The Future of Intraocular Lenses Optical Quality, Peripheral Imaging and Accommodative Concepts

Purpose: To evaluate the limitations of current intraocular lenses (IOLs) regarding peripheral image quality, glare and mesopic vision, and to outline future IOL concepts based on the anatomy of the natural crystalline lens. Methods: Personal clinical and photographic experience using the Retcam wide-field fundus imaging system (≈160°) was analysed in pseudophakic eyes with different IOL designs. Findings were compared with anterior-segment OCT imaging of the natural lens versus pseudophakia, with data from retinal laser surgery using the Goldmann three-mirror contact lens, and with recent published studies on aspheric, extended-depth-of-focus (EDOF), multifocal and accommodative IOLs. Results: Symmetrically biconvex IOLs with an optic diameter of 6.0 mm (effective optical zone often only 5.5 mm) produced pronounced ring-shaped light reflexes that overlapped the macula, optic disc and mid-periphery. IOLs with a stronger posterior curvature and aspheