Refractive outcomes and biometric prediction accuracy following Optiflex Trio trifocal intraocular lens implantation

To assess the refractive performance and predictive reliability of four commonly used intraocular lens (IOL) power calculation formulas in eyes receiving the Optiflex Trio lens. This retrospective analysis included 554 eyes of 348 individuals who underwent phacoemulsification followed by Optiflex Trio IOL implantation for either visually significant cataracts or refractive lens exchange. Preoperative and postoperative measurements including refraction, keratometry, and visual acuity, were reviewed. The prediction errors generated by the SRK/T, Hoffer Q, Barrett Universal II, and Haigis-L formulae were compared. Participants had a mean age of 61.46 ± 9.87 years. Cataract removal occurred in 481 eyes (86.8%), whereas 73 eyes (13.2%) underwent refractive lens exchange. The spherical equivalent (SE) changed from a preoperative value of + 0.21 ± 2.71 D to − 0.31 ± 0.56 D postoperatively (p < 0.001). After surgery, 44.2% of eyes were within ± 0.25 D of the target refraction, 70.2% within ± 0.50 D, and 92.1% within ± 1.00 D. All formulas showed a tendency to produce hyperopic predictions relative to actual postoperative outcomes (p < 0.001). Although the mean prediction errors did not differ significantly among formulas (p = 0.712), threshold-based analysis demonstrated meaningful differences at ± 0.25 D and ± 0.50 D (p = 0.024 and p < 0.001, respectively). Across all benchmarks, the Barrett Universal II formula yielded the highest proportion of eyes that met the specified accuracy level. In this large Optiflex Trio IOL cohort, more than 90% of the eyes achieved postoperative refractions within ± 1.00 D. Although the overall accuracy was comparable across formulas, Barrett Universal II provided superior precision at narrower tolerance limits, supporting its preferential use for IOL power calculation.