<b>Quantitative Evaluation of Pupil Size Influence on Distance, Intermediate, and Near Visual Acuity in Eyes Implanted with Three Presbyopia-Correcting IOLs</b>

<b>Abstract</b><b>Purpose </b>– To quantify the influence of mesopic pupil size on distance, intermediate, and near visual acuity (VA) after implantation of three presbyopia‑correcting intraocular lenses (IOLs).<b>Setting</b> – Eleven ophthalmology clinics and outpatient surgical centers, Germany.<b>Design</b> – Retrospective multicenter cohort study; non‑randomized and unmasked.<b>Methods</b> – Electronic health‑record data from 19 315 eyes (October 2016 to September 2024) were screened. Eyes implanted with Eyhance, FineVision, or RayOne Trifocal IOLs and with documented mesopic pupil size were eligible. Decimal VAs were converted to logMAR and invalid values removed. Linear regression related pupil size to uncorrected and corrected distance VA (UDVA/CDVA) in 3 563 eyes; after restricting to UDVA ≤ 0.10 logMAR, uncorrected intermediate (UIVA) and near (UNVA) VAs were analyzed in 3 073 eyes. Extreme pupil‑size quartiles were compared with the Mann‑Whitney test; false‑discovery rate was controlled. A‑priori and post‑hoc statistical powers were calculated for both tests.<b>Results</b> – Thirty IOL–VA combinations were evaluated; a‑priori power ≥ 0.80 was achieved in 29. FineVision monocular UIVA showed a quartile difference (p = 0.014; Cliff’s Δ = –0.10) and RayOne Trifocal binocular UNVA exhibited a slope of –0.017 logMAR per mm (p = 0.003). Post‑hoc power for these findings was low (0.47 and 0.05, respectively). Eyhance displayed non‑significant trends toward worse UIVA and UNVA with larger pupils (p ≈ 0.20). No distance‑vision dependence on pupil size was detected. All lenses yielded safety indices &gt; 1 and efficacy indices &gt; 0.97.<b>Conclusion </b>– All three IOLs demonstrated generally stable postoperative visual acuity across mesopic pupil diameters. Statistically significant but underpowered associations were found for binocular UNVA with the RayOne Trifocal and monocular UIVA with FineVision, and additional non-significant trends justify confirmation in larger, prospective cohorts.