Objective Evaluation and Comparison of Diffractive versus Refractive Phakic Intraocular Lenses for Presbyopia...

Phakic intraocular lenses (IOLs) have newly been introduced for presbyopia correction, with no studies to date directly comparing the various models to one another. This study assesses and compares the optical quality of two phakic IOLs - a diffractive IPCL (Care Group) with +2.5D added power and a refractive Artiplus (Ophtec) - in a laboratory setting.

A custom-made insert contained a -3D phakic IOL and a 23D monofocal (Precizon Monofocal, Ophtec). Two samples of each phakic IOL were tested using OptiSpheric IOL PRO2 under spherical and chromatic-aberration conditions at 3 and 4.5mm apertures at near (40cm), intermediate (67cm) and far distances. Modulation transfer function (MTF) related variables, and the 1951 USAF resolution target images were compared.

The MTFs at far distances, 67cm, and 40cm revealed minor differences between the two IOLs for a 3-mm pupil. Simulated visual acuity showed no disparity at distance but improved by 0.01 and 0.05 logMAR with Artiplus at intermediate and near points. Additionally, Artiplus exhibited a plateau in intermediate performance, while the IPCL demonstrated higher optical quality close to 50cm, corresponding to its secondary-focus location. Both lenses showed reduced optical quality with larger apertures. The USAF resolution target results supported these findings.

Artiplus and IPCL (+2.5D add) showed good optical quality across the focus range, with Artiplus having a flatter simulated defocus curve. While the expected visual acuity differences were minimal, they may become more pronounced in patients with larger pupils, warranting further investigation.