Static and Dynamic Factors Associated With Extended Depth of Focus in Monofocal Intraocular Lenses

Am J Ophthalmol. 2020 Aug:216:271-282. doi: 10.1016/j.ajo.2020.04.014. Epub 2020 Apr 23.


Purpose: To analyze factors affecting depth of focus (DOF) and near vision functionality in eyes implanted with aspheric monofocal intraocular lenses (IOLs).

Methods: This prospective study included 111 eyes of 74 patients that underwent phacoemulsification with monofocal IOL implantation. Ninety-one normal eyes were randomized to receive aberration-free (n = 30) or negative-spherical aberration (SA) IOLs (n = 61). Twenty post-hyperopic femto-LASIK eyes received aberration-free IOLs. Corneal higher-order aberrations (SA, coma, trefoil, and corneal asphericity) for a 6 mm pupil were measured by Scheimpflug tomography. Ray-tracing metrics (visual Strehl optical transfer function [VSOTF], effective range of focus [EROF], sphere shift [SS], EROF-SS), pupil size measurements at far and near, and ocular and corneal SA were obtained using ray-tracing aberrometry. Distance-corrected near visual acuity (DCNVA) and subjective defocus curves up to ±4.0 diopters were evaluated.

Results: Multivariable logistic regression found corneal profile and IOL type to be determinants of extended DOF with monofocal IOLs. The aberration-free IOL group showed significantly better DCNVA and higher total SA than the negative-SA group. Post-hyperopic LASIK eyes showed significantly better DCNVA; higher negative SA, coma, and Q value (P < .05), and smaller pupil size (P = .05) than normal eyes implanted with aberration-free IOLs.

Conclusion: Corneal profile and type of IOL implanted were the most important factors influencing near vision functionality with aspheric monofocal IOLs. Higher positive SA in the aberration-free group potentially led to better DCNVA than the negative-SA group in normal eyes. Hyperprolate corneas had better DOF curves and DCNVA than normal corneas. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aberrometry
  • Aged
  • Aged, 80 and over
  • Corneal Wavefront Aberration / physiopathology
  • Depth Perception / physiology*
  • Female
  • Humans
  • Lens Implantation, Intraocular*
  • Lenses, Intraocular*
  • Male
  • Phacoemulsification*
  • Prospective Studies
  • Pseudophakia / physiopathology
  • Refraction, Ocular / physiology
  • Visual Acuity / physiology