Optical and simulated visual outcomes of two presbyopia-correcting intraocular lenses tested in clinically relevant decentration and tilt conditions.

We evaluated the effect of intraocular lens (IOL) misalignment on image quality under clinically relevant conditions (0.2, 0.4 mm decentration and 2°, 4° tilt). Two presbyopia-correcting IOLs, an extended depth of focus (EDOF) (Alcon Vivity) and a diffractive multifocal (Alcon PanOptix), were tested. Through-focus modulation transfer function (MTF)-based measures were taken using an on-bench model eye with average corneal spherical aberration and apertures of 3.0 and 4.5 mm. Optical image quality and simulated visual acuity (VA) were assessed for both aligned and misaligned IOLs. The aligned EDOF lens showed superior distance vision quality compared to the multifocal, particularly with the 4.5 mm pupil. The EDOF lens was, however, more sensitive to decentration than the multifocal, which showed very low sensitivity across far, intermediate, and near regions with both apertures. Degradation with IOL tilt occurred at a slower rate than with decentration. Despite the optical degradation produced by mild misalignment (up to 0.4 mm decentration and 4° tilt), the predicted VA demonstrates that these effects should be negligible on postoperative vision with a 3 mm pupil. This holds true not only at a far distance, but also at the relevant intermediate and near foci.