Impact Of Pupil Size And Corneal Aberrations In Three Refractive Extended-Depth-Of-Focus Intraocular Lens Technologies

To evaluate three extended-depth-of-focus intraocular lenses (EDOF IOLs) under various optical conditions using a comprehensive in vitro model.

Rothschild Foundation Hospital, Paris, France.

In vitro wavefront data were acquired with a Mach-Zehnder sensor (NIMO TEMPO, Lambda-X, Belgium) to assess three EDOF IOLs: Tecnis Puresee (Johnson & Johnson), AcrySof IQ Vivity (Alcon, wavefront-shaping), and LuxSmart (Bausch & Lomb, asphericity modulation with 4th and 6th order spherical aberrations). Through-focus Modulation Transfer Function (MTF) curves (average MTF from 0 to 50 lp/mm) were generated using synthetic ISO-2 eye models across eight apertures (2–5.5 mm, 0.5 mm steps) and 21 corneal spherical aberration (SA) values (-0.49 to 0.91 μm at 5.15 mm, in 0.07 μm steps), totaling 168 eye model configurations. Various metrics were analyzed to evaluate contrast rendering and depth of focus.

IOL profile reconstruction from wavefront acquisition shows similarity among these lenses. Vivity and Puresee demonstrated comparable optical performance across pupil sizes and corneal SA. With smaller pupils, LuxSmart showed less defocus tolerance than Vivity and Puresee but increased optical power, potentially inducing a beneficial myopic shift via the near miosis reflex. For larger pupils, Puresee and Vivity maintained high contrast in normal corneas, while LuxSmart provided better contrast in corneas with negative SA, such as those post-hyperopic or presbyopic refractive surgery.

This study underscores the close relationship between EDOF IOL design and patient-specific eye anatomy, such as pupil size and corneal SA, with Vivity and Puresee exhibiting similar performance, while LuxSmart demonstrates distinct optical behavior.