Distance Visual Outcomes of Trifocal Intraocular Lenses in Highly Myopic Eyes Without Myopic Maculopathy

Why clinicians should know about it

• Picked for Ophthalmology (paper of the day, 4 October 2026): Trifocal IOLs provide satisfactory distance vision in high myopia

Abstract

PURPOSE: To analyze the refractive and visual distance outcomes of trifocal intraocular lens (IOL) implantation in highly myopic patients and to investigate potential preoperative factors predictors of postoperative vision. METHODS: This retrospective study included eyes with axial length (AL) between 26 mm and 31mm without signs of pathological myopia and a preoperative corrected distance visual acuity (CDVA) equal or better than 0.1 logMAR who underwent diffractive trifocal IOL implantation (AT LISA tri or FineVision). Visual and refractive measurements, as well as biometric values (AL, anterior chamber depth, keratometry, white-to-white) were recorded both preoperatively and postoperatively. Comparisons were performed between eyes achieving predefined CDVA (0.0 logMAR or better) and uncorrected distance visual acuity (UDVA) (0.2 logMAR or better) thresholds and those that did not. Multivariable logistic regression analysis was performed to identify preoperative factors associated with these thresholds. RESULTS: The study included 361 eyes with a mean preoperative CDVA of 0.03±0.04 logMAR, which significantly improved to 0.01±0.03 logMAR postoperatively (p<0.001). The mean postoperative spherical equivalent was -0.26 ± 0.40 D, with 80.1% of the eyes within ± 0.50 D range. Overall, 19.9% and 18.9% of eyes did not achieve 0.0 logMAR CDVA and 0.2 logMAR UDVA, respectively, and 8% required postoperative corneal refractive enhancement. Besides subtle differences, no determinant preoperative biometric parameters were significantly associated with postoperative distance vision outcomes. CONCLUSIONS: Trifocal IOLs performed satisfactorily in terms of distance vision in highly myopic eyes without signs of pathological myopia; however nearly one-fifth of eyes did not achieve the expected visual acuity, highlighting the importance of careful patient selection and appropriate preoperative counselling.

Abstract as published, via PubMed.