Multifocal intraocular lenses improve near vision but increase optical aberrations in patients with non-proliferative diabetic retinopathy

To evaluate the long-term effects of phacoemulsification with monofocal (SIOL) versus multifocal intraocular lens (MIOL) implantation on visual quality in patients with non-proliferative diabetic retinopathy (NPDR). A retrospective analysis was performed on 138 NPDR patients who underwent cataract surgery at the First People's Hospital of Xianyang between August 2021 and August 2023. Patients were assigned to either the SIOL group (n=62) or the MIOL group (n=76). Two years postoperatively, visual outcomes were assessed, including uncorrected and corrected visual acuity (LogMAR), spherical equivalent (SE), defocus curves, visual quality indicators (NEI VFQ-25 scores, higher-order aberrations [HOAs], contrast sensitivity), and complication rates. Multivariate logistic regression was performed to identify independent predictors of visual quality. The MIOL group showed significantly better uncorrected near and intermediate visual acuity than the SIOL group (both P < 0.05), with no significant differences in uncorrected or corrected distance visual acuity or SE between groups (both P > 0.05). The MIOL defocus curve revealed a broad functional range from 0.0 D to -3.0 D, whereas the SIOL curve declined sharply after 0.0 D. MIOL recipients also had significantly lower HOAs and higher visual quality scores (P < 0.05). Contrast sensitivity and complication rates were comparable between groups (both P > 0.05). Logistic regression identified diabetes duration, total HOAs, IOL type, and complications as independent predictors of postoperative visual quality. MIOL implantation offers superior near and intermediate vision and overall visual quality compared to SIOLs in patients with NPDR. However, increased higher-order aberrations in some cases may affect visual function. Key determinants of visual outcomes include the duration of diabetes, IOL type, and postoperative complications.