Effect Of Tilt And Decentration On Optical Performance Of Advanced Monofocal Intraocular Lenses

Scleral fixation techniques for premium intraocular lenses (IOLs) including advanced monofocals may induce tilt and decentration, potentially degrading optical quality. This study evaluated the optical performance of advanced monofocal IOLs and simulated the impact of clinically relevant misalignment.

Laboratory optical bench study.

Four +20.0 D advanced monofocal IOLs were tested: Eyhance (Johnson & Johnson Vision), Isopure/Serenity (BVI Medical), Precizon Go (Ophtec), and Impress (HOYA). Optical quality was measured using NIMO TEMPO and PMTF systems (Lambda-X, Belgium) with Mach–Zehnder interferometry in an ISO-2 model eye incorporating +0.28 µm corneal spherical aberration (6-mm pupil). Tilt of 1°, 2°, 3°, and 4° and decentration of 0.25, 0.5, 0.75, and 1.0 mm were induced. Through-focus modulation transfer function (MTF) at 50 lp/mm (3-mm pupil) was analyzed.

All IOLs showed progressive reduction in peak distance MTF with increasing tilt and decentration; however, the magnitude of degradation differed by design. Distance MTF decreased more prominently beyond 2° tilt and 0.5 mm decentration in some lenses, whereas others maintained relatively stable peak performance up to moderate misalignment. Eyhance demonstrated relative pupil-independent distance performance. Precizon Go and Impress showed greater resistance to MTF reduction under both tilt and decentration. Changes in intermediate MTF profiles were design-dependent, reflecting differences in spherical aberration distribution.

Advanced monofocal IOLs show different optical responses to tilt and decentration. Although optical bench findings may not directly translate to clinical outcomes, the results suggest that IOL design influences tolerance to misalignment, which may be relevant in scleral fixation settings.