Prediction of Monocular and Binocular Visual Acuity for the Pseudophakic Patients Using Simulated Modulation Transfer Function

Purpose: To develop a correlation of simulated modulation transfer function (MTF) to clinical monocular and binocular visual acuity (VA) to predict the VA defocus curves of intraocular lenses (IOLs) in the early preclinical development. Methods: Ray tracing software was used to generate MTF area (MTFa) data at defocus positions from − 3.0 D to +2.0 D. which were then correlated with clinical monocular and binocular VA data to predict preclinical metrics. Simulated MTF data was generated (with mean photopic pupil size of 3 mm with photopic spectral weighting) in a modified pseudophakic Navarro eye model, with corneal spherical aberration (SA) both at the matched and the average human corneal SA. MTFa was calculated across two spatial frequency ranges, and linear and polynomial functions were fit to the pairs of MTFa − 1 and VA data for different groups of the lens models. MTFa and VA data of five single-piece acrylic IOL models were analyzed, including aspheric monofocal, non-diffractive extended depth of focus (EDOF), and diffractive multifocal designs. Results: Simulated MTFa (with mean photopic pupil size of 3 mm with photopic spectral weighting) is broadly well correlated with clinical VA ( R 2 ≥ 0.9). Simulated VA defocus curves followed the clinical VA curves within the clinical standard deviation. Division of IOL models by type generally increased correlation strength compared to fitting MTFa-VA data for all lens models at once. Corneal spherical aberration showed minimal impact on MTFa-VA correlation. A wider spatial frequency integration interval for the MTFa calculation yielded higher R 2 , except in the case of grouping of diffractive-only IOLs. Conclusion: Monocular and binocular fittings showed similar correlation coefficients for the prediction of VA. VA calculated from simulated MTFa can be an accurate predictor of the clinical performance of an IOL design, helping to identify promising IOL designs early in the development process, improving optical quality and reducing the risk of suboptimal lenses advancing to manufacturing and clinical trials. Keywords: defocus curve, ray tracing, pseudophakic eye model, spherical aberration, preclinical evaluation, monocular visual acuity, binocular visual acuity