Tilt and decentration with various intraocular lenses: A narrative review

We find that tilt and decentration of intraocular lens (IOL) commonly cause visual quality deterioration after cataract surgery. Multiple factors affect IOL tilt and decentration in the pre-, mid-, and post-operation phases. Moreover, the tilt and decentration of 1-piece IOL are less correlated with internal ocular HOAs than those of 3-piece IOL. Aspherical IOLs are more sensitive to decentration or tilt than spherical IOLs. Furthermore, the optical performance of toric IOLs with an accurate axis remains stable irrespective of tilt and decentration. The optical quality of asymmetric multifocal IOLs varies significantly after decentration and tilt in different directions. The image quality enhances or deteriorates in the direction of the decentered IOL. An extended depth of focus IOL can achieve good visual acuity in the distant, intermediate, and near range. Additionally, its tilt and decentration have less impact on the vision than bifocal and trifocal IOL. This is the first review that compares the effect of IOL tilt and decentration on image quality for various IOL designs. The result indicates that a deeper understanding of tilt and decentration of various IOLs can help achieve a better visual effect to visually improve refractive cataract surgery.