Comparative Visual Performance Of A Refractive Extended Depth Of Focus And A Wavefront-Shaping Extended Depth Of Focus Intraocular Lens Using A Real Model Eye

To compare the through-focus visual performance, contrast characteristics, and pupil-size dependency of a purely refractive extended depth of focus (EDOF) intraocular lens (IOL) (TECNIS PureSee, Johnson & Johnson Vision) and a wavefront-shaping EDOF IOL (AcrySof IQ Vivity, Alcon) using an optical bench model eye system across multiple aperture sizes.

ASUCA Eye Clinic Sendai Mark One, Sendai, Japan, and Tsukazaki Hospital, Himeji, Japan. Retrospective study approved by the institutional ethics committees of both institutions.

Both 20.0 D IOLs were mounted in a real model eye with a PMMA cornea (refractive index 1.4938, spherical aberration +0.20 µm at 6.0 mm). Defocus images of a Landolt C chart were captured from +2.0 to –4.0 D in 0.25 D steps using a CCD camera (Pentax Q10, Ricoh Imaging) at aperture sizes of 2, 3, and 4 mm. Visual acuity at each defocus level was measured by image decomposition analysis. Contrast was quantified using the Michelson contrast formula at the 0.3 logMAR target. Night scene images were captured at 5 mm aperture to assess glare profiles.

At 2 mm aperture, both IOLs showed comparable defocus curves with approximately 2.5 D depth of focus (DOF) at 0.2 logMAR. PureSee demonstrated a broader DOF at logMAR 0 (1.25 D), suggesting greater refractive error tolerance. At 3 mm, PureSee exhibited superior far contrast visual acuity with a bimodal defocus profile, while Vivity showed better intermediate vision up to approximately 1 m. PureSee outperformed at near distances. At 4 mm, PureSee maintained superior far contrast with energy shift toward distance, whereas Vivity showed overall contrast reduction. Both IOLs showed limited near vision at larger apertures. Near vision was comparable at approximately –3.0 D in both groups.

PureSee and Vivity exhibited similar overall visual performance as non-diffractive EDOF IOLs. PureSee demonstrated advantages in far-distance contrast and refractive error tolerance, particularly under mesopic conditions with larger pupils. Vivity showed superior intermediate vision performance. Both IOLs had comparable near vision limitations. The purely refractive design of PureSee showed pupil-dependent energy redistribution toward distance at larger apertures, maintaining far contrast while Vivity showed global contrast reduction. These complementary performance profiles may guide IOL selection based on individual patient visual demands.