Visual simulation to customize depth of focus with ArtIOL aspheric intraocular lenses

Purpose: A new type of aspheric intraocular lenses (IOLs) has been designed to increase depth of focus. To account for individual differences in the patient’s eye optics and neural response, the specific value of spherical aberration of the IOL to be implanted needs to be customized. We evaluate a customization procedure using an adaptive optics visual simulator.
Methods: An Adaptive Optics Visual Simulator (VAO, Voptica SL, Murcia, Spain) was used to measure visual acuity (VA) at far, intermediate (80 cm) and near (40 cm) distances in 6 eyes with paralyzed accommodation. A new type of aspheric IOL with four models having different values of spherical aberration (ArtIOLs, Voptica SL, Murcia, Spain) were simulated. Inter-subject averages and 95% confidence intervals (CI), calculated as 1.96*SD, were estimated for all viewing distances.
Results: The mean values of VA at intermediate and near distances improved (from 0.06 to -0.05 at intermediate, from 0.62 to 0.12 LogMAR at near) as asphercity increased while VA at far decreased slightly (from -0.11 to -0.01 LogMAR). However, visual performance for each lens design depended on each subject with an inter-subject variability of VA, expressed as CI, ranging between 0.07 and 0.29 LogMAR.
Conclusions: A new type of aspheric IOLs have been designed to obtain different ranges of depth of focus (ArtIOLs). Each model can provide quite different visual performance for different subjects at different distances. Preoperative visual simulation using adaptive optics instruments, such as VAO, would allow selection of the optimum type IOL to customize vision.