IOL Comparison: Visual Outcomes with Different IOL Types (Monofocal, Multifocal, Accommodative): A Prospective Comparative Study

Background: Cataract surgery has evolved from sight-restoring to refractive surgery, with increasing demand for postoperative spectacle independence. Monofocal intraocular lenses (IOLs) provide excellent distance vision but typically require reading correction. Multifocal and accommodative IOLs aim to restore functional near and intermediate vision, but may be associated with dysphotopsia and altered contrast sensitivity. Aim: To compare postoperative visual outcomes and patient-reported visual quality among monofocal, multifocal, and accommodative IOLs after uncomplicated phacoemulsification. Methods: Prospective comparative study of 100 patients undergoing phacoemulsification with in-the-bag implantation of monofocal (n=40), multifocal (n=40), or accommodative (n=20) IOLs. Outcomes at 3 months included uncorrected distance (UDVA), intermediate (UIVA), near (UNVA) visual acuity (logMAR), contrast sensitivity (Pelli–Robson), refractive accuracy, spectacle independence, dysphotopsia (halos), satisfaction score, and complications. Results: Baseline profiles were comparable across groups. At 3 months, UDVA was similar (p=0.265). UIVA differed significantly (monofocal 0.28±0.09 vs multifocal 0.17±0.09 vs accommodative 0.21±0.09 logMAR; p=0.000005). UNVA showed the largest difference (monofocal 0.44±0.14 vs multifocal 0.16±0.11 vs accommodative 0.18±0.10 logMAR; p<0.001). Contrast sensitivity was lower in multifocal IOLs (1.59±0.13) compared with monofocal (1.74±0.08) and accommodative (1.69±0.09) (p<0.001). Spectacle-free near vision was highest with multifocal IOLs (77.5%) and accommodative IOLs (50%) vs monofocal (12.5%) (p<0.001). Moderate–severe halos were more frequent with multifocal IOLs (17.5%) (p<0.001). Conclusion: All IOLs achieved excellent distance outcomes. Multifocal IOLs provided the greatest near/intermediate spectacle independence but at the cost of more halos and reduced contrast sensitivity. Accommodative IOLs offered an intermediate balance between functional near vision and photic phenomena.