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The effect of mesopic pupil size and IOL centration on overall patient satisfaction with the TECNIS multifocal IOL

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Session Details

Session Title: Pseudophakic IOLs: Toric & Multifocal

Session Date/Time: Tuesday 08/09/2015 | 08:00-10:30

Paper Time: 09:42

Venue: Room 11

First Author: : F.Bucci, Jr USA

Co Author(s): :    A. Fluet                    

Abstract Details


To explore the effect of pupil size, IOL centration and other variables on the visual performance of patients receiving two diffractive multifocal IOLs.


Bucci Laser Vision Institute, Wilkes-Barre, Pennsylvania, USA


55 (TMF/TMF) best case patients with (1) six month neuroadaptation (2) corrected residual refractive error (3) necessary YAGs completed (4) aggressive management of the ocular surface were prospectively randomized for a 1 vs. 3-piece TMF (+4.00s) & eye dominance. The dependent variable overall pt. satisfaction was regressed against 40 independent variables including 31 objective clinical metrics such as reading speed & accuracy, angle kappa, asphericity, higher order aberrations, mesopic, photopic pupil size, residual sph. eq. & astigmatism, near, intermediate vision at fixed & preferred focal distances etc, and responses to 9 variables from a questionnaire addressing performance of everyday tasks.


64% (35/55) were very satisfied, 36% (20/55) were satisfied, 0% neutral, 0% dissatisfied and 0% very dissatisfied. The regression equation of overall satisfaction indicated that variables related to intermediate vision were strong predictors of overall patient satisfaction. Strong correlations between pupil size and intermediate vision from bivariate analysis justified a multivariate analysis with intermediate vision as a dependent variable. Intermediate vision = +112.87 (constant) -2.89 mesopic pupil (p less than .005) -5.01 centration (IOL) (p=.02) Results revealed that smaller pupils (p less than .005) and better IOL centration (p=.02) were associated with better intermediate vision beyond the pinhole effect.


1. The patient's ability to read the newspaper, work at a computer, and their intermediate visual function strongly predicted overall patient satisfaction. 2. IOL centration and pupil size beyond the pinhole effect significantly influenced intermediate visual function. 3. The central 1.0mm zone of the TMF is designed as a +2.00 add and explains the above findings for intermediate vision, pupil size, and IOL centration. 4. Pupil size is a meaningful preop predictor of postop intermediate vision when implanting the (+4.00) TECNIS multifocal IOL.

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