Predicting Visual Acuity in Pseudophakic Eyes With Pupil-Dependent Extended Depth of Focus Intraocular Lenses.

Purpose: To analyze the impact of the pupil size on the prediction of the clinical monocular visual acuity (VA) with a representative pupil-dependent extended depth of focus intraocular lens (EDOF IOL).

Methods: An optical bench with a model eye was used to obtain with 2-, 3-, and 4.5-mm pupils (at the IOL plane) the through-focus area under the modulation transfer function (TF-MTFa) of the refractive EDOF AcrySof IQ Vivity (Alcon Laboratories, Inc). The TF-MTFa curve with a 3-mm pupil was correlated with the clinical VA defocus curve (R² = 0.95) of a large sample of pseudophakic patients (n = 107). This group also was split into three cohorts according to pupil size: small (< 3 mm; n = 6), medium (3 to 4 mm; n = 52), and large (> 4 mm; n = 49). Each pupil group showed a differentiated clinical VA defocus curve that was highly correlated with the 2- (R² = 0.97), 3- (R² = 0.97), and 4.5-mm (R² = 0.96) TF-MTFa, respectively. The clinical VA versus MTFa curves were fitted using the formula proposed by the American National Standards Institute to derive for each pupil a new set of fitting coefficients to transform MTFa into expected VA accordingly.

Results: Four new predictive functions of the clinical VA were obtained for the pupil-dependent refractive EDOF IOL: one for the whole sample of patients, which averages out pupillary differences between patients, and three functions that incorporate the influence of the pupil size.

Conclusions: Better prediction of the clinical VA of pseudophakic patients implanted with pupil-dependent refractive EDOF IOLs is achieved with fitting functions that take into account the pupil size.