Optical Performance of RayOne EMV and Tecnis Synergy Under Varying Pupil Sizes and Corneal Aberrations

<b>Background/Objectives:</b> Premium intraocular lenses (IOLs) are increasingly being selected for cataract and refractive lens surgery, but their functional performance depends critically on pupil size and corneal spherical aberration (SA). This study evaluates how these factors modulate the optical behavior of the RayOne EMV and Tecnis Synergy using a profilometry-based Through Object modulation transfer function (TO MTF) analysis. <b>Methods:</b> The surface profiles of the RayOne EMV and Tecnis Synergy were measured with a confocal optical profilometer and implemented in pseudophakic eye models via ray tracing. TO MTF at 50 cycles/mm was computed for object vergences from -4.0 D to +2.0 D over entrance pupil diameters from 2.0 to 5.5 mm in three corneal configurations derived from the Liou-Brennan model and ISO recommendations: mean population SA, aberration-free, and a myopic LASIK-like oblate cornea. Simulated optotype images were generated to relate TO MTF values to the expected distant, intermediate, and near visual performances. <b>Results:</b> RayOne EMV delivered high-quality distant image performance in all models. Its depth of focus increased only modestly and showed a strong dependence on pupil size. Intermediate and near vision rarely reached clinically acceptable levels. The Tecnis Synergy produced a broad depth-of-field plateau in distant to near visual performance for mean population spherical aberration at a 3.5 mm pupil. However, image quality at 90 cm remained limited. Optical performance worsened with increasing pupil size and positive spherical aberration, particularly under post-myopic LASIK conditions. <b>Conclusions:</b> The RayOne EMV behaves predominantly as a distance-oriented design with minimal true presbyopic benefit; the Tecnis Synergy provides a wider range of vision but is highly sensitive to corneal spherical aberration and pupil size, so thorough preoperative evaluation of corneal asphericity and functional pupil diameter is essential for IOL selection and power targeting.