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Purpose: To assess visual and refractive outcomes and patient satisfaction after bilateral sequential implantation of a primary capsular bag intraocular lens (IOL) and a supplementary sulcus-fixated trifocal IOL., Methods: All patients had bilateral implantation of a mono-focal IOL in the capsular bag followed by a supplementary trifocal IOL (Sulcoflex 703F, Rayner Intraocular Lenses Limited) in the sulcus. Patients were evaluated for monocular uncorrected and corrected distance visual acuity, binocular uncorrected and corrected distance, intermediate and near visual acuity, photopic and mesopic contrast sensitivity, defocus curves, visual symptoms, spectacle independence, and patient satisfaction at 1 and 6 months postoperatively., Results: Forty eyes of 20 patients were evaluated. Six months after surgery, mean binocular uncorrected visual acuity was -0.07 ± 0.06 logMAR for distance vision (range: -0.2 to 0.0 logMAR), -0.03 ± 0.17 logMAR for intermediate vision (range: -0.1 to 0.6 logMAR), and 0.09 ± 0.08 logMAR for near vision (range: -0.1 to 0.2 logMAR). All patients reported full spectacle independence after 6 months and no adverse events were reported for any of the patients., Conclusions: Sequential implantation of a monofocal IOL in the capsular bag and a supplementary trifocal IOL in the sulcus provides a safe and effective choice for patients who desire spectacle independence after cataract surgery. [J Refract Surg. 2021;37(2):105-111.]., (Copyright 2021, SLACK Incorporated.)

Purpose: The visual performance of monofocal, bifocal, and trifocal intraocular lenses was evaluated by human individuals using a vision simulator device. This allowed investigation of the visual impression after cataract surgery, without the need actually to implant the lenses., Methods: The randomized, double-masked, three-way cross-over study was conducted on 60 healthy male and female subjects aged between 18 and 35 years. Visual acuity (Early Treatment Diabetic Retinopathy Study; ETDRS) and contrast sensitivity tests (Pelli-Robson) under different lighting conditions (luminosities from 0.14-55 cd/m 2 , mesopic to photopic) were performed at different distances., Results: Visual acuity tests showed no difference for corrected distance visual acuity data of bi- and trifocal lens prototypes ( P = 0.851), but better results for the trifocal than for the bifocal lenses at distance corrected intermediate ( P = 0.021) and distance corrected near visual acuity ( P = 0.044). Contrast sensitivity showed no differences between bifocal and trifocal lenses at the distant ( P = 0.984) and at the near position ( P = 0.925), but better results for the trifocal lens at the intermediate position ( P = 0.043). Visual acuity and contrast sensitivity showed a strong dependence on luminosity ( P < 0.001)., Conclusions: At all investigated distances and all lighting conditions, the trifocal lens prototype often performed better, but never worse than the bifocal lens prototype., Translational Relevance: The vision simulator can fill the gap between preclinical lens development and implantation studies by providing information of the perceived vision quality after cataract surgery without implantation. This can reduce implantation risks and promotes the development of new lens concepts due to the cost effective test procedure.