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

To predict the postoperative visual function of patients after implantation of monofocal and presbyopia-correcting intraocular lenses (IOLs) based on objective optical-quality metrics.

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

We assessed defocus curves of patients implanted with various IOL models. In total, three trifocal IOLs (FineVision Pod F, AcrySof IQ PanOptix, and Tecnis Synergy), one extended-depth-of-focus (Tecnis Symfony), and one enhanced-monofocal (Tecnis Eyhance) lens were included. In addition, the optical-quality metrics of these IOLs were determined using an optical-bench setup. Non-linear modeling was applied to establish the relationship between clinically-derived visual function parameters and laboratory-measured IOL’s tolerance to defocus.

The individual prediction accuracy (adjusted R-squared) ranged from 0.70 to 0.90, but for the pooled IOL data, it was 0.67. Hence, the former approach was used for further analysis. Based on the 0.20 logMAR criterion, the predicted vs. clinical depth-of-focus of the PanOptix IOLs were -3.25D and -3.50 D. A close correspondence was found between the predicted and in vivo depth of focus for the POD F (-3.75D) and the Synergy (3.50D). The Symfony demonstrated -2.25D for both approaches, with the Eyhance showing only a minimal EDoF extension confirmed in vitro and clinically (-1.0D).

Optical-quality metrics can be used to predict and assess the postoperative function of presbyopia-correcting IOLs. The clinical and simulated results indicate depth-of-focus differences between the studied models. Furthermore, our results support using a model-specific formula for estimating visual acuity with IOLs to ensure accurate patient outcomes.