Differences in visual quality with orientation of a rotationally asymmetric bifocal intraocular lens design

Purpose To evaluate visual and perceptual performance for different orientations of a rotationally asymmetric bifocal intraocular lens (IOL) (M‐Plus) simulated optically using a simultaneous vision simulator. Setting Instituto de Optica, Madrid, Spain. Design Prospective observational study. Methods Perceptual quality and decimal high‐contrast visual acuity (HCVA) was measured under cycloplegia for 8 orientations of the asymmetric bifocal IOL phase pattern at far, intermediate, and near distances simulated with a simultaneous vision simulator using face images and tumbling E targets. The preferred orientation at each distance was calculated as the centroid of the data for 8 orientations. The visual Strehl value was calculated using the subjects’ ocular aberrations and multifocal pattern at each orientation. Optical predictions were obtained by implementing a differential visual Strehl values–based ideal observer model. Results The study comprised 20 subjects (aged 21 to 62 years). Horizontal orientation (near segment at 0 or 180 degrees ± 45 [SD]) was preferred by 14 subjects and by 13 subjects at far and near distances, respectively; 8 subjects showed strong orientation preferences. The mean difference in preferred orientation between far and near was 27 ± 22 degrees. No significant differences in HCVA were observed. Optical predictions correlated strongly and significantly with measurements (far r = 0.71, near r = 0.62; P < .0001). The mean difference between measurement and simulation in the preferred orientation was 28 ± 29 degrees at far and 36 ± 28 degrees at near. Conclusions The perception varied for different orientations of an asymmetric bifocal IOL design tested using a simultaneous vision simulator. Optimum orientation was driven by interactions of the design with the eye’s optical aberrations. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned.

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