Abstract:  Objective  To compare the visual quality after implantation of extended depth-of-focus (EDOF) and rotational asymmetric refractive intraocular lenses(IOL). Design  Retrospective cohort study. Participants  A total of 78 patients (110 eyes) who underwent phacoemulsification combined with IOL implantation at Beijing Tongren Hospital between July 2023 and October 2024. Methods  Based on the type of IOL implanted, patients were divided into the EDOF group (TECNIS Symfony ZXR00 IOL) included 46 patients (62 eyes), and rotational asymmetric refractive group (SBL-3 IOL) comprised 32 patients (48 eyes). At 3 months postoperatively, uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuity, defocus curves, and visual function satisfaction questionnaire (NEI VFQ-25) results were compared. Objective visual quality was assessed using the OPD-Scan III aberrometer. Main Outcome Measures  Postoperative distance, intermediate, and near visual acuity; defocus curves; visual satisfaction scores; total and higher-order aberrations (HOAs); Strehl ratio (SR); and modulation transfer function (MTF). Results  At 3 months postoperatively, no significant differences were observed in UDVA or UNVA between the two groups. The EDOF group demonstrated significantly better in UIVA than the rotational asymmetric refractive group (P<0.001). Defocus curves revealed a flat profile from 0.0 to -2.5 D in the EDOF group, whereas the rotational asymmetric refractive group exhibited a bifocal pattern with peaks at 0.0 D and -2.5 D. No significant differences were found in NEI VFQ-25 total or subscale scores. At 3 mm pupil diameter, the EDOF group showed lower spherical aberration than the rotational asymmetric refractive group (P=0.017). At 5 mm and 6 mm pupil diameters, spherical aberration was higher in the EDOF group (P=0.020, 0.030). Coma aberration was lower in the EDOF group at 3~5 mm pupil diameters (all P<0.001). Trefoil and total ocular aberrations were significantly lower in the EDOF group across all pupil diameters (all P<0.001). The EDOF group also exhibited higher SR and MTF values compared to the rotational asymmetric refractive group (all P<0.001). Conclusion  Both EDOF and rotational asymmetric refractive IOL provide effective full-range vision and satisfactory visual quality. The EDOF IOL offers superior intermediate vision, though its spherical aberration is more influenced by pupil size.

Key words:  Extended depth-of-focus IOL, Rotational asymmetric refractive IOL, Visual quality