Optical Assessment and Expected Visual Quality of Four Extended Range of Vision Intraocular Lenses

PURPOSE: To assess the optical performance of four extend-ed range of vision (ERV) intraocular lenses (IOLs) and predict the visual quality of the average pseudophakic patient.METHODS: Four ERV IOLs (LuxSmart, Bausch & Lomb; Vivity, Alcon Laboratories, Inc; Tecnis Eyhance, Johnson & Johnson Vision; and Isopure, PhysIOL) were inserted in an on-bench model eye. Their performance was assessed using through-focus modulation transfer function (MTF)-based metrics, through-focus point spread function, and halo analysis for three pupils (2.0, 3.0, and 4.5 mm). The expected visual acuity and the range of vision was estimated from the through-focus area under the MTF curve. A monofocal IOL (Tecnis ZCB00; Johnson & Johnson Vision) was included as reference. RESULTS: The Tecnis ZCB00 showed the highest image qual-ity at far for all pupil conditions, closely followed by the Tec-nis Eyhance. The LuxSmart and Vivity performed similarly in the intermediate range (-1.00 to-2.00 diopters [D]) with a 3.0-mm pupil and showed better performance than the other ERV IOLs for that range. All ERV lenses presented pupil de-pendent performance. All lenses reached normal expected visual acuity (0.0 logMAR) at far distance. The Tecnis ZCB00, Tecnis Eyhance, and Isopure decreased their expected vi-sual acuity with defocus (0.1 logMAR at 66 cm) faster than the LuxSmart and Vivity (0.0 logMAR at 66 cm). The LuxSmart and Vivity produced greater halos than the Tecnis ZCB00, but they showed little change with larger pupils. The Isopure lens showed a pupil-dependent halo. CONCLUSIONS: The expected visual acuity decreased with the object distance differently, depending on the ERV design. The Vivity and LuxSmart lenses showed an expanded imaging capability (>= 0.50 D) with respect to a monofocal lens that may benefit intermediate vision. The Tecnis Eyhance and Isopure lenses showed more modest extensions that mainly rely on pupil constriction.