Background/Objectives: Enhanced monofocal and non-diffractive extended depth-of-focus (EDoF) intraocular lenses (IOLs) aim to improve intermediate vision while maintaining contrast sensitivity. However, direct comparative evidence under both photopic and mesopic conditions remains limited. This study prospectively compared the visual performance of two enhanced monofocal IOLs (Tecnis^® Eyhance^™ and ISOPure^®) and one non-diffractive EDoF IOL (AcrySof^® IQ Vivity^™). Methods: Sixty patients undergoing bilateral cataract surgery were implanted with one of three IOL groups (n = 20 each). Patients were assigned to one of three IOL groups based on preoperative consultation and clinical indications. One month postoperatively, monocular corrected distance (CDVA), distance-corrected intermediate (DCIVA), and near visual acuity (DCNVA) were measured under photopic and mesopic conditions. Photopic defocus curves, contrast sensitivity under photopic and mesopic conditions and correlation between pupil diameter and visual acuities were also assessed. Results: Baseline characteristics were comparable among groups. Under photopic conditions, Vivity^™ achieved significantly better UDVA, DCIVA and DCNVA than both Eyhance^™ and ISOPure^®. Under mesopic conditions, distance acuity did not differ significantly, but Vivity™ showed superior DCIVA and DCNVA. Defocus curves demonstrated a broader functional range of vision with Vivity™, while Eyhance^™ and ISOPure^® showed nearly overlapping profiles. Contrast sensitivity was similar among all IOLs under both lighting conditions, with no statistically significant differences. Conclusions: The non-diffractive EDoF AcrySof^® IQ Vivity^™ provided a wider and more functional depth-of-focus than the enhanced monofocal lenses evaluated, without compromising contrast sensitivity. Eyhance^™ and ISOPure^® offered comparable performance, with good distance vision and modest depth-of-focus extension. All three IOLs maintained CS levels comparable to those typically reported for standard monofocal IOLs under both photopic and mesopic illumination, indicating no clinically relevant contrast penalty.

To evaluate whether multifocal contact lenses (CLs) can serve as preoperative simulators of postoperative vision with enhanced monofocal and extended depth of focus (EDOF) intraocular lenses (IOLs), using the SimVis Gekko™ adaptive-optics visual simulator. Twenty-four presbyopic subjects (mean age 54.9 ± 5.0 years; range 46-63) underwent monocular simulation of two daily disposable multifocal CLs (1-Day Acuvue® Moist Multifocal, medium addition; and Biotrue® ONEday for Presbyopia, high addition) and two IOLs (Tecnis® Eyhance™, enhanced monofocal; and LuxSmart™, EDOF) using the SimVis Gekko™ under photopic conditions and a fixed 3 mm pupil aperture. Monocular defocus curves were obtained from -3.00 to +1.00 D in 0.50 D steps. Area under the curve (AUC), negative-defocus cutoff at the 0.2 logMAR threshold, and defocus slopes from linear mixed-effects models were compared across lens conditions for both raw and offset corrected datasets. Both CLs exhibited a systematic -0.50 D myopic offset relative to the IOL simulations, consistent with their center-near design. After applying a +0.50 D vergence correction, AUC values were comparable across all four designs (p = 0.18). At the 0.2 logMAR threshold, LuxSmart showed the widest functional range (cutoff -2.38 ± 0.66 D) and Biotrue the narrowest (-1.69 ± 0.53 D). Mixed-effects modeling indicated equivalent defocus slopes between 1-Day Acuvue Moist and Tecnis Eyhance after vergence alignment (p = 0.894), while LuxSmart showed greater defocus tolerance and Biotrue degraded significantly faster (p = 0.005). Once the intrinsic -0.50 D myopic offset is compensated, the 1-Day Acuvue Moist Multifocal closely replicates the through-focus visual performance of the Tecnis Eyhance IOL, supporting its use as a practical preoperative simulator for patients being considered for enhanced monofocal implantation. Multifocal CLs combined with adaptive optics simulation may assist surgeons in tailoring IOL selection and improve shared decision-making before cataract surgery.