Assessment Of Pupil Size Independence For Visual Acuity Outcomes Following Implantation Of A Gaussian Diffractive Trifocal Intraocular Lens

To determine whether visual acuity (VA) outcomes after cataract surgery with implantation of the Vivinex Gemetric intraocular lens (IOL) demonstrate independence from physiologic pupil size variation. This study evaluated the relationship between pupil diameter and uncorrected and corrected VA at distance, intermediate, and near under photopic conditions.

Retrospective study conducted at the Clinique Jules Verne of patients who underwent standard phacoemulsification with implantation of the Vivinex Gemetric IOL as part of routine clinical care between October 10, 2022 and October 31, 2025.

Patients implanted with Gemetric (G) or Gemetric Plus (GP) were assessed at 3-6 months postoperatively. Uncorrected distance (UDVA), intermediate (UIVA) and near VA (UNVA), and corrected distance VA (CDVA), distance-corrected intermediate VA (DCIVA), and distance-corrected near VA (DCNVA) were assessed using standardized logMAR protocols. Pupil size was measured under photopic lighting using the CSO Sirius. Scatter plots with linear regression using the Bland and Altman Method were generated for each VA measure. Pearson correlation coefficients (r) and corresponding p-values were calculated to evaluate presence or absence of statistically significant correlations between pupil size and VA. This is a continuation of a previous analysis.

A total of 152 eyes from 76 consecutive patients were included: G = 103, GP = 49. Pupil size ranged from 2.23 to 5.21 mm. Regression analyses showed no significant correlation between pupil size and UDVA (G: r = -0.07, p = 0.466, GP: r = 0.07, p = 0.646), UIVA (G: r = 0.16, p = 0.130, GP: r = -0.15, p = 0.326), UNVA (G: r = -0.09, p = 0.370, GP: r = 0.21, p = 0.149), CDVA (G: r = 0.09, p = 0.389, GP: r = 0.01, p = 0.924), DCIVA (G: r = 0.10, p = 0.382, GP: r = 0.01, p = 0.973), or DCNVA (G: r = -0.07, p = 0.494, GP: r = 0.29, p = 0.052). Slopes for all regression lines were near zero, indicating stable VA across the full physiologic pupil range tested.

Visual acuity outcomes in all distances following implantation of the Vivinex Gemetric and Gemetric Plus Trifocal IOLs demonstrated no clinically or statistically significant association with pupil diameter under photopic conditions. These findings continue to demonstrate that the optical performance of these trifocal IOLs remains consistent across physiologic pupil variations encountered in real world clinical settings.