PURPOSE: To compare the in vitro optical performance of five premium multifocal intraocular lenses (IOLs), including a single-valued metric that shows the total range of distances where a multifocal IOL generates an acceptable image quality. METHODS: Through-focus modulation transfer function (MTF) and the image of a United States Air Force target were obtained for a 3-mm pupil and a wavelength of 546 nm in five multifocal IOLs (Tecnis Symfony [Johnson & Johnson], FineVision Micro F [PhysIOL], Acrysof IQ PanOptix [Novartis], and Artis Symbiose Mid and Plus [Cristalens Industrie] multifocal IOLs). Total depth of focus (TDOF) is computed by adding the vergence intervals where the through-focus MTF at 50 cycles/mm is 0.15 or greater. RESULTS: Due to their different optical designs (bifocal, trifocal, or extended depth of focus), energy is distributed differently between far, intermediate, and near focus for each multifocal IOL. The light distribution of the Symbiose Mid and Plus multifocal IOLs was similar, concentrating the energy into far focus and the intermediate into near focus, but extending the intermediate focus more (Plus) or less (Mid) toward the near focus. TDOFs were: 1.58 diopters [D] (FineVision); 1.71 D (Tecnis Symfony); 1.73 D (Artis Symbiose Plus); 1.74 D (Artis Symbiose Mid); and 1.90 D (Acrysof IQ PanOptix). CONCLUSIONS: TDOFs were similar between multifocal IOLs with a maximum difference of 0.32 D and mean value of 1.73 D. The combination of the Symbiose Mid and Plus IOLs can theoretically provide a TDOF of 2.90 D in case one is implanted in one eye and the other in the fellow eye. [ J Refract Surg . 2020;36(9):578–584.]

It is well known that depth-of-focus (DOF) is influenced by optical factors (such as pupil size and monochromatic aberrations). However, neural factors such as blur sensitivity and defocus adaptation may play an important role on the extent of DOF. A series of experiments were conducted to study if optical or neural factors are most pertinent in explaining the variability of DOF across subjects. An adaptive optics system with a black and white target, a 3.8-mm artificial pupil, and a subjective criterion (based on objectionable blur) were used to measure depth of field ([DOFi]; DOF computed in the object space) in 11 participants, after at least 6 min of adaptation. This was done under three conditions: (a) with their own higher order aberrations (HOA); (b) after correction of their monochromatic HOA; and (c) after altering the HOA pattern for some participants to reflect the HOA pattern measured for a different participant. Natural DOFi and DOFi after HOA correction were positively correlated (R 2 ¼ 0.461), but a significant decrease in DOFi (21% on average) was found after HOA correction (p ¼ 0.042). Effect of HOA on the intersubject variability of DOFi was 3.9 times smaller than the effect of the image neural processing. This study shows that DOFi depends on both optical and neural factors, but the latter seems to play a more important role than the former.