Tailoring Extended Depth-of-Focus Intraocular Lens Design with Pupil Diameter and Spherical Aberration Profile

INTRODUCTION: Several intraocular lens (IOL) designs have been designed for the correction of presbyopia. The purpose of this study is to evaluate the visual performance of two IOL models and their variation according to spherical aberration (SA) and pupil diameter (PD). METHODS: Prospective analysis of all patients implanted with AcrySoft Vivity (“VIVITY”) or Precizon Presbyopic NVA (“PRESBY”) at the Refractive Surgery Unit of a tertiary hospital between January 2021 and December 2023. Patients with incomplete follow-up, amblyopia, and posterior capsule opacification were excluded. Defocus curve testing was performed at 0.5 diopters (D) intervals from +1.0 D to -3.0 D at the same examination room. PD, chord μ, and corneal wavefront profile was registered using a Scheimpflug system (Pentacam, Oculus). RESULTS: We included 99 eyes of 54 patients - 50 eyes from the VIVITY group and 49 eyes from the PRESBY group. Baseline evaluation showed no significant differences. The VIVITY group showed better intermediate vision (logMAR 0.07 ± 0.06 vs 0.21 ± 0.25, p<0.001, respectively). The PRESBY group showed better near vision (logMAR 0.46 ± 0.11 vs 0.59 ± 0.16, p<0.001, respectively). Chord μ was not correlated with optical performance in either group. Near vision was positively correlated with PD (r=0.470, p<0.001 for 33 cm; r=0.350, p=0.015 for 40 cm; r=0.318, p=0.028 for 50 cm) and with SA (r=0.334, p=0.02 for 33 cm; r=0.374, p=0.009 for 40 cm; r=0.271, p=0.062 for 50 cm) only in the VIVITY group. Regarding PRESBY group, near vision was not significantly correlated with PD (r=0.224, p=0.143 for 33 cm; r=0.083, p=0.593 for 40 cm; r=0.146, p=0.343 for 50 cm) and statistically independent of SA (r=0.016, p=0.912 for 33 cm; r=0.221, p=0.131 for 40 cm; r=0.081, p=0.584 for 50 cm). CONCLUSION: Each IOL performance in intermediate vision is different according to PD and SA: with VIVITY, it is better with smaller PD and less positive SA. With PRESBY, it is pupil-independent and clinically favored by more positive SA. Thus, preoperative evaluation of SA and PD near vision may influence the choice of refractive IOL for each patient.