Enhanced Depth-of-focus Intraocular Lenses: Latest Wavefront-shaped Optics versus Diffractive Optics.

Abstract

The modulation transfer functions (MTFs) of two novel enhanced depth-of-focus (EDoF) intraocular lenses (IOLs) were compared with an established diffractive EDoF IOL. Such assessment, which was not described before in the literature, is of high clinical impact in lens surgery. A new kind of nondiffractive, wavefront-shaped EDoF IOLs has been introduced very recently to cope with halos and glare known from diffractive optics. We aimed to assess the performance of two of these novel EDoF IOLs compared with an established diffractive EDoF IOL. TECNIS Symfony, AcrySof IQ Vivity, and LuxSmart Crystal IOLs (22 D each) were assessed by the OptiSpheric IOL PRO 2 imaging test bench with an ISO-2 cornea and a wavelength of 546 nm. Measurements were carried out by TRIOPTICS GmbH. Through-frequency MTF, Strehl ratio, and U.S. Air Force targets were evaluated. A decentration of 1 mm and a tilt of 5° as well as different apertures of 3 and 4.5 mm were applied additionally. TECNIS Symfony performed superiorly to Vivity and LuxSmart for our settings. The diffractive optics of Symfony showed a considerable decrease in MTF and Strehl ratio when decentered. Overall, decentration had more impact on MTF and Strehl ratio than tilt. Larger aperture led to a decreased MTF and Strehl ratio for all IOLs tested. U.S. Air Force targets had better contrast for Symfony and for small aperture. The novel wavefront-shaped EDoF IOLs failed to outperform the established diffractive achromatic optics of Symfony EDoF IOL with respect to MTF and qualitative contrast function. These results apply only to the distance viewing condition. Near vision performance will be evaluated in a future study.