Optical bench evaluation of the effect of pupil size in new generation monofocal intraocular lenses

Abstract

Background A new generation of enhanced monofocal IOLs has been introduced to slightly increase the depth of focus as compared to standard monofocal IOLs. The purpose of this study is to evaluate the effect of pupil size on the through-focus optical performance of three new enhanced monofocal IOLs, designed to improve the range of vision as compared to standard monofocal IOLs. Methods Optical bench testing in white light was performed for different pupils, using an average cornea eye. Distance image quality was evaluated using Modulation Transfer Function (MTF) measurements. Through-focus Visual Acuity (VA) was simulated from these measurements (sVA). Three enhanced monofocal IOLs (ICB00, ISOPure, and RayOne-EMV) and three standard monofocal IOLs: two aspheric (ZCB00 and SN60WF) and one spherical (AAB00) were included. Results The enhanced monofocal IOLs provided an improvement in the intermediate sVA as compared to standard monofocal IOLs. For ICB00, the improvement was independent of the pupil size, while for the ISOPure and RayOne-EMV, the intermediate sVA improved with increased pupil size. Similar to the spherical monofocal IOL, the ISOPure and RayOne-EMV showed a strong correlation between improvement in intermediate sVA and reduction of distance sVA and MTF, and increasing pupil size. ICB00 provided the same distance sVA as the aspheric monofocal IOLs and the lowest variability in MTF with pupil size. Conclusion Optical bench results showed that the ISOPure and RayOne-EMV provide similar performance to a spherical monofocal IOL, with a strong pupil dependency for distance and intermediate vision. The other enhanced monofocal IOL, ICB00, provided a sustained improvement in simulated intermediate VA and maintained distance image quality comparable to that of the standard aspheric monofocal IOLs, even for larger pupils.

Optical and aberrometric evaluation of a new enhanced monofocal intraocular lens with isofocal optic design

“…The visual quality evaluated with the double-pass system OQAS showed similar MTF and SR values for both lenses, although the MTF cut-off frequency was higher than normal for both lenses, having an average value close to 30 c/deg, with the 4.0-mm pupil diameter set with the OQAS. These 'in-vivo' findings with the ISOPure lens are in line with those obtained by Alarcon et al 19 and Azor-Moron et al 20 on an optical bench.…”

“…Alarcon et al 19 also noted that the larger pupil sizes in eyes implanted with EM-IOLs, which do not fully compensate for corneal SA, might lead to a decrease in MTF. As demonstrated by our findings, the ISOPure lens design affected HOAs across larger optical zones when compared with the monofocal MicroPure lens.…”

Visual and refractive outcomes after bilateral implantation of an enhanced monofocal intraocular lens: prospective study

“…16 Alarcon et al also performed optical bench testing to evaluate the distance image quality of 3 enhanced monofocal IOLs including the RayOne EMV. 17 The simulated visual acuity demonstrated that the RayOne EMV provided as good distance vision as that of a standard monofocal; both papers are in good agreement with the clinical findings in our study where mean CDVA was excellent and slightly better than 20/20 (−0.03 ± 0.06 logMAR).…”

Clinical Results and Factors Affecting Visual Function in Eyes Implanted with an Enhanced Monofocal Intraocular Lens

“… 22 Alarcon et al also reported that the improvement in intermediate simulated VA obtained from the through-focus VA was independent of the pupillary size. 23 …”