Effect of Decentration on the Optical Quality of Monofocal, Extended Depth of Focus, and Bifocal Intraocular Lenses

PURPOSE: To compare the effect of intraocular lens (IOL) decentration on the optical quality in patients with implantation of three IOLs: monofocal, extended depth of focus (EDOF), and bifocal. METHODS: Patients had cataract surgery with implantation of one of the three above-mentioned IOLs. Higher order aberrations (HOAs), modulation transfer function (MTF), point spread function (PSF), retinal straylight, and dysphotopsia phenomena were evaluated 3 months after surgery. IOL decentration was quantified as the distance between the visual axis center and the IOL center using the OPD-Scan III aberrometer (Nidek Co., Ltd., Gamagori, Japan). The patients who received each IOL type were then divided into two subgroups (decentration of <= 0.25 or > 0.25 mm) to analyze the effect of IOL decentration on these optical qualities. RESULTS: The study included 54 eyes (54 patients), with 18 eyes in each IOL group. The distance of IOL decentration did not differ significantly among the three groups. With a decentration of more than 0.25 mm, MTF, PSF, and coma were only significantly deteriorated in the bifocal IOL (ZMB00; Abbott Medical Optics, Santa Ana, CA). HOAs, coma, PSF, and glare perception were better in the monofocal and EDOF IOLs than those in the ZMB00 IOL when decentration was more than 0.25 mm. Furthermore, IOL decentration was significantly correlated with HOAs, coma, MTF, and PSF in the ZMB00 IOL. CONCLUSIONS: The monofocal and EDOF IOLs are more immune to optical quality degradation caused by IOL decentration than the ZMB00 IOL.