Extended Depth of Focus Versus Monofocal Intraocular Lenses in Cataract Surgery: A Prospective Randomized Clinical Study of Visual and Patient-Reported Outcomes

Cataract is the leading cause of reversible blindness worldwide, and intraocular lens (IOL) implantation is central to visual rehabilitation. Monofocal IOLs reliably restore distance vision but offer limited intermediate and near performance, resulting in continued dependence on spectacles. Extended depth of focus (EDOF) IOLs are designed to enhance functional vision across a broader range while preserving distance clarity. This prospective, randomized, assessor-masked clinical trial was conducted at Shree Bharatimaiya College of Optometry \& Physiotherapy, Surat, India, between August 2024 and May 2025. Seventy-five patients were screened, and 60 eyes from 60 patients aged 50--75 years with age-related cataract were randomized 1:1 to receive either a monofocal or an EDOF IOL. Surgeries were performed using standardized phacoemulsification techniques. Primary outcomes at one month included uncorrected and best-corrected distance visual acuity (UDVA, BCDVA), uncorrected intermediate (UIVA) and near visual acuity (UNVA), refractive accuracy (spherical equivalent, SE), contrast sensitivity (Pelli-Robson), and patient-reported satisfaction using the Cataract 9SF questionnaire. Both groups achieved excellent UDVA and BCDVA (p > 0.05), with similar refractive predictability (mean SE: $-0.21 \pm 0.36$ D vs $-0.18 \pm 0.39$ D; p = 0.64). EDOF IOLs provided significantly better UIVA ($0.18 \pm 0.09$ vs $0.32 \pm 0.11$ logMAR; p < 0.001) and UNVA ($0.24 \pm 0.10$ vs $0.38 \pm 0.12$ logMAR; p < 0.001). Contrast sensitivity was marginally higher with monofocals ($1.76 \pm 0.12$ vs $1.68 \pm 0.15$; p = 0.047). Patient-reported satisfaction and spectacle independence were significantly greater in the EDOF group (p < 0.05). In conclusion, EDOF IOLs extend functional vision and improve spectacle independence compared with monofocals, with only a modest reduction in contrast sensitivity. These findings support EDOF IOLs as a patient-centered alternative in cataract surgery, with lens choice guided by lifestyle demands and expectations.