Influence of Corneal Higher Order Aberrations on Visual Performance With a Multifocal Intraocular Lens

Purpose To evaluate the impact of corneal aberrations on the visual performance of patients who received a multifocal intraocular lens (MIOL) implant. Methods Two hundred seventy patients who underwent cataract or refractive lens exchange and were implanted with an apodized diffractive MIOL were included in the analysis. Relationships between total higher order aberrations (HOAs), coma, trefoil, and spherical aberration (SA) measured with a Scheimpflug topographer at 4 mm versus visual acuity and contrast sensitivity areas under the defocus curves (AUC) were evaluated. Relationships between other demographic and biometric variables with total AUCs were also explored. Results Eyes rarely showed coma and trefoil aberrations exceeding 0.2 μm, 0.1 μm for SA, and 0.3 μm for the total HOAs. The total HOAs showed correlations with age (rho = 0.32, P < .0005) and anterior chamber depth (rho = −0.21, P = .001). The mesopic pupil size, age, and chart luminance, in the following order, were mainly correlated with total AUCs. A correction by mesopic pupil was required to unmask weak correlations of AUCs with the corneal aberrations. These were found particularly for total HOAs and total and near AUCs ( P < .05). Conclusions Values below 0.3 μm for total HOAs, 0.2 μm for coma and trefoil, and 0.1 μm for SA at 4 mm are safe for the study IOL. Higher values are rare but still can be safe, and the 0.5 μm cut-off at 4 mm for contraindication merits further research with this and other IOLs. [ J Refract Surg . 2025;41(4):e291–e299.]