Association of preoperative corneal spherical aberration with intermediate-to-near visual acuity in enhanced monofocal intraocular lens implantation: a retrospective cross-sectional cohort study

BACKGROUND: Eyhance ICB00 or DIB00 and Eyhance Toric DIU). METHODS: In this retrospective cross-sectional cohort study, we included 45 eyes from 34 patients who received enhanced monofocal IOLs from January 2023 to March 2025. Pearson's correlation analysis evaluated the relationship between preoperative corneal SA and uncorrected intermediate visual acuity (UIVA). Receiver operating characteristic (ROC) analysis was used to determine the optimal cutoff value of SA for detecting UIVA > 0.1 logMAR. Patients were then divided into low and high SA groups based on this cutoff. Defocus curves (for a range of + 1.50 D to -5.00 D), Quality of Vision (QoV), and Spectacle Independence questionnaire scores were analyzed. RESULTS: Preoperative corneal SA significantly positively correlated with the UIVA in logMAR (r = 0.496, P = 0.001). ROC analysis estimated the corneal SA threshold as 0.2935 μm (Area under the curve = 0.752, P = 0.005). Compared to the high SA group, the low SA group showed better intermediate and near visual acuity from 100 to 20 cm (P < 0.05) and less frequent spectacle use (P < 0.05). Conversely, distance vision, contrast sensitivities, and QoV scores were comparable between both groups (all P > 0.05). CONCLUSIONS: Lower preoperative corneal SA was significantly associated with a wider depth of focus; thus, corneal SA may help guide preoperative counseling regarding possible intermediate visual performance and spectacle independence.