Impact Of Preoperative Corneal Higher Order Aberrations On Intermediate Visual Acuity After Enhanced Monofocal Intraocular Lens Implantation

Enhanced monofocal intraocular lenses (IOLs) such as TECNIS Eyhance are designed to improve intermediate vision while preserving distance visual acuity without the use of diffractive optics. However, it remains unclear whether preexisting corneal higher order aberrations (HOAs) influence postoperative intermediate outcomes. This study investigated the association between preoperative corneal HOAs and intermediate visual acuity after Eyhance IOL implantation.

Chungnam National University Hospital, Daejeon, Republic of Korea

This retrospective study included patients who underwent uncomplicated cataract surgery with TECNIS Eyhance IOL implantation in Chungnam National University Hospital. Corneal wavefront aberrations were measured preoperatively using Pentacam HR/AXL (Scheimpflug imaging). Total corneal HOA root mean square (RMS, 3rd–6th order, 6-mm pupil) was recorded as the primary independent variable. UIVA at 66 cm (logMAR) measured at 1 month postoperatively as the primary outcome. Spearman correlations, univariable and multivariable regression analysis were performed. Receiver operating characteristic (ROC) analysis evaluated the predictive ability of HOA for poor UIVA.

28 eyes of 28 patients were included. Mean preoperative total corneal HOA was 2.18 ± 1.20 µm, and mean postoperative UIVA was 0.29 ± 0.11 logMAR. Higher preoperative HOA and larger pupil were significantly associated with worse postoperative UIVA (Spearman ρ = 0.36, p = 0.047 for HOA, ρ = 0.40, p = 0.036 for pupil diameter). In univariable regression, each 1-µm increase in HOA corresponded to a 0.046 logMAR decrease in UIVA (p = 0.007, R² = 0.25). In multivariable regression adjusting pupil diameter, axial length, keratometry, and refractive status, HOA remained independently associated with worse UIVA. (β = 0.03 logMAR/µm). Preoperative HOA demonstrated useful discrimination for predicting reduced UIVA (decimal < 0.5), with an AUC of 0.75.

Preexisting corneal higher order aberrations significantly affect intermediate visual outcome after Eyhance IOL implantation. Higher HOAs were associated with worse postoperative UIVA. Preoperative assessment of corneal high order aberrations may help patient selection and counseling and should be considered during surgical planning alongside IOL choice.