OPTICAL QUALITY IN DECENTRATION OF INTRAOCULAR LENSES: an updated systematic review

Area of Science:

• Ophthalmology
• Optical Engineering
• Biomedical Optics

Background:

• Intraocular lens (IOL) decentration, a common postoperative complication, can impact visual acuity and quality.
• Understanding the optical consequences of IOL decentration is crucial for patient satisfaction and visual performance.

Purpose of the Study:

• To evaluate the impact of IOL decentration on optical quality and performance.
• To analyze the response of different IOL designs (monofocal, extended depth of focus [EDoF], multifocal, toric) to decentration.

Main Methods:

• A systematic review of 74 peer-reviewed optical bench studies published within the last 20 years.
• Data extraction on optical metrics (MTF, Strehl ratio, aberrations, PSF) related to IOL decentration and lens types.
• Utilized ray-tracing numerical simulations to complement experimental data.

Main Results:

• Aspheric monofocal IOLs with negative spherical aberration showed greater optical degradation than spherical models when decentered.
• Multifocal and EDoF IOLs exhibited higher sensitivity to decentration, leading to reduced image quality and contrast.
• Toric IOLs were particularly affected by decentration combined with rotational misalignment.

Conclusions:

• IOL decentration has a measurable and clinically significant impact on optical quality, particularly for aspheric and multifocal IOL designs.
• Optimal IOL centration is not always achievable due to anatomical variability, emphasizing the need to understand lens-specific decentration tolerance.
• Knowledge of how different IOL designs tolerate decentration is essential for appropriate lens selection and optimizing postoperative visual outcomes.