{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T20:39:46Z","timestamp":1786653586781,"version":"build-2736575974"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 1","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Prospective, randomized, comparative clinical trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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\u2013Wallis; Mann\u2013Whitney U with Bonferroni) were applied at the patient level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      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) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.322). NAVQ indicated minimal difficulty with near\/intermediate tasks (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.127). The Catquest-9SF Rasch person measures were \u22123.52 \u00b1 0.77, \u22123.64 \u00b1 0.35, and \u22123.79 \u00b1 0.29, respectively (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.221). One TyPE intermediate-vision item favored Synergy over PanOptix (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.015). Photic phenomena were infrequent and comparable among groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijo.ijo_2566_25","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T16:00:19Z","timestamp":1777564819000},"page":"S40-S45","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Subjective visual quality after bilateral implantation of three diffractive trifocal intraocular lenses: A prospective randomized clinical trial"],"prefix":"10.4103","volume":"74","author":[{"given":"Ivan C","family":"Teixeira","sequence":"first","affiliation":[{"name":"Deparment of Ophthalmology, Hospital de Olhos Paulista, S\u00e3o Paulo, Brazil"},{"name":"Deparment of Ophthalmology, PEnsE Institute, Vision One, S\u00e3o Paulo, Brazil"},{"name":"Department of Ophthalmology and Visual Sciences, Federal University of S\u00e3o Paulo (UNIFESP), S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardo Kaplan","family":"Moscovici","sequence":"additional","affiliation":[{"name":"Deparment of Ophthalmology, Hospital de Olhos Paulista, S\u00e3o Paulo, Brazil"},{"name":"Deparment of Ophthalmology, PEnsE Institute, Vision One, S\u00e3o Paulo, Brazil"},{"name":"Department of Ophthalmology and Visual Sciences, Federal University of S\u00e3o Paulo (UNIFESP), S\u00e3o Paulo, Brazil"},{"name":"Department of Ophthalmology, Hospital Oftalmol\u00f3gico Vis\u00e3o Laser, Santos, Brazil"},{"name":"Department of Medicine, Postgraduate Program in Translational Medicine, Escola Paulista de Medicina, Federal University of S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilson T","family":"Hida","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Hospital Oftalmologico de Brasilia, Brasilia, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro Silveira","family":"de Queiroz Campos","sequence":"additional","affiliation":[{"name":"Deparment of Ophthalmology, Hospital de Olhos Paulista, S\u00e3o Paulo, Brazil"},{"name":"Deparment of Ophthalmology, PEnsE Institute, Vision One, S\u00e3o Paulo, Brazil"},{"name":"Department of Ophthalmology and Visual Sciences, Federal University of S\u00e3o Paulo (UNIFESP), S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"R1-20260430","doi-asserted-by":"crossref","first-page":"2523","DOI":"10.3390\/jcm12072523","article-title":"Comparison of Five Presbyopia-Correcting Intraocular Lenses: Optical-Bench Assessment with Visual-Quality Simulation","volume":"12","author":"\u0141abuz","year":"2023","journal-title":"J Clin Med"},{"key":"R2-20260430","first-page":"431","article-title":"Visual outcomes and patient satisfaction after implantation of a trifocal intraocular lens in Japanese eyes","volume":"47","author":"Bissen-Miyajima","year":"2016","journal-title":"Ophthalmic Surg Lasers Imaging Retina"},{"key":"R3-20260430","first-page":"244","article-title":"Comparison of visual and patient-reported outcomes between trifocal and monofocal intraocular lenses","volume":"32","author":"Modi","year":"2018","journal-title":"Eye (Lond)"},{"key":"R4-20260430","first-page":"201","article-title":"Binocular performance of trifocal intraocular lenses in highly myopic patients","volume":"205","author":"Shen","year":"2019","journal-title":"Am J Ophthalmol"},{"key":"R5-20260430","doi-asserted-by":"crossref","first-page":"e000146","DOI":"10.1136\/bmjophth-2018-000146","article-title":"Digital eye strain: Prevalence, measurement and amelioration","volume":"3","author":"Sheppard","year":"2018","journal-title":"BMJ Open Ophthalmol"},{"key":"R6-20260430","first-page":"378","article-title":"Visual and refractive outcomes following implantation of a diffractive trifocal intraocular lens","volume":"46","author":"Lawless","year":"2018","journal-title":"Clin Exp Ophthalmol"},{"key":"R7-20260430","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.jcrs.2013.06.025","article-title":"Comparative visual performance of bifocal and trifocal diffractive intraocular lenses during one year of follow-up","volume":"40","author":"Mojzis","year":"2014","journal-title":"J Cataract Refract Surg"},{"key":"R8-20260430","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1177\/1120672118762231","article-title":"Clinical outcomes with a diffractive trifocal intraocular lens","volume":"28","author":"Ali\u00f3","year":"2018","journal-title":"Eur J Ophthalmol"},{"key":"R9-20260430","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s41687-024-00717-9","article-title":"Psychometric evaluation of the near activity visual questionnaire presbyopia (NAVQ-P) and additional patient-reported outcome items","volume":"8","author":"Sims","year":"2024","journal-title":"Journal of Patient-Reported Outcomes"},{"key":"R10-20260430","first-page":"201","article-title":"Visual function after bilateral trifocal intraocular lens implantation in myopic eyes","volume":"205","author":"Shen","year":"2019","journal-title":"Am J Ophthalmol"},{"key":"R11-20260430","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1016\/j.jcrs.2010.11.032","article-title":"Dissatisfaction after