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

Arnaud Lognon,1 Benjamin Matagrin,1 Emilie Agard,2 Hussam El Chehab,2 Sarah Verrecchia,1,3 Antoine Levron,2 Roman Chudzinski,1 Jeremy Billant,1,2 Axel Goissaud-Mignard,1 Ines Fenniri,1 Corinne Dot1,2 1Department of Ophthalmology, Edouard Herriot Hospital, Lyon, France; 2Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France; 3Department of Ophthalmology, Pierre Wertheimer Hospital, Lyon, FranceCorrespondence: Corinne Dot, Department of Ophthalmology, Edouard Herriot Hospital, 5 Pl. d’Arsonval, Lyon, 69003, France, Tel +33 825 08 25 69, Email corinnedot.pro@hotmail.frPurpose: 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.Plain Language Summary: This study compared two versions of a low-addition refractive bifocal intraocular lens: the standard IOL and its astigmatism-correcting toric version—to see how well they perform in real-world use. While it was already known that low-add bifocal lenses help with intermediate tasks like computer work, and that toric lenses are needed to correct astigmatic eyes for the best outcomes, this research provides the first direct head-to-head comparison under standardized conditions. The findings show that the toric lens effectively and stably corrects astigmatism and improves vision at multiple distances regardless of the IOL orientation in the eye, without reducing overall vision quality. Both lens types delivered strong results within one month after surgery: clear distance vision for activities like driving, good intermediate vision for screens and countertops, and satisfactory near vision when using both eyes together—all with minimal visual disturbances. For patients with astigmatism, this means the toric version offers the same visual benefits as the standard lens while also correcting corneal astigmatism providing reliable all-distance vision without compromise.Keywords: intraocular lenses, toric intraocular lenses, astigmatism, refraction, ocular, visual acuity, refractive rotationally asymmetric, low-addition refractive bifocal