OBJECTIVE To compare the visual performance after implantation of the Akreos Adapt Advanced Optics aspheric intraocular lens (IOL) and the Sensar AR40e spherical acrylic IOL. METHODS Eye Department, Southampton University Hospital, United Kingdom. METHODS Randomized masked single-center clinical trial. METHODS Patients with bilateral cataract who were older than 50 years with a biometry-predicted IOL power between 10.0 diopters (D) and 30.0 D were recruited. Outcome measures included corrected distance visual acuity (CDVA) using a high-contrast logMAR chart, contrast sensitivity measured with the Pelli-Robson chart, range of accommodation using the Royal Air Force (RAF) rule, pseudoaccommodation and mesopic and scotopic pupil diameters measured with a power refractor, and patient satisfaction evaluated using a previously validated questionnaire 3 months after second-eye surgery. RESULTS The difference in the mean value between the 2 IOLs (40 patients) was 0.015 (95% confidence interval [CI], 0.0009 to 0.070) for CDVA in favor of the spherical IOL, 0.02 (95% CI, -0.0534 to 0.0159) for contrast sensitivity, and 0.05 (95% CI, -1.90 to +2.90) for range of accommodation. Questionnaire results showed no difference in dysphotopsia or patient satisfaction between the 2 IOLs. CONCLUSIONS Although there were no statistically significant differences in contrast sensitivity, range of accommodation, dysphotopsia, or subjective patient satisfaction or preference between the 2 IOLs, the difference in CDVA was statistically significant, but not clinically important (relative difference 1.5%), in favor of the spherical IOL. BACKGROUND No author has a financial or proprietary interest in any material or method mentioned.