Multifocal contact lenses for preoperative simulation of enhanced monofocal and extended depth of focus intraocular lenses using adaptive optics

PURPOSE: To evaluate whether multifocal contact lenses (CLs) can serve as preoperative simulators of postoperative vision with enhanced monofocal and extended depth of focus (EDOF) intraocular lenses (IOLs), using the SimVis Gekko™ adaptive-optics visual simulator. METHODS: Twenty-four presbyopic subjects (mean age 54.9 ± 5.0 years; range 46-63) underwent monocular simulation of two daily disposable multifocal CLs (1-Day Acuvue® Moist Multifocal, medium addition; and Biotrue® ONEday for Presbyopia, high addition) and two IOLs (Tecnis® Eyhance™, enhanced monofocal; and LuxSmart™, EDOF) using the SimVis Gekko™ under photopic conditions and a fixed 3 mm pupil aperture. Monocular defocus curves were obtained from -3.00 to +1.00 D in 0.50 D steps. Area under the curve (AUC), negative-defocus cutoff at the 0.2 logMAR threshold, and defocus slopes from linear mixed-effects models were compared across lens conditions for both raw and offset corrected datasets. RESULTS: Both CLs exhibited a systematic -0.50 D myopic offset relative to the IOL simulations, consistent with their center-near design. After applying a +0.50 D vergence correction, AUC values were comparable across all four designs (p = 0.18). At the 0.2 logMAR threshold, LuxSmart showed the widest functional range (cutoff -2.38 ± 0.66 D) and Biotrue the narrowest (-1.69 ± 0.53 D). Mixed-effects modeling indicated equivalent defocus slopes between 1-Day Acuvue Moist and Tecnis Eyhance after vergence alignment (p = 0.894), while LuxSmart showed greater defocus tolerance and Biotrue degraded significantly faster (p = 0.005). CONCLUSIONS: Once the intrinsic -0.50 D myopic offset is compensated, the 1-Day Acuvue Moist Multifocal closely replicates the through-focus visual performance of the Tecnis Eyhance IOL, supporting its use as a practical preoperative simulator for patients being considered for enhanced monofocal implantation. Multifocal CLs combined with adaptive optics simulation may assist surgeons in tailoring IOL selection and improve shared decision-making before cataract surgery.