Refractive Profile, Optical Assessment And Expected Visual Quality Analysis Of Four Advanced Monofocal Intraocular Lenses

To evaluate the refractive profile and optical performance of four advanced monofocal intraocular lenses (IOLs) and predict the visual quality of an average pseudophakic patient.

Study conducted at Optical Department of the Universidade do Minho and the Ophthalmology Unit of Unidade Local de Saúde de Gaia e Espinho.

Four advanced monofocal IOLs (Hoya Impress, J&J Eyhance, PhysIOL IsoPure, and Rayner RayOne) with a nominal power of 20.0D were measured using the NIMO TR1504 interferometer (Lambda-X, Belgium) to assess wavefront deviation and generate power maps, and in-vivo profiles were estimated from the ex-vivo results by incorporating the average corneal spherical aberration values. They were further inserted in an on-bench model eye, and their performance was evaluated using through-focus modulation transfer function (MTF)–based metrics, through-focus point spread function (PSF), and halo analysis for three pupils (2.0, 3.0, and 4.5 mm); expected visual acuity was estimated from the through-focus area under the MTF curve.

Except for the RayOne, all IOLs exhibited a progressive central addition design, where power decreased from the center outward. The power gradients and central zones varied among lenses: Impress (1.65mm, 21.4D–20.0D), Eyhance (0.85mm, 22.5D–20.0D), IsoPure (0.87mm, 23.1D–20.0D). The RayOne displayed a monofocal-like power distribution with a positive spherical aberration profile. Image quality assessed with through-focus MTF showed similar results for intermediate range for all pupil conditions, with all lenses achieving normal expected visual acuity (0.0 logMar) at far distance. The PSF and halo analysis further depicts the differences in lens design/pupil dependence, which is key in understanding IOL performance in a real word setting.

The differences in power profiles and spherical aberration characteristics among these IOLs likely explain reported variations in clinical outcomes, particularly regarding pupil dependence. Understanding these optical properties, image quality and expected visual acuity can aid in preoperative IOL selection and improve postoperative refractive results.