Analysis of Visual Quality after Implantation of Diffractive Multifocal Intraocular Lens Diff - aA in Cataract Patients

Objective To explore the visual quality analysis of cataract patients after implantation of the aspheric diffractive multifocal intraocular lens (IOL) Diff - aA IOL. Methods Prospective cohort study. Cataract patients who visited the Third Department of Ophthalmology of the First Affiliated Hospital of Zhengzhou University from September 2024 to September 2025 were selected as the study cohort, and a total of 93 cases (93 eyes) were included. According to the models of intraocular lenses (IOLs) implanted in the patients, they were divided into two groups: the observation group consisted of 53 cases (53 eyes) of patients who received the Diff-aA IOL (HumanOptics, Germany); the control group included 40 cases (40 eyes) of patients who received the Tecnis ZMB00 IOL (Advanced Medical Optics, USA). At 1 month and 3 months after surgery, the uncorrected far, intermediate, and near visual acuities of both eyes of the patients in the two groups were measured respectively, and the defocus curves were plotted. For objective visual quality, the Itrace was used to measure the modulation transfer function (MTF) curve, Strehl ratio (SR), and point spread function (PSF), and for subjective visual quality, the VF − 14 - CN scale was used for evaluation. Results The uncorrected near vision of the observation group was slightly lower than that of the control group (P < 0.05), while the uncorrected intermediate vision of the observation group was better than that of the control group (P < 0.001). The fitted defocus curve at 1 month after surgery showed that at the defocus levels of 0.00D and − 3.50D, the visual acuity of the control group was better than that of the observation group (P = 0.003, P < 0.001); at the defocus levels of -1.50D to -2.50D, the visual acuity of the observation group was better than that of the control group (P < 0.001, P < 0.001, P = 0.004). The fitted defocus curve at 3 months after surgery indicated that at the defocus levels of -1.50D to -2.50D, the visual acuity of the observation group was better than that of the control group (P < 0.001, P < 0.001, P < 0.001). At 3 months after surgery, the AUDOC of the observation group was better than that of the control group, suggesting that the overall visual performance of the observation group was better (P < 0.001); at 3 months after surgery, there were no significant differences in the THOA, MTF Avg Height, SR, and PSF indicators between the two groups (P > 0.05). There was no statistically significant difference in the average VF − 14 scores between the two groups (P = 0.667). In terms of the incidence of optical interference phenomena, halos were the most common, reported by 45.45% of patients in the Diff - aA group and 45.16% of patients in the ZMB00 group. Followed by glare (reported by 27.27% in the Diff - aA group and 35.48% in the ZMB00 group) and starburst (reported by 18.18% in the Diff - aA group and 22.58% in the ZMB00 group). The report rate of diplopia was relatively low, with only one patient in the ZMB00 group reporting it. Conclusion The aspheric diffractive multifocal intraocular lens Diff - aA IOL can provide excellent far and near visual acuities and satisfactory intermediate visual acuity, achieve a relatively continuous visual range after surgery, and at the same time obtain a satisfactory spectacle - independence rate and a low incidence of adverse visual phenomena.