Quality of vision through diffractive bifocal intraocular lenses

Two elderly women have each received a monofocal intraocular lens in one eye and a 3M diffractive bifocal intraocular lens in the other eye. Both eyes were shown to have equivalent retinal/neural function by measuring contrast sensitivity to laser interference fringes which bypassed refractive and other defects of the ocular media. The eyes with a bifocal intraocular lens displayed a much greater depth of focus, though at the expense of diminished contrast sensitivity compared with the normal values expected for that age. Simulation experiments suggested that the observed reduction in contrast sensitivity was not adequately explained by a simple reduction in retinal illumination of the in-focus image as might intuitively be expected from the bifocal separation of incident light to two simultaneous focal points. The simultaneous superimposition of the out-of-focus image on the in-focus image must also be considered, since this caused a significant reduction in contrast sensitivity when the retinal illumination was insufficiently above the photopic luminance threshold.