Advanced vs. Standard Monofocal IOLs: Optical Quality and Patient-Perceived Visual Outcomes

<b>Background/Objectives:</b> The objective of this study is to compare the optical and visual quality provided by the advanced monofocal intraocular lens (IOL) ISOPure and the standard monofocal IOL MicroPure in cataract patients, using objective and subjective assessments. <b>Methods:</b> This prospective, single-blind clinical study includes 28 patients with cataracts, bilaterally implanted with either the ISOPure or MicroPure IOL. Eligible eyes had no ocular comorbidities and regular corneal astigmatism ≤ 1.00 D. Three months postoperatively, uncorrected distance and intermediate (UDVA, UIVA) and corrected distance and intermediate (CDVA, DCIVA) visual acuities were measured at 4 m, 80 cm, and 66 cm under photopic (85 cd/m²) and mesopic (3.5 cd/m²) conditions. Photic phenomena, including halo and glare, were evaluated. Objective optical quality was assessed using Objective Scattering Index (OSI), Modulation Transfer Function (MTF), Strehl Ratio (SR), and ocular aberrations. Subjective patient satisfaction was evaluated using Quality of Vision (QoV) and Catquest-9SF questionnaires. <b>Results:</b> Under photopic conditions, logMAR DCIVA at 80 cm, UIVA at 66 cm, and DCIVA at 66 cm were 0.18 ± 0.06, 0.25 ± 0.12, and 0.20 ± 0.13, respectively, for ISOPure, and 0.22 ± 0.06, 0.30 ± 0.09, and 0.25 ± 0.09 for MicroPure (<i>p</i> = 0.05, 0.02, and 0.05, respectively). No significant differences were observed in halo/glare size or intensity, OSI, MTF, or SR. However, statistically significant differences were found in higher-order total aberrations for pupil sizes of 3.0, 4.0 mm, and 5.0 mm. Questionnaires indicated greater satisfaction and functional intermediate vision with ISOPure. <b>Conclusions:</b> The ISOPure IOL offers superior intermediate vision without compromising distance vision, delivering a balanced combination of optical quality, functional performance, and patient satisfaction.