Comparison of clinical outcomes of trifocal versus extended depth of focus intraocular lenses: meta-analysis of randomized controlled trials

The advent of refractive cataract surgery has led to the widespread adoption of functional intraocular lenses (IOLs), including trifocal and extended depth of focus (EDOF) IOLs. However, the relative effects of these IOLs on postoperative distance, intermediate, and near visual performance, as well as dysphotopsia, spectacle independence, and contrast sensitivity, remain unclear. This meta-analysis aimed to evaluate and compare the postoperative visual function and other clinical outcomes between trifocal and EDOF IOLs. PubMed, Embase, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing trifocal and EDOF IOLs. Primary outcomes included uncorrected and corrected distance, intermediate, and near visual acuity (VA); postoperative sphere, cylinder, and spherical equivalence; photic phenomena; spectacle independence; and contrast sensitivity. Statistical analyses were performed using RevMan software (version 5.3). Ten RCTs comprising 431 eyes implanted with trifocal IOLs and 443 eyes implanted with EDOF IOLs were analyzed. Statistical analysis revealed that EDOF IOLs provided better postoperative spherical outcomes and corrected distance visual acuity (CDVA) compared with trifocal IOLs ( P < 0.05). Meanwhile, no significant differences were observed in postoperative cylinder, spherical equivalent, uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and distance-corrected intermediate visual acuity (DCIVA) ( P > 0.05). However, trifocal IOLs provided significantly better uncorrected near visual acuity (UNVA) and distance-corrected near visual acuity (DCNVA) than EDOF IOLs ( P < 0.05). Trifocal IOLs offered superior near vision and greater spectacle independence but were not associated with fewer photic phenomena. Trifocal and EDOF IOLs provide comparable postoperative distance and intermediate VA. Trifocal IOLs offer superior near vision and greater spectacle independence, whereas EDOF IOLs may be associated with fewer photic phenomena. These differences support individualized IOL selection based on patients’ visual needs and daily activities.