Purpose: To evaluate visual and refractive outcomes, as well as patient satisfaction after bilateral implantation of an enhanced monofocal intraocular lens (IOL) with emmetropia as a target refraction. Setting: San Carlos Hospital, Madrid, Spain. Design: Prospective, monocentric, noncomparative study. Methods: Adults 21 years or older suitable for cataract surgery and with corneal astigmatism <1.50 diopters (D) were bilaterally implanted with the RayOne EMV IOL and followed up for 3 months. Outcomes measures included refraction, monocular and binocular uncorrected distance visual acuity, corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity, distance-corrected intermediate visual acuity (DCIVA), and defocus curve, aberrometry, and satisfaction. Visual symptoms were assessed using the CatQuest-9SF questionnaire. Results: 50 eyes of 25 patients were included. At month 3, the mean manifest spherical equivalent was −0.39 ± 0.28 D, with all eyes within 1.00 D. Binocularly, uncorrected, at distance, 68% of patients could read ≤0.0 logMAR and 95% ≤0.2 logMAR; at intermediate 59% of patients could read ≤0.1 and 100% ≤0.2 logMAR. Mean monocular CDVA was −0.03 ± 0.06 logMAR and mean monocular DCIVA was 0.28 ± 0.07 logMAR. Binocular defocus curve demonstrated a visual acuity ≤0.2 logMAR over a 2 D range from +1.00 D to −1.25 D. Satisfaction was good in 96% of patients. Conclusions: Bilateral implantation of an enhanced monofocal IOL with emmetropia as a target provided excellent binocular CDVA and good DCIVA, with a high level of satisfaction.

Purpose: This study is to evaluate the optical characteristics of a non-diffractive wavefront-shaping intraocular lens which incorporates surface refractive modifications for shaping the wavefront in order to achieve extended depth of focus (EDoF) and to assess whether the nominal power of this IOL influences the attainable add power. Methods: A commercially available optical bench NIMO TR1504 device (LAMBDA-X, Nivelles, Belgium) was employed to obtain full optical characterization of three non-diffractive EDoF intraocular lenses with + 10 D, + 20 D, and + 30 D powers. After NIMO measurements, data were computed using a custom-made MATLAB program (Mathworks, Inc., Natick, MA, USA) to evaluate the optical quality functions, such as the point spread function (PSF), wavefront profiles, and modulation transfer function (MTF) for two pupil sizes: 3 mm and 4.0 mm. Results: The non-diffractive EDoF intraocular lens showed a central serrated power profile behavior with additions of + 2.00 to + 2.50 D over the nominal power. Higher order aberrations were found to be driven mainly by the spherical aberration, with almost null comatic influence. Optical quality metrics showed good values, better for a 3 mm pupil compared to a 4.5 mm one, as expected. The three IOL powers tested showed a very similar behavior in terms of power and aberrometric profiles, with minimal to null differences related to the nominal power. Conclusion: The non-diffractive wavefront-shaping EDoF intraocular lens achieves a near addition up to + 2.50 D aiming for an extended range of vision, almost independently of the base power.

Purpose: To evaluate the rotational stability, decentration, visual outcomes, and patient satisfaction after bilateral implantation of a trifocal toric intraocular lens (IOL), Clareon PanOptix Toric. Setting: San Carlos Hospital, Madrid, Spain. Design: Prospective, single-center, observational, noncomparative. Methods: Patients aged 50 years or older suitable for cataract surgery without comorbidities and with regular corneal astigmatism >1.50 diopters (D) were bilaterally implanted with the Clareon PanOptix Toric IOL and followed up for 3 months. Outcomes measured included IOL displacement and rotation, quantified by the PIOLET software. In addition, refraction and uncorrected visual acuity at far (4 m) were measured, along with corrected visual acuities, monocular and binocular, at far (corrected visual acuity [CDVA]), intermediate (DCIVA), and near (DCNVA) distances. Results: A total of 80 eyes from 40 patients were included in this study. At 3 months, the mean rotation was 1.04 ± 0.97 degrees, and the mean displacement was 0.19 ± 0.36 mm along the x axis and 0.19 ± 0.25 mm along the y axis. The postoperative spherical equivalent was −0.09 ± 0.35 D. Binocularly, the mean visual acuities were CDVA, −0.03 ± 0.05 logMAR; DCIVA, 0.07 ± 0.08 logMAR; and DCNVA, 0.09 ± 0.07 logMAR. Regarding satisfaction, 97% of patients indicated they were either very satisfied or fairly satisfied. Conclusions: The bilateral implantation of the Clareon PanOptix Toric IOL demonstrated excellent rotational stability, minimal decentration, and effective astigmatism correction. It provided strong visual acuity outcomes and high patient satisfaction, making it a viable option for patients seeking spectacle independence.

Background/Objectives: The purpose of the study is to assess visual and refractive outcomes and patient satisfaction after bilateral implantation of an enhanced monofocal intraocular lens (IOL) in a monovision configuration. Methods: Prospective, monocentric, non-comparative study including adults 21 years or older, with astigmatism less than 1.50 D, who were suitable for bilateral cataract surgery targeted with −1.00 D monovision. Participants were implanted with the RayOne EMV and followed up for three months. Outcome measures included refraction, monocular and binocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected and distance-corrected intermediate visual acuity (UIVA and DCIVA) at 66 cm and 80 cm, binocular defocus curve, and CatQuest-9SF questionnaire. Results: Sixty eyes of thirty patients were included. Postoperative spherical equivalent (SEQ) was −0.16 ± 0.29 D in the dominant eyes and −1.24 ± 0.43 D in the non-dominant eyes. Binocularly, mean UDVA at 4 m was −0.01 ± 0.07 and 0.1 logMAR or better in all patients. Mean binocular UIVA at 66 cm was 0.08 ± 0.08 and 0.2 logMAR or better in 92.9% of patients. Binocular UDVA was statistically significantly improved compared to monocular UDVA of the dominant eye targeted for distance (p < 0.001). Similarly, binocular UIVA was statistically significantly improved compared to monocular UIVA of the non-dominant eye targeted for −1.00 D (p < 0.001). A total of 96.6% of patients were satisfied with their sight. Conclusions: Bilateral implantation of an enhanced monofocal IOL in a monovision configuration provided excellent binocular uncorrected vision at distance and intermediate ranges, demonstrating effective binocular summation and a high level of patient satisfaction.

Topic: To evaluate the impact of intraocular lens (IOL) decentration on optical quality and performance using optical bench studies and ray-tracing numerical simulations, and to analyze how different IOL designs (monofocal, extended depth of focus [EDoF], multifocal, and toric) respond to decentration. Clinical relevance: IOL decentration may adversely affect visual outcomes, particularly with newer IOL designs. Despite advances in surgical techniques, optimal centration cannot always be guaranteed due to anatomical variability and other factors. Understanding how different IOL designs tolerate decentration is therefore essential for appropriate lens selection and optimized postoperative visual quality. Methods: A systematic review of the literature was conducted following PRISMA guidelines. Searches were performed in PubMed, Scopus, and Google Scholar using Boolean operators and truncated terms. Inclusion criteria focused on peer-reviewed optical bench studies published in English over the past 20 years. Data were extracted on optical metrics such as modulation transfer function, Strehl ratio, wavefront aberrations, and point spread function, in relation to various degrees of IOL decentration and lens types. Results: A total of 74 studies were included. Aspheric monofocal IOLs with negative spherical aberration showed greater optical degradation with decentration compared to spherical models. Multifocal and EDoF IOLs were more sensitive to decentration, with notable reductions in image quality and contrast sensitivity, especially at higher decentration levels. Toric IOLs were particularly affected when decentration was combined with rotational misalignment. Optical quality loss was directly related to each lens’s design and optical profile. Conclusions: IOL decentration has a measurable and clinically relevant impact on optical quality, especially in aspheric and multifocal designs. Understanding IOL behavior under decentration conditions is essential for optimizing lens selection and postoperative visual outcomes.

The optical performance of rotationally asymmetric multifocal intraocular lenses (IOLs) may be especially vulnerable to decentration due to their non-rotationally symmetric refractive design. This study explores the effect of controlled decentration of IOLs on the aberrometric behavior of low-addition and high-addition Acunex IOLs. Both IOLs were evaluated on an optical bench using the NIMO system in centered position and under induced decentrations of 0.5 mm and 1.0 mm applied in horizontal and vertical directions. Average Zernike coefficients were analyzed for two apertures intended to represent smaller and larger pupil conditions. Both lenses showed similar aberrometric profiles under centered conditions and for the smaller aperture. However, with increasing decentration, the larger aperture revealed evident direction-dependent performance. The induced changes followed structured patterns that differed by magnitude and direction of decentration. The most noticeable variations were observed in asymmetric aberrations, particularly coma-related, while spherical aberration also changed under specific displacements. Although both IOLs shared similar trends, their responses differed, suggesting that the addition profile may influence decentration tolerance. Controlled decentration produces measurable, direction-dependent changes in the aberrometric profile of rotationally asymmetric Acunex IOLs, especially for larger aperture.