Association of intraocular lens tilt and decentration with visual acuity using SS-OCT-based analysis

Abstract Purpose To evaluate the association of postoperative IOL tilt and decentration and corrected distance visual acuity (CDVA) by performing analyses using IOLMaster700 data and custom-developed software. Setting University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands. Methods This case series included patients after cataract surgery who underwent SS-OCT scans using the IOLMaster700 with custom-developed software for tilt and decentration analyses. The outcomes based on our custom-developed software were conducted along the pupillary axis (PA) and corneal topographic axis (CTA). Associations between tilt, decentration and CDVA were evaluated. Results A total of 168 eyes (168 patients) were analyzed. The maximum observed IOL tilt was 9.54° along the CTA and 3.69° along the PA. Maximum decentration reached 2.22 mm (CTA) and 2.17 mm (PA). Mean tilt was 1.21 ± 0.69° (PA) and 4.87 ± 1.52° (CTA), while mean decentration was 0.27 ± 0.25 mm (PA) and 0.27 ± 0.26 mm (CTA). Regression analyses showed no statistically significant associations between tilt or decentration and CDVA, irrespective of the reference axis used. For tilt along the PA, the regression coefficient (B) was 0.004 (95%CI -0.011, 0.020; P = 0.592), for tilt along the CTA, B was − 0.006 (95%CI -0.013, 0.001; P = 0.082). For decentration, B was 0.012 (95%CI -0.020, 0.044; P = 0.455) and 0.002 (SE = 0.018, 95%CI -0.034, 0.037; P = 0.925) along the PA and CTA, respectively. Conclusion In this cohort, IOL tilt and decentration were generally small, with no detectable association with CDVA. The findings emphasize that different assessment methods should not be used interchangeably, and potential effects cannot be excluded given the limited sample and range of values.