Purpose: To study the optical performance of intraocular lenses (IOLs) in the human eye to ascertain how multifocality affects the optical performance of refractive and diffractive technologies and the relationship to pupil size.
Setting: Vissum-Instituto de Oftalmológico de Alicante, Alicante, Spain.
Methods: Ten eyes each received the monofocal AcrySof MA60 IOL (Alcon) or 1 of the following multifocal pupil-dependent IOLs: diffractive AcrySof ReSTOR (Alcon) or refractive ReZoom (Advanced Medical Optics). The intraocular optical quality in vivo with 3.0 mm and 5.0 mm pupils was characterized by comparing the means of the difference between the total and corneal optical aberrations 3 months postoperatively. The main outcomes measures were total, higher-order, spherical, and coma aberrations (root-mean-square values); modulation transfer function values; point-spread function; and the Strehl ratio.
Results: The ReZoom group had higher in vivo intraocular aberrations than the AcrySof ReSTOR and AcrySof MA60 groups (P = .022). The difference in spherical aberration between the AcrySof ReSTOR and ReZoom groups was statistically significant with 5.0 mm pupils (P = .003) and 3.0 mm pupils (P = .001). The AcrySof ReSTOR group had statistically significant lower coma aberration values with a 5.0 mm pupil (P = .012); there were no differences between IOLs with a 3.0 mm pupil (P = .185).
Conclusions: Multifocal refractive IOLs resulted in higher intraocular aberrations. The hybrid refractive-diffractive IOL was the least affected by pupil diameter in terms of intraocular aberrations and showed significantly less increase in optical aberrations when the pupil was enlarged.