Range Of Vision And Pupil-Size Effects Of Phakic Intraocular Lenses For Presbyopia Treatment

While phakic intraocular lenses (IOLs) have been extensively studied for refractive-error treatment, investigations evaluating and comparing phakic IOLs mitigating the effects of presbyopia are limited. This study aimed to assess two types of phakic IOLs –a diffractive IPCL (Care Group) with +2.5D added power and a novel refractive Artiplus (Ophtec).

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

A custom-made insert contained a simulated natural lens (23D Precision Monofocal, Ophtec) posteriorly and a -3D phakic IOL anteriorly. The optical quality of two samples of each phakic IOL was measured using an optical-metrology setup under spherical- and chromatic-aberration conditions. Objective optical quality metrics were measured, from which simulated visual acuity (simVA) was derived and compared at 3.0- and 4.5mm apertures at near (40 cm), intermediate (67 cm), and far distances. 

The optical quality metrics at far and intermediate distances were close, with an expected marginal difference in simVA of 0.02 logMAR, while the VA gap between the two lenses increased slightly to 0.04 logMAR at 40 cm, where the Artiplus model demonstrated additional benefits. Both the IPCL and Artiplus yielded reduced optical quality as the aperture size increased. Although the far and intermediate optical functions were comparable between the two models, the near-focus performance of the diffractive IOL was weaker, with an overall narrower depth of focus compared to the refractive model. 

The Artiplus and the IPCL (+2.5D add) demonstrated good optical quality across the studied focus range, with the former providing a flatter simulated defocus curve. While expected differences in VA between the two approaches were minimal, they may become more pronounced in patients with larger pupils, warranting further investigation in a clinical setting.