Clinical Tolerance to Induced Astigmatism in Eyes Implanted with a Single Extended Depth of Focus Intraocular Lens (AT LARA®)

Wilson Takashi Hida,1 Bernardo Kaplan Moscovici,2– 4 Paulo Eduardo Souto Castro Miziara,1 Daniel Cruz Nogueira,1 Cesar Vilar,1,5 Danilo Varela Kniggendorf,1 Patrick Frensel De Moraes Tzelikis,1 Leandro P Mundim,1 Irineu Ribeiro de Melo Junior,1 André Lins De Medeiros,1 Walton Nose,2 Pedro C Carricondo6 1Department of Ophthalmology, Hospital Oftalmológico de Brasília, Brasília, DF, Brazil; 2Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil; 3Department of Ophthalmology, Hospital Visão Laser, Santos, SP, Brazil; 4Postgraduate Program in Translational Medicine, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil; 5Vilar Hospital de Olhos, Teresina, PI, Brazil; 6Department of Ophthalmology, University of São Paulo, São Paulo, SP, BrazilCorrespondence: Bernardo Kaplan Moscovici, Department of Ophthalmology, Federal University of São Paulo (UNIFESP), Rua Cayowaa, 854, apt. 82, São Paulo, SP, 05018-001, Brazil, Email [email protected]: To evaluate clinical tolerance to induced astigmatism in pseudophakic eyes bilaterally implanted with an extended depth of focus (EDOF) intraocular lens (AT LARA®, Carl Zeiss Meditec). We hypothesized that small amounts of induced astigmatism may be clinically well tolerated by patients implanted with this EDOF IOL.Methods: Prospective study including 10 patients (20 eyes) bilaterally implanted with the same EDOF IOL. Monocular defocus curves were obtained under photopic conditions after introducing cylindrical lenses of +1.00 D, +2.00 D, and +3.00 D at with-the-rule (WTR) and against-the-rule (ATR) orientations.Results: The IOL demonstrated good tolerance up to +1.00 D of induced astigmatism, with significant reductions in visual acuity at higher magnitudes of astigmatism. Tolerance was higher for ATR astigmatism compared to WTR, consistent with axis-dependent depth-of-focus effects.Conclusion: The AT LARA® EDOF IOL maintained functional visual performance with up to +1.00 D of regular astigmatism, while higher magnitudes led to clinically meaningful degradation. Axis orientation modulated performance, with ATR preserving intermediate and near vision and WTR favoring distance.Keywords: extended depth of focus intraocular lens, pseudophakia, astigmatism tolerance, defocus curve, with-the-rule, against-the-rule, toric intraocular lens