Comparative Visual Outcomes of Toric and Nontoric Intraocular Lenses Featuring Combined Diffractive Extended Depth of Focus and Multifocal Designs

Abstract

Purpose To assess and compare visual quality and subjective outcomes of the toric and nontoric versions of a trifocal intraocular lens (IOL) combining a diffractive extended depth of focus (EDoF) profile with a diffractive multifocal pattern. Methods This prospective cohort study included patients bilaterally implanted with the TECNIS Synergy or TECNIS Synergy Toric II IOL. At 3 months postoperatively, monocular and binocular uncorrected distance visual acuity (UDVA), corrected visual acuity (VA) at 100%, 50%, and 10% contrast, and binocular defocus curves were evaluated. A five‐point Likert scale questionnaire assessed satisfaction at different distances, perception of halos, and willingness to choose the same lens again. Results A total of 114 eyes (52 nontoric and 62 toric) were analyzed. Monocular UDVA was 0.02 ± 0.07 logMAR (nontoric) and 0.08 ± 0.11 logMAR (toric) (p = 0.02), while binocular UDVA was −0.05 ± 0.06 logMAR and −0.02 ± 0.10 logMAR, respectively (p = 0.13). Defocus curves showed VA better than 0.1 logMAR from +1.0 to −2.5 D in both groups. No significant differences in contrast sensitivity were observed between groups at any level (p > 0.05). Over 80% of patients in each group reported being satisfied or very satisfied at all distances. Halos were described as not or only slightly bothersome by 42% of patients. A small percentage expressed a low likelihood of choosing the same lens again (4% nontoric, 9% toric). Conclusion Both IOL models provided similar and effective visual restoration from distance to near. Despite some reported visual disturbances, patient satisfaction and visual quality were high and comparable between the toric and nontoric lenses when appropriately aligned.