Refractive Outcomes of a Low-Addition Refractive, Rotationally Asymmetric Bifocal IOL and Its Toric Version: A Comparative Cohort Study of 316 Eyes

Purpose: To analyze and compare functional and refractive postoperative outcomes of a low-addition refractive bifocal intraocular lenses (IOL) and its toric version at 1 month. Settings: Desgenettes Military Hospital, Lyon. Design: Single-center retrospective study. Methods: This study included 316 eyes of patients who underwent bilateral phacoemulsification with implantation of either the standard IOL, the Comfort LS-313 MF15 (n=245, group 1) or its toric version, the Comfort LS-313 MF15T (n=71, group 2). Patients were evaluated at 7 days and 1 month postoperatively to measure uncorrected and corrected distance (UDVA and CDVA), uncorrected intermediate (UIVA), and near (UNVA) visual acuity at 4 meters, 60 cm and 40 cm. Spectacle independence and photic phenomena were assessed using a modified McAlinden questionnaire. Results: At one month, both groups had similar mean UDVA (0.004 vs 0.02 logMAR; p=0.063). UIVA (0.12 vs 0.17 logMAR; p=0.783) and UNVA (0.34 vs 0.3 logMAR; p=0.292) were also comparable. CDVA was excellent (-0.009 vs -0.02 logMAR; p=0.348). The toric IOL significantly reduced residual astigmatism (p<0.01), with a mean of 0.23±0.34 D. Photic phenomena were minimal (score: 2.17), with no severe effects. Twenty-five patients responded to the questionnaire, 56% of them reported total or high spectacle independence. Conclusion: The low-addition refractive bifocal IOL and its toric version provide effective refractive correction, ensuring excellent UDVA and satisfactory UIVA. The toric model yields comparable outcomes to the non-toric version, with the added benefit of improved control of preoperative astigmatism. The refractive performance of the toric model remained consistent regardless of the axis of implantation and the position of the low addition segment. These findings demonstrate satisfactory functional outcomes, though validation in larger prospective studies with objective optical quality assessments is needed.