Background/Objectives: To assess the optical performance of two refractive premium IOLs across pupil sizes and values of corneal spherical aberration (SA). Methods: Two refractive IOLs were evaluated in this study: Tecnis Eyhance and Mini Well. The surface profiles were obtained to calculate the through-object MTF (TO MTF) curves and simulate optotype images. Entrance pupil sizes ranging from 2 to 5.5 and three corneal models were analyzed in the simulation: an average population aberrated cornea, an aberration-free cornea and a post-Lasik myopic cornea. Results: For Model 1 and pupil sizes between 3.0 and 3.5 mm, Mini Well provided acceptable visual quality from far to near distances, whereas Eyhance struggled to maintain visual quality at distances closer than intermediate. For patients with lower-than-normal corneal SA (i.e., more prolate corneas, such as post-hyperopic LASIK) both IOLs exhibited a hyperopic shift in far focus. Conversely, for patients with higher-than-normal corneal SA (i.e., more oblate corneas, such as post-myopic LASIK), the shift occurred in the myopic direction. Despite the implementation of an optimized IOL power to circumvent any shift, the TO MTF nevertheless reflected the interaction between corneal and IOL SA. Furthermore, the Mini Well demonstrated increased tolerance to less negative SA values, while Eyhance exhibited behavior consistent with a monofocal lens for more positive SA values. Conclusions: Surgeons should consider each patient’s corneal asphericity and typical pupil diameter when selecting and calculating the power of the premium IOLs studied, particularly in patients with a history of refractive surgery.

Background/Objectives: Premium intraocular lenses (IOLs) are increasingly being selected for cataract and refractive lens surgery, but their functional performance depends critically on pupil size and corneal spherical aberration (SA). This study evaluates how these factors modulate the optical behavior of the RayOne EMV and Tecnis Synergy using a profilometry-based Through Object modulation transfer function (TO MTF) analysis. Methods: The surface profiles of the RayOne EMV and Tecnis Synergy were measured with a confocal optical profilometer and implemented in pseudophakic eye models via ray tracing. TO MTF at 50 cycles/mm was computed for object vergences from −4.0 D to +2.0 D over entrance pupil diameters from 2.0 to 5.5 mm in three corneal configurations derived from the Liou–Brennan model and ISO recommendations: mean population SA, aberration-free, and a myopic LASIK-like oblate cornea. Simulated optotype images were generated to relate TO MTF values to the expected distant, intermediate, and near visual performances. Results: RayOne EMV delivered high-quality distant image performance in all models. Its depth of focus increased only modestly and showed a strong dependence on pupil size. Intermediate and near vision rarely reached clinically acceptable levels. The Tecnis Synergy produced a broad depth-of-field plateau in distant to near visual performance for mean population spherical aberration at a 3.5 mm pupil. However, image quality at 90 cm remained limited. Optical performance worsened with increasing pupil size and positive spherical aberration, particularly under post-myopic LASIK conditions. Conclusions: The RayOne EMV behaves predominantly as a distance-oriented design with minimal true presbyopic benefit; the Tecnis Synergy provides a wider range of vision but is highly sensitive to corneal spherical aberration and pupil size, so thorough preoperative evaluation of corneal asphericity and functional pupil diameter is essential for IOL selection and power targeting.