Trifocal Intraocular Lens Selection: Predicting Visual Function From Optical Quality Measurements

Abstract

Purpose: To apply in vitro quality metrics to assess and compare three trifocal intraocular lenses (IOLs). Methods: The optical performance of the AT LISA tri 839MP (Carl Zeiss Meditec AG), AcrySof IQ PanOptix (Alcon Laboratories, Inc), and TECNIS Synergy (Johnson & Johnson Vision) was compared. The modulation transfer function (MTF) metrics were obtained using an optical bench set-up. A polychromatic light source and a model cornea inducing chromatic and spherical aberrations were used to mimic in vivo characteristics. The area under the MTF was calculated at each defocus position, which served as a parameter in a nonlinear formula applied to predict postoperative visual acuity (VA). Results: All of the studied IOLs had a predicted VA of 0.2 logMAR or better throughout the range of 0.00 to −3.00 diopters (D). Simulated VA differences between the IOLs were negligible (< 0.01 logMAR) at the far point. Although the three models were comparable at −1.00 D, at −2.00 D the AT LISA tri 839MP's VA was 0.06 and 0.08 logMAR worse than with the TECNIS Synergy and AcrySof IQ PanOptix, respectively. At near focus, the AcrySof IQ PanOptix's estimated VA was 0.06 logMAR (40 cm); for the AT LISA tri 839MP and TECNIS Synergy, it was 0.06 and 0.03 logMAR, respectively, at 36 cm. Conclusions: Although simulated distance VA was comparable between the studied models, differences can be found in the intermediate focus' position and quality and the expected reading distance. Therefore, simulations of defocus curves from optical quality metrics provide insight into IOL characteristics and highlight differences between the IOLs, which may guide the selection of a trifocal lens based on patients' needs. [ J Refract Surg . 2023;39(2):111–118.]