When trifocal IOLs disappoint: diagnostic and management pathway.
Trifocal presbyopia-correcting intraocular lenses (IOLs) are widely used in cataract surgery and refractive lens exchange to expand functional vision across distance, intermediate, and near ranges and to reduce spectacle dependence. Despite generally favorable visual outcomes, some patients experien...
| Publicado en: | Therapeutic Advances in Ophthalmology Vol. 18; pp. 1 - 14 |
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| Autores principales: | , , , , |
| Formato: | review tables/charts Journal Article |
| Publicado: |
Sage Publications Inc.
8/25/2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=196473501&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 196473501 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 25158414 LAW0 jtl: Therapeutic Advances in Ophthalmology issn: 25158414 maglogo: Y pubinfo: dt: 8/25/2026 vid: 18 pid: 344 pub: Sage Publications Inc. place: Thousand Oaks, California artinfo: ui: 196473501 196473501 196473501 10.1177/25158414261471349 196473501 ppf: 1 ppct: 13 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: When trifocal IOLs disappoint: diagnostic and management pathway. aug: au: Khorrami-Nejad, Masoud Mohammed Noori, Ahmed Jadidi, Khosrow Narooie-Noori, Foroozan Khodaparast, Mehdi affil: Conceptualization, Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran sug: subj: Lenses, Intraocular Adverse Effects Contact Lenses, Trifocal Patient Satisfaction Refractive Errors Dry Eye Syndromes Cataract Extraction Prosthesis Failure Device Removal Vision Disorders ab: Trifocal presbyopia-correcting intraocular lenses (IOLs) are widely used in cataract surgery and refractive lens exchange to expand functional vision across distance, intermediate, and near ranges and to reduce spectacle dependence. Despite generally favorable visual outcomes, some patients experience postoperative dissatisfaction related to dysphotopsia, reduced visual quality, or unmet functional expectations. Evidence suggests that, at 1 year, trifocal IOLs show no clear differences versus bifocal IOLs in uncorrected distance or near visual acuity, while uncorrected intermediate acuity may be improved, although certainty is low and reporting of adverse visual phenomena and quality-of-life outcomes is limited. Comparative studies with bifocal and extended depth-of-focus lenses suggest that trifocal IOLs may provide stronger near performance and greater spectacle independence, although photic phenomena such as halos may occur more frequently in some patients. Contemporary evidence indicates that dissatisfaction is multifactorial and may involve residual refractive error, dysphotopsia, ocular surface disease, neuroadaptation failure, and IOL–capsule complex abnormalities such as tilt, decentration, capsular contraction, or posterior capsule opacification. This narrative review synthesizes current evidence on the epidemiology and contributors to trifocal IOL dissatisfaction and proposes a pragmatic diagnostic and management framework. The approach emphasizes symptom characterization, rigorous refraction and binocular testing, early ocular surface optimization, targeted evaluation of the IOL–capsule complex, and stepwise intervention sequencing, including deferring Nd:YAG capsulotomy until IOL exchange is unlikely. Standardized outcome sets and prospective trials of staged care pathways are needed to improve comparability and guide individualized treatment decisions. Plain language summary: Why some patients are unhappy after trifocal lens surgery and how doctors can help Trifocal intraocular lenses are special artificial lenses placed in the eye during cataract or vision-correction surgery. They are designed to help people see clearly at far, middle, and near distances and reduce the need for glasses. Many patients are satisfied with these lenses, but some still experience problems after surgery. Some people report blurred vision at certain distances, especially for computer work. Others notice unwanted light effects, such as halos or glare around lights at night. Dry eye, small leftover focusing errors, lens movement, or slow adjustment of the brain to the new vision can also affect satisfaction. In some cases, clouding behind the lens or changes in the eye's natural support structures may contribute to poor visual quality. Research shows that trifocal lenses often provide good near vision but may cause more visual disturbances than some other lens types. Studies also suggest that doctors do not always measure patient comfort and daily visual performance in the same way, making it harder to compare results. This review explains the common reasons why trifocal lenses may not meet a patient's expectations and offers a practical step-by-step approach for eye doctors. It encourages careful listening to patient concerns, accurate vision testing, treatment of dry eye, and detailed examination of the implanted lens. Treatments should be chosen gradually and thoughtfully, and major procedures should be delayed until simpler causes are ruled out. Better research and standardized testing methods are needed to improve care and help patients achieve the best possible visual outcomes. pubtype: Academic Journal doctype: review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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