Laboratory Investigation of Preclinical Visual-Quality Metrics and Halo-Size in Enhanced Monofocal Intraocular Lenses

Introduction This study aims to compare preclinical visual-quality metrics and halo size of intraocular lenses (IOL) with enhanced intermediate vision to a standard monofocal lens. Methods Three monofocal- IOL models with an extended-depth-of-focus (EDoF) intended for monocular implantation (Tecnis ICB00, AE2UV/ZOE, and IsoPure) and one for monovision (RayOne EMV) were compared against a standard monofocal lens (Tecnis ZCB00). An optical-metrology station was used in the assessment of IOLs' optical quality in polychromatic light. The imaging quality was compared with metrics derived from the optical transfer function. Halo size was estimated from the projection of the point spread function under scotopic pupil. Results The monofocal IOL showed the highest image quality at the far focus. The ICB00’s, the AE2UV/ZOE’s, and the IsoPure’s performance at − 1D was superior to that of the monofocal lens. The monocular defocus tolerance of the RayOne EMV was comparable with that of the ZCB00. The RayOne EMV’s intermediate range was improved in a monovision configuration (− 1D offset). This approach, however, yielded the largest halo area, i.e., 53% of the ZCB00’s halo, compared to 34% for the IsoPure, 14% for the AE2UV/ZOE, and 8% for the ICB00. Conclusion The mono-EDoF models have a clear advantage over the standard monofocal lens by expanded imaging capability beyond − 0.5D. Although the RayOne EMV provided the largest (binocular) visual-range extension, it was at the expense of monocular vision and higher susceptibility to halo. The ICB00’s and the AE2UV/ZOE’s halo-profile was similar to that of the ZCB00, indicating their low potential to induce photic phenomena.