sensitivity did not differ between groups under photopic conditions, but may be worse in the trifocal group in 1 of the 4 frequencies under mesopic conditions at 3 months (MD −0.19, 95% CI −0.33 to −0.05; n = 25).

Mean quality of life or visual function (measured using Visual Function Index‐14 tool)

(1 year)

‐

‐

1 study examined vision‐related quality of life using the NEI‐VFQ‐25 at 6 months and found no evidence of a difference between trifocal and bifocal IOLs (MD 1.41, 95% CI −1.78 to 4.60; 40 participants).

Adverse events

(1 year)

‐

129 (2 RCTs)

⊕⊕⊝⊝
LOW ^{1 2}

1 study reported no intraoperative or postoperative complications; in the other study, 4 eyes (11.4%) in the bifocal group and 3 eyes (7.5%) in the trifocal group developed significant posterior capsular opacification requiring YAG capsulotomy.

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; IOL: intraocular lens; LogMAR: logarithm of the minimum angle of resolution; MD: mean difference; NEI‐VFQ‐25: 25‐item National Eye Institute Visual Function Questionnaire; RCT: randomized controlled trial

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.