A Comparative Analysis of Tolerance to Induced Astigmatism Across Various Categories of Intraocular Lenses

Purpose: To compare tolerance to induced astigmatism (TIA) across four intraocular lenses (IOLs). Setting: Medical University of South Carolina, Charleston, South Carolina, USA. Design: Prospective observational study. Methods: Patients underwent cataract surgery with a standard monofocal (ZCB00), enhanced monofocal (DIB00), diffractive violet light filter (VLF) extended depth of field (DOFi) (ZXR00V), or VLF full DOFi (DRN00V) IOL. At 1–3 months postoperatively, astigmatic defocus (0.5–2.0 D) was simulated in WTR, oblique, and ATR orientations. Results: 100 patients were included. DCIVA was statistically significantly better with VLF extended DOFi compared with the monofocal (P≤0.001) and enhanced monofocal IOLs (P=0.002). DCNVA was significantly better with VLF Full-DOFi IOL than with all other groups (P<0.001). No statistically significant differences were observed among the four IOL groups with induction of WTR astigmatism ≤1.0 D. At 0.5D oblique, the enhanced monofocal group outperformed the extended DOFi group (P=0.014), and at 2.0 D induced oblique astigmatism, it surpassed all other IOL groups. The enhanced monofocal IOL group showed the greatest tolerance to induced ATR astigmatism across all magnitudes. The VLF Full-DOFi IOL group maintained astigmatic tolerance like standard monofocal, enhanced monofocal, and extended DOFi IOLs up to 2.0 D in WTR and ATR, and 1.5 D in oblique orientations. Conclusion: TIA was not statistically significantly different among the standard monofocal, enhanced monofocal, VLF extended DOFi, and VLF Full-DOFi IOL groups with low to moderate induced WTR astigmatism. The enhanced monofocal IOL provided the greatest tolerance to induced astigmatism, especially under oblique and ATR astigmatic defocus.