Beyond Visual Acuity: Dynamic Wavefront Assessment Of Visual Quality In Lens-Based, Biomechanical, And Pharmacologic Presbyopia Treatment

To compare treatment outcomes of intraocular lens (IOL) and non-IOL presbyopia interventions using Modulation Transfer Function (MTF) and Visual Strehl Optical Transfer Function (VSOTF) as measures of visual quality. 

Retrospective comparative analysis of pooled patient-level data derived from multiple previously conducted clinical studies evaluating intraocular lens implantation, Laser Scleral Microporation, and pharmacologic miotic therapy. Data were collected from refractive and cataract surgery centers with dynamic wavefront aberrometry performed under standardized protocols.

Dynamic Shack–Hartmann wavefront aberrometry was quantified for four visual quality components contributing to Dynamic Range of Focus (DRoF): objective accommodation (AoA), extended depth of focus (EDoF), pseudoaccommodation (DoF), and diaphragmatic pupil (pinhole) response. Both the Modulation Transfer Function (MTF) and the VSOTF were calculated from the wavefront data. DRoF, MTF, and VSOTF results were compared with those from monofocal, bifocal, trifocal, and EDoF IOLs. 

Dynamic wavefront aberrometry differentiated presbyopia treatments across DRoF. Monofocal IOLs showed high peak contrast with limited depth of focus (DoF ≈1.3–1.6D) and no stimulus-dependent shift. Multifocal/trifocal IOLs increased DoF (up to ≈2.4D) with reduced peak MTF and VSOTF, reflecting contrast trade-offs, while EDOF lenses produced broadened static profiles. LSM demonstrated stimulus-dependent peak shift consistent with true optical power change, expanding DRoF from −2D to +2D while preserving peak VSOTF amplitude. Miotic simulation increased DoF proportionally to pupil reduction (2mm ≈1.2D vs 4.9mm ≈0.5D), with flattening of the VSOTF curve indicating reduced image quality. NAVQ scores correlated with objective DRoF findings.

Dynamic wavefront aberrometry enables objective differentiation between static optical extension and true dynamic restoration of visual function. Lens-based and expand-depth-of-focus interventions achieve depth-of-focus expansion through optical compromise, whereas biomechanical scleral-based pharmacological interventions demonstrate stimulus-driven optical power changes consistent with the natural elements of physiologic accommodation. Dynamic Wavefront Aberrometry offers a new opportunity to comprehensively understand real-world vision, bridging the divide between subjective and objective vision quality and opening a new frontier for precision medicine.