Effectiveness Of Presbyopia‑Correcting Intraocular Lenses Across A Broad Range Of Corneal Spherical Aberration

A broad range of positive corneal spherical aberration (SA) has been reported. This variability is further increased after corneal laser refractive surgery, which, depending on the refractive error treated, may increase positive SA or shift it toward negative values. In contrast, each intraocular lens (IOL) design provides a single SA profile, which can result in under‑ or overcorrection of SA at the individual level. The impact of residual SA on IOL performance is particularly critical for presbyopia‑correcting IOLs with complex optics, whose benefits may be reduced by their interaction with corneal aberrations. Quantifying this interaction across a broad range of corneal SA was the purpose of the current study.

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

We evaluated three extended‑depth‑of‑focus (EDoF) IOLs: two refractive and one diffractive; three trifocal IOLs; enhanced monofocal and standard monofocal IOLs. All lenses were measured with the NIMO TEMPO (Lambda‑X Ophthalmics), which includes software to construct individualized model eyes and simulate the interaction of IOL optics with customized levels of SA. In this study, corneal SA ranged from -0.42 µm to +0.43 µm in 0.05 µm steps, resulting in 18 distinct SA conditions. For each model eye with a single SA value, the corresponding IOL was introduced and optical quality was assessed. The area under the modulation transfer function was used to quantify the impact of SA, due to its high correlation with clinical visual acuity.

For all IOLs, negative residual SA caused a hyperopic shift and positive SA a myopic shift at both 3‑ and 4.5‑mm pupils. At 3 mm, the impact of SA on optical quality was smaller, but negative SA remained more detrimental than positive SA. Refractive EDoF IOLs tolerated a broader SA range, whereas diffractive EDoF and trifocal IOLs were more sensitive, with negative SA and larger pupils reducing performance and, in some cases, compromising the multifocal effect. Monofocal and enhanced monofocal IOLs maintained good 3‑mm performance, with marked degradation at extreme negative SA and at 4.5‑mm pupils, occurring earlier for the enhanced monofocal.

For each level of corneal SA, a suitable IOL design should be selected to maximize postoperative outcomes, as patients with larger positive or negative SA may gain limited benefit from presbyopia correction or may experience reduced distance vision. Trifocal IOLs perform best within the normal SA range, whereas refractive EDoF IOLs better tolerate deviations and can be considered individually. In extreme SA, enhanced or standard monofocal IOLs provide more acceptable optical quality. Preoperative pupil assessment may further help predict the impact of residual SA and guide optimal IOL selection.