multifocal intraocular lens implantation","volume":"37","author":"de Vries","year":"2011","journal-title":"J Cataract Refract Surg"},{"key":"R12-20260430","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.clae.2007.01.004","article-title":"Development of a near activity visual questionnaire to assess accommodating intraocular lenses","volume":"30","author":"Gupta","year":"2007","journal-title":"Cont Lens Anterior Eye"},{"key":"R13-20260430","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s41687-024-00717-9","article-title":"Psychometric evaluation of the near activity visual questionnaire presbyopia (NAVQ-P) and additional patient-reported outcome items","volume":"8","author":"Sims","year":"2024","journal-title":"J Patient Rep Outcomes"},{"key":"R14-20260430","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/j.jcrs.2008.11.038","article-title":"Catquest-9SF patient outcomes questionnaire: nine-item short-form Rasch-scaled revision of the Catquest questionnaire","volume":"35","author":"Lundstr\u00f6m","year":"2009","journal-title":"J Cataract Refract Surg"},{"key":"R15-20260430","first-page":"533","article-title":"Remediating ceiling effects in visual function questionnaires: Rasch analysis applications","volume":"19","author":"Pesudovs","year":"2010","journal-title":"Qual Life Res"},{"key":"R16-20260430","doi-asserted-by":"crossref","first-page":"e000064","DOI":"10.1136\/bmjophth-2016-000064","article-title":"Assessment of dysphotopsia in pseudophakic subjects with multifocal intraocular lenses","volume":"1","author":"Buckhurst","year":"2017","journal-title":"BMJ Open Ophthalmology"},{"key":"R17-20260430","first-page":"516","article-title":"Visual outcomes and dysphotopsia in trifocal intraocular lens implantation","volume":"34","author":"Zhao","year":"2018","journal-title":"J Refract Surg"},{"key":"R18-20260430","first-page":"196","article-title":"Comparative optical performance of trifocal and EDOF intraocular lenses","volume":"104","author":"Nochez","year":"2020","journal-title":"Br J Ophthalmol"},{"key":"R19-20260430","first-page":"330","article-title":"Bilateral implantation of Tecnis Synergy versus blended implantation with Eyhance: Comparative analysis","volume":"37","author":"Yang","year":"2021","journal-title":"J Refract Surg"},{"key":"R20-20260430","first-page":"2442","article-title":"Visual outcomes with PanOptix trifocal intraocular lens","volume":"35","author":"Ali\u00f3","year":"2021","journal-title":"Eye (Lond)"},{"key":"R21-20260430","first-page":"1","article-title":"Visual Field Stability After Trifocal Intraocular Lens Implantation: A Longitudinal Standard Automated Perimetry Study","volume":"20","author":"Hida","year":"2026","journal-title":"Clin Ophthalmol"},{"key":"R22-20260430","first-page":"9","article-title":"Defocus curve and optical quality of trifocal intraocular lenses","volume":"6","author":"Ferreira","year":"2019","journal-title":"Eye Vis (Lond)"},{"key":"R23-20260430","doi-asserted-by":"crossref","first-page":"6","DOI":"10.3390\/vision10010006","article-title":"Wavefront Automated Refraction Comparison of Three Different IOLs: Aspheric Monofocal and Two Enhanced Monofocal IOLs","volume":"10","author":"van den Berg","year":"2026","journal-title":"Vision (Basel)"},{"key":"R24-20260430","first-page":"e586","article-title":"Contrast sensitivity and photic phenomena with diffractive multifocal intraocular lenses","volume":"95","author":"Kamiya","year":"2017","journal-title":"Acta Ophthalmol"},{"key":"R25-20260430","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.2147\/OPTH.S136164","article-title":"Trifocal intraocular lenses: a comparison of the visual performance and quality of vision provided by two different lens designs","volume":"11","author":"Gundersen","year":"2017","journal-title":"Clin Ophthalmol"},{"key":"R26-20260430","first-page":"1361","article-title":"Intermediate vision with hybrid diffractive-EDOF intraocular lenses","volume":"42","author":"Gatinel","year":"2016","journal-title":"J Cataract Refract Surg"},{"key":"R27-20260430","first-page":"1957","article-title":"Multifocal intraocular lens satisfaction and quality of vision","volume":"7","author":"De Vries","year":"2013","journal-title":"Clin Ophthalmol"},{"key":"R28-20260430","first-page":"629","article-title":"Halo and glare in new-generation multifocal intraocular lenses","volume":"101","author":"Monaco","year":"2017","journal-title":"Br J Ophthalmol"},{"key":"R29-20260430","doi-asserted-by":"crossref","first-page":"2545","DOI":"10.2147\/OPTH.S318203","article-title":"Spectacle Independence and Quality of Vision After Bilateral Implantation of a Trifocal Intraocular Lens","volume":"15","author":"Shatz","year":"2021","journal-title":"Clin Ophthalmol"},{"key":"R30-20260430","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1016\/j.jcrs.2016.06.033","article-title":"Visual outcomes after implantation of a new diffractive trifocal intraocular lens","volume":"42","author":"Cochener","year":"2016","journal-title":"J Cataract Refract Surg"},{"key":"R31-20260430","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1016\/j.jcrs.2009.03.056","article-title":"Using Rasch analysis to revisit the validity of the Cataract TyPE Spec instrument for measuring cataract surgery outcomes","volume":"35","author":"Gothwal","year":"2009","journal-title":"J Cataract Refract Surg"}],"container-title":["Indian Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_2566_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:39:40Z","timestamp":1786649980000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_2566_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":31,"journal-issue":{"issue":"Suppl 1","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/ijo.ijo_2566_25","relation":{},"ISSN":["0301-4738","1998-3689"],"issn-type":[{"value":"0301-4738","type":"print"},{"value":"1998-3689","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]},"assertion":[{"value":"2025-10-10","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-02","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}