Subjective visual quality after bilateral implantation of three diffractive trifocal intraocular lenses: A prospective randomized clinical trial

PURPOSE: To compare subjective visual quality and patient-reported outcomes after bilateral implantation of three diffractive trifocal intraocular lenses (IOLs): AT LISA tri 839MP, AcrySof IQ PanOptix, and Tecnis Synergy. DESIGN: Prospective, randomized, comparative clinical trial. METHODS: Forty-three patients with bilateral cataract were randomized to one of the three trifocal IOL models. A single surgeon used standardized techniques, and assessments were performed 3 months after second-eye surgery. Subjective visual quality was evaluated using three validated patient-reported outcome measures: Cataract TyPE Spec (TyPE), Near Activity Visual Questionnaire (NAVQ), and Catquest-9SF (Rasch-modeled). Outcomes included global and item-level scores, satisfaction, and photic phenomena. Nonparametric tests (Kruskal-Wallis; Mann-Whitney U with Bonferroni) were applied at the patient level. RESULTS: All IOLs yielded high visual function and satisfaction, with ceiling effects across questionnaires. The median TyPE global scores were 56 (AT LISA tri), 54 (PanOptix), and 59 (Synergy) ( P = 0.322). NAVQ indicated minimal difficulty with near/intermediate tasks ( P = 0.127). The Catquest-9SF Rasch person measures were -3.52 ± 0.77, -3.64 ± 0.35, and -3.79 ± 0.29, respectively ( P = 0.221). One TyPE intermediate-vision item favored Synergy over PanOptix ( P = 0.015). Photic phenomena were infrequent and comparable among groups. CONCLUSIONS: All three diffractive trifocal IOLs provided excellent subjective visual performance, satisfaction, and spectacle independence. Although Synergy showed a slight advantage for intermediate tasks, overall differences were minimal, supporting consistently high patient-reported outcomes with current trifocal optics.