Pupil dependence assessment with multifocal intraocular lenses through visual acuity and contrast sensitivity defocus curves

Eur J Ophthalmol. 2021 Nov;31(6):2989-2996. doi: 10.1177/1120672120940202. Epub 2020 Jul 3.


Purpose: To identify the most sensitive visual performance metric for evaluating the pupil-dependency of a multifocal intraocular lens (MIOL) and to determine the pupil measurement method most correlated with such metric.

Methods: Twenty-seven right eyes implanted with a MIOL were included in the analysis. Three pupil size measurements were obtained preoperatively and at 1 month after surgery with the Keratograph 5M system: photopic (PP), mesopic (MP), and the average from both (AP). Pupil was also measured with a rule (RP) under the same light conditions of postoperative visual performance measurements that included, corrected visual acuities (VA) at three distances (far, 67 cm and 40 cm), visual acuity (VADC) and contrast sensitivity defocus curves for optotype sizes of 0.3 logMAR (CSDC3) and 0.7 logMAR (CSDC7). Differences in visual performance were also analyzed for eyes with RP > 3 mm (Group A) and RP ⩽ 3 mm (Group B).

Results: PP diameter decreased after surgery by 16% (p = 0.001), whereas MP (p = 0.013) and AP (p = 0.008) decreased by 10%. The best agreement with RP was obtained for AP. Group B showed a trend to better performance than Group A for all the included metrics (p > 0.05). From the three types of defocus curves, CSDC3 obtained generally highest statistical power for testing differences between groups. The strongest statistically significant correlations between pupil size and CSDC3 were obtained for RP and AP.

Conclusion: The CSDC3 was the most sensitive metric to detect MIOL pupil-dependency. PR and AP were more correlated with CSDC3 than PP and MP.

Keywords: Multifocal intraocular lens; contrast sensitivity; defocus curves; visual acuity.

MeSH terms

  • Contrast Sensitivity
  • Humans
  • Lens Implantation, Intraocular
  • Lenses, Intraocular*
  • Multifocal Intraocular Lenses*
  • Phacoemulsification*
  • Prospective Studies
  • Prosthesis Design
  • Pupil
  • Visual Acuity