Predicting Visual Function From Optical Measurement For Customized Intraocular-Lens Selection

To apply in-vitro quality metrics to assess intraocular lenses (IOL) and correlate their image-quality metrics with function effects observed clinically.

David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Germany.

The optical performance of three trifocal intraocular lenses, i.e., AT Lisa Tri (Carl Zeiss Meditec), PanOptix (Alcon Inc), and Tecnis Synergy (Johnson & Johnson), were compared. The modulation transfer function (MTF) metrics were obtained using an optical bench setup. A polychromatic light source and a model corneal with the average amount of spherical aberration were used to mimic in vivo characteristics. The area under the MTF was calculated at each defocus position, which served as a parameter in a non-linear formula applied to predict postoperative visual acuity (VA). The optically-derived VA prediction was then compared to clinically-reported values in the literature to link laboratory evaluation and reported patients’ outcomes.

From -4.0 D to 0 D, the simulated defocus curves of the PanOptix and the AT Lisa Tri were generally consistent with the ones reported in clinical studies. A slight variability between clinical values from various studies was detected at -2.0 D for the PanOptix and -1.5 D for the AT Lisa Tri. By contrast, the difference in the Synergy between VA obtained from different studies was considerable. The in vitro assessment demonstrated the best prediction accuracy at higher defocus, which fell substantially at -1 D.

The VA-prediction model can be assessed through a comprehensive parametrization of trifocal IOLs, which may improve decision-making by matching patients’ needs with the expected postoperative outcome. A customized model for the Synergy lens is required for improved VA prediction.