Clinical, optical bench, and model-based assessment of an extended depth-of-focus versus a monofocal intraocular lens: A through-focus comparative study

Abstract: PURPOSE: To evaluate the relationship between clinical, optical bench, and model-predicted through-focus performance of an extended depth-of-focus (EDOF) intraocular lens (IOL), and to determine how optotype choice influences clinically derived depth-of-focus measurements and their comparability across studies. MATERIALS AND METHODS: Thirty eyes implanted with the Aspicio™ monofocal IOL and 44 eyes implanted with the Asqelio™ nondiffractive EDOF IOL were evaluated 3 months postoperatively. Monocular clinical defocus curves were recorded under photopic conditions using best-distance correction, accounting for recognition versus resolution optotypes, using the Clinical Trial Suite system. Both lenses were also tested on an optical bench to obtain through-focus modulation transfer function (MTF) profiles and generate model-predicted defocus curves from bench data. RESULTS: The EDOF group demonstrated higher uncorrected and distance-corrected intermediate visual acuity, while corrected distance visual acuity remained comparable between groups. Optical bench testing showed a depth of focus of 0.5 D for the monofocal and 2.0 D for the EDOF IOL at the 0.1 MTF threshold. Clinically, the EDOF IOL demonstrated a broader and flatter through-focus response, maintaining ≤0.2 logMAR across ~1.75 D. Model-generated defocus curves closely matched clinical behavior and confirmed the efficacy underlying the extended range of vision. Applying optotype-based correction enabled a valid comparison of defocus performance between groups. CONCLUSIONS: Optical bench and computed defocus curves reliably predicted clinical through-focus performance, supporting their role as complementary tools in EDOF evaluation. Standardizing clinical methodology, including optotype selection or correction, may improve comparability across studies assessing IOL designs.