A Comparative Analysis of Tolerance to Induced Astigmatism Across Various Categories of Intraocular Lenses

PURPOSE: To compare tolerance to induced astigmatism (TIA) across four intraocular lenses (IOLs). SETTING: Medical University of South Carolina, Charleston, South Carolina, USA. DESIGN: Prospective observational study. METHODS: Patients underwent cataract surgery with a standard monofocal (ZCB00), enhanced monofocal (DIB00), diffractive violet light filter (VLF) extended depth of field (DOFi) (ZXR00V), or VLF full DOFi (DRN00V) IOL. At 1-3 months postoperatively, astigmatic defocus (0.5-2.0 D) was simulated in WTR, oblique, and ATR orientations. RESULTS: 100 patients were included. DCIVA was statistically significantly better with VLF extended DOFi compared with the monofocal (P≤0.001) and enhanced monofocal IOLs (P=0.002). DCNVA was significantly better with VLF Full-DOFi IOL than with all other groups (P<0.001). No statistically significant differences were observed among the four IOL groups with induction of WTR astigmatism ≤1.0 D. At 0.5D oblique, the enhanced monofocal group outperformed the extended DOFi group (P=0.014), and at 2.0 D induced oblique astigmatism, it surpassed all other IOL groups. The enhanced monofocal IOL group showed the greatest tolerance to induced ATR astigmatism across all magnitudes. The VLF Full-DOFi IOL group maintained astigmatic tolerance like standard monofocal, enhanced monofocal, and extended DOFi IOLs up to 2.0 D in WTR and ATR, and 1.5 D in oblique orientations. CONCLUSION: TIA was not statistically significantly different among the standard monofocal, enhanced monofocal, VLF extended DOFi, and VLF Full-DOFi IOL groups with low to moderate induced WTR astigmatism. The enhanced monofocal IOL provided the greatest tolerance to induced astigmatism, especially under oblique and ATR astigmatic defocus.