Comparison of tolerance to induced astigmatism in pseudophakic eyes implanted with small aperture, trifocal, or monofocal intraocular lenses

Purpose: To compare the effect of induced astigmatic defocus on visual performance in pseudophakic eyes implanted with a small aperture, trifocal, or monofocal intraocular lens (IOL). Patients and methods: The study included 44 eyes with one of four types of IOL (IC-8 IOL (AcuFocus Inc., USA); FineVision (PhysIOL SA, Belgium); AT Lisa (Carl Zeiss AG, Germany); and enVista monofocal (Bausch & Lomb, USA). For astigmatic tolerance assessment, monocular distance visual acuity was measured with cylindrical lenses (power range=0.00–2.50 diopters (D) in 0.50 D increments) added to the subjects best-corrected distance manifest refraction. The assessment was repeated on three pre-determined axes (90°, 180°, and either 45° or 135°). The magnitude of astigmatic tolerance at each defocus step was assessed by taking the difference between logMAR visual acuity at the defocus step relative to that at 0.0 D (ie, no defocus condition). Results: Across all three axes, the reduction of mean monocular visual acuity at all defocus levels relative to no defocus was significantly smaller in IC-8 group compared to the other IOL groups. When the data was combined across all axes, the astigmatic tolerance of the IC-8 group was better than AT Lisa group from 0.50 D to 2.50 D and FineVision group from 0.50 D to 1.50 D (all P<0.05, ANOVA). The IC-8 group was better than the enVista group, but not significantly (P>0.05, ANOVA). Among individual orientations, statistically significant differences were seen between IC-8 IOLs and the other IOLs, with the largest difference being in the oblique axis. Astigmatic tolerance at all axes combined was 1.40 D for IC-8 IOL, 0.70 D for AT Lisa and FineVision, and 1.00 D for enVista IOLs. Conclusion: The small aperture IC-8 IOL showed greater tolerance to induced astigmatic defocus compared to trifocal and monofocal IOLs.