• Cataract/Anterior Segment, Refractive Mgmt/Intervention

    Review of: Unilateral Versus Bilateral Refractive Lens Exchange With a Trifocal Intraocular Lens in Emmetropic Presbyopic Patients

    Fernández-García J, Llovet-Rausell A, Ortega-Usobiaga J, et al. American Journal of Ophthalmology, March 2021

    Investigators compared visual outcomes and patient satisfaction between unilateral and bilateral trifocal diffractive IOL implantation in emmetropic patients with presbyopia.

    Study design

    In this retrospective, multicenter, observational case series, 122 emmetropic presbyopes (171 eyes) underwent refractive lens exchange followed by FineVision trifocal IOL implantation in either the nondominant eye or both eyes. Outcomes included UDVA, CDVA, UIVA and UNVA.


    Both UDVA and CDVA were similar in the monocular and binocular groups, whereas UIVA and UNVA were better in patients who had the trifocal IOL in both eyes. The binocular group experienced worse visual dysphotopsias but had higher spectacle independence for all distances.


    The study was limited by its retrospective design and only assessed one IOL that is not available in the United States.

    Clinical significance

    Several studies have looked at outcomes of trifocal lenses in patients with cataracts, but this study evaluates refractive lens exchange in emmetropic patients, which the authors admit is controversial. These patients will have the highest expectations and the findings show that the rate of visual dysphotopsias in the binocular group was higher than in other refractive lens exchange studies.