Visual simulation through different intraocular lenses using adaptive optics: Effect of tilt and decentration

PURPOSE: To analyze visual quality differences between intraocular lenses (IOLs) and assess the impact of IOL decentration and tilt on visual quality. SETTING: University of Valencia, Valencia, Spain. DESIGN: Cohort study. METHODS: The crx1 adaptive optics visual simulator was used to simulate the wavefront aberration pattern of 2 commercially available aspheric aberration-correcting IOLs (Acrysof IQ SN60WF and Tecnis ZA9003) and 2 spherical IOLs (Akreos Adapt and Triplato) in 5 situations: centered, decentered 0.2 mm and 0.4 mm, and tilted 2 degrees and 4 degrees. Monocular distance visual acuity at 100%, 50%, and 10% contrast and the depth of focus were measured. RESULTS: Ten eyes of 10 patients were evaluated. When the IOLs were centered, there were no differences in visual acuity between the 4 IOLs at any contrast. The aberration-correcting IOLs were more sensitive to tilt and decentration than the spherical IOLs; Tecnis ZA9003 IOL was the most sensitive to decentration and the Acrysof IQ SN60WF IOL was the most sensitive to tilt. Higher residual spherical aberration slightly improved depth of focus and the tolerance to defocus. CONCLUSIONS: The results in this study suggest that the aspheric aberration-correcting and spherical IOLs provided comparable visual quality when centered in eyes in which the corneal higher-order aberrations are those of the average of the human cornea. Tilt and decentration of the IOLs had an impact on visual quality, with aberration-correcting IOLs having a greater effect than the spherical IOLs. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.