Comparison of through-focus image quality across five presbyopia-correcting intraocular lenses (an American Ophthalmological Society thesis).

Purpose: To assess through-focus polychromatic image sharpness of five US Food and Drug Administration-approved presbyopia-correcting intraocular lenses (IOLs) through a range of object vergences and pupil diameters utilizing an image sharpness algorithm.

Methods: A 1951 US Air Force resolution target was imaged through a Crystalens AO (AO) (Bausch & Lomb Surgical, Aliso Viejo, California), Crystalens HD (HD) (Bausch & Lomb Surgical, Aliso Viejo, California), aspheric ReSTOR +4.0 (R4) (Alcon Laboratories, Fort Worth, Texas), aspheric ReSTOR +3.0 (R3) (Alcon Laboratories, Fort Worth, Texas), and Tecnis Multifocal Acrylic (TMF) (Abbott Medical Optics, Irvine, California) IOL in an anatomically and optically accurate model eye and captured digitally for each combination of pupil diameter and object vergence. The sharpness of each digital image was objectively scored using a two-dimensional gradient function.

Results: The AO lens had the best distance image sharpness for all pupil diameters, followed by the HD. With a 5-mm pupil, the R4 lens achieved distance image quality similar to the HD, but inferior to the AO. The R3 successfully moved the near focal point farther from the patient compared to the R4, but did not improve image sharpness at intermediate distances and showed worse distance and near image sharpness. Consistent with apodization, the ReSTOR IOLs displayed better distance and poorer near image sharpness as pupil diameter increased. The TMF lens showed consistent distance and near image sharpness across pupil diameters and exhibited the best near image sharpness for all pupil diameters.

Conclusions: Differing IOL design strategies to increase depth of field are associated with quantifiable differences in image sharpness at varying vergences and pupil sizes. An objective comparison of the imaging properties of specific presbyopia-correcting IOLs, in conjunction with patients' pupil sizes, can be useful in selecting the most appropriate IOL for each patient.