Influence Of Pupil Diameter On Visual Performance Of A Non-Diffractive Extended Depth Of Focus Intraocular Lens: Puresee

To evaluate the effect of pupil diameter on visual performance in eyes implanted with the Puresee (Johnson & Johnson) extended depth of focus (EDOF) intraocular lens (IOL).

Koç University Hospital, Department of Ophthalmology, Istanbul, Türkiye

This prospective observational study included 54 eyes of 27 bilaterally operated patients implanted with the Puresee EDOF IOL. Photopic pupil diameter was measured using corneal topography and eyes were stratified into three groups (<3 / 3.0-3.4 / >3.4mm). Examinations were performed 6 months postoperatively. Defocus curves (+2.0 to −4.0 D) were primarily analyzed using linear mixed-effects models to account for inter-eye correlation with Bonferroni post hoc correction. Visual acuity (VA) outcomes were evaluated similarly. Contrast sensitivity (CS) was assessed under photopic and mesopic conditions, and area under the log contrast sensitivity function (AULCSF) was calculated. Statistical significance was set at p<0.05.

Overall mean defocus performance did not differ among pupil-size groups (p=0.651); however a significant defocus level × pupil interaction was observed (p=0.049, η²p =0.076), indicating that pupil size influenced the shape of the defocus curve. Linear mixed model analysis demonstrated that increasing pupil diameter (range: 2.32–4.48 mm) was significantly associated with worse visual acuity at defocus levels of +2.0 D, +1.5 D, and +1.0 D (β = 0.183, 0.109, and 0.119 logMAR per 1-mm increase, p = 0.033). No significant differences were detected in other VA measures either between groups or in relation to increasing pupil diameter. CS analysis revealed no significant differences in mesopic or photopic among groups (p=0.976 and p=0.975).

This study demonstrates that the Puresee EDOF IOL provides comparable visual acuity at negative defocus levels as well as at far, intermediate, and near distances across different pupil size groups. These findings suggest that the lens maintains a consistent overall visual performance within this range of pupil diameters, allowing clinicians to confidently select it irrespective of pupil size.