PURPOSE: To evaluate whether the prediction of visual performance based on the modulation transfer function area (MTFa) calculated with optical simulations is better correlated with visual acuity or contrast sensitivity obtained from defocus curves in patients implanted with a trifocal intraocular lens. METHODS: Biometric eye data from 43 patients were used to create a mean eye model. A trifocal intraocular lens with a power obtained from the mean of the eyes implanted was incorporated into the model and the MTFa was calculated at the 11 defocus planes corresponding the 11 defocus locations measured in clinical practice. Simulations were conducted for pupil diameters of 2.5, 3, 3.5, and 4 mm. The MTFa correlation with visual acuity and contrast sensitivity was evaluated with the mean obtained after stratification of the clinical sample in four groups according to the previous pupil diameters. RESULTS: A linear model predicted the visual acuity and contrast sensitivity from MTFa with similar accuracy to nonlinear models, with R 2 approximately 0.50 for visual acuity and approximately 0.42 for contrast sensitivity. A change of −0.01 logMAR and −0.02 logC was produced per unit of MTFa for visual acuity and contrast sensitivity, respectively. The mean difference between the visual acuity and contrast sensitivity obtained from the model and that measured in clinical practice was close to zero, but the bias varied depending on the defocus lens used, with higher deviation at −0.50 and −3.00 diopters of defocus. CONCLUSIONS: The MTFa obtained from optical simulations can be used to predict the mean visual acuity and contrast sensitivity consistently, with contrast sensitivity being more sensitive but with higher bias. [ J Refract Surg. 2019;35(12):789–795.]

PURPOSE: To evaluate the distribution of pupil size in patients implanted with multifocal intraocular lenses (IOLs) and to assess the variations according to age. METHODS: A total of 168 eyes that had implantation of several multifocal IOLs and were measured at the 3-month follow-up visit were included in the analysis. The Keratograph 5M (Oculus Optikgeräte) was used to measure the photopic and mesopic pupil size, as well as the average between both (average pupil size). Eyes were stratified in four groups by age: 50 years or younger, 51 to 60 years, 61 to 70 years, and older than 70 years. RESULTS: Considering the total sample, 84.5% and 95.8% of eyes had a photopic pupil size of 3 and 3.5 mm or less, respectively. The mesopic pupil size was greater than 4.5 mm in 39.3% and greater than 5 mm in 16.7% of eyes. The average pupil size was 3.5 and 4 mm or less in 54.2% and 85.1% of eyes, respectively. Mesopic pupil size resulted in a steeper decrease with age than photopic pupil size: 0.028 versus 0.015 mm/year, respectively. Statistically significant differences were found among the four age groups ( P < .0005). No significant mean differences were found between multifocal IOL models for photopic pupil size, mesopic pupil size, or average pupil size ( P > .05). CONCLUSIONS: Eyes implanted with multifocal IOLs had a photopic pupil size of 3.5 mm or less and mesopic pupil size of 5 mm or less. Mesopic and photopic pupil size decreased 0.28 and 0.15 mm per decade, respectively. This information can help surgeons to understand the general functioning of multifocal IOLs whose performance varies with pupil size. [ J Refract Surg . 2020;36(11):750–756.]

The increase in the depth of focus (DoF) for the treatment of presbyopia or cataracts is a topic of great interest for anterior segment surgeons who have seen how new surgical possibilities to achieve DoF enlargement have emerged. Nowadays, several technologies to extend the DoF are available, from corneal laser refractive surgery procedures in presbyopia to intraocular lens (IOL) implantation in cataract or refractive lens exchange. Some of these procedures are based on aspheric profiles, either in the cornea or in the IOL, which modulate the spherical aberration (SA) and, therefore, extend the light energy on different focal planes. The aim of this narrative review was to give an overall picture about the reasons why there is not a general solution persistent along time of SA induction to extend DoF, especially considering that SA depends on pupil diameter and this decreases with age.

(1) Background: To evaluate the efficacy at 6 years postoperative after the implantation of a trifocal intraocular lens (IOL) AT Lisa Tri 839MP. The secondary objective was to evaluate the contrast sensitivity defocus curve (CSDC), light distortion analysis (LDA), and patient reported outcomes (PROs). (2) Methods: Sixty-two subjects participated in phone call interviews to collect data regarding a visual function questionnaire (VF-14), a patient reported spectacle independence questionnaire (PRSIQ), and questions related to satisfaction and decision to be implanted with the same IOL. Thirty-seven of these subjects were consecutively invited to a study visit for measurement of their visual acuity (VA), CSDC, and LDA. (3) Results: The mean monocular distance corrected VA was −0.05, 0.08, and 0.05 logMAR at far and distances of 67 cm and 40 cm, respectively. These VAs were significantly superior to those reported in previous literature (p < 0.05). The total area under the CSDC was 2.29 logCS/m−1 and the light distortion index 18.82%. The mean VF-14 score was 94.73, with 19.4% of subjects requiring spectacles occasionally for near distances, and 88.9% considering the decision of being operated again; (4) Conclusions: Long-term AT LISA Tri 839MP IOL efficacy results were equal or better than those reported 12 months postoperatively in previous studies. The spectacle independence and satisfaction rates were comparable to those reported in short-term studies.

Purpose: To identify the most sensitive visual performance metric for evaluating the pupil-dependency of a multifocal intraocular lens (MIOL) and to determine the pupil measurement method most correlated with such metric. Methods: Twenty-seven right eyes implanted with a MIOL were included in the analysis. Three pupil size measurements were obtained preoperatively and at 1 month after surgery with the Keratograph 5M system: photopic (PP), mesopic (MP), and the average from both (AP). Pupil was also measured with a rule (RP) under the same light conditions of postoperative visual performance measurements that included, corrected visual acuities (VA) at three distances (far, 67 cm and 40 cm), visual acuity (VADC) and contrast sensitivity defocus curves for optotype sizes of 0.3 logMAR (CSDC3) and 0.7 logMAR (CSDC7). Differences in visual performance were also analyzed for eyes with RP > 3 mm (Group A) and RP ⩽ 3 mm (Group B). Results: PP diameter decreased after surgery by 16% ( p = 0.001), whereas MP ( p = 0.013) and AP ( p = 0.008) decreased by 10%. The best agreement with RP was obtained for AP. Group B showed a trend to better performance than Group A for all the included metrics ( p > 0.05). From the three types of defocus curves, CSDC3 obtained generally highest statistical power for testing differences between groups. The strongest statistically significant correlations between pupil size and CSDC3 were obtained for RP and AP. Conclusion: The CSDC3 was the most sensitive metric to detect MIOL pupil-dependency. PR and AP were more correlated with CSDC3 than PP and MP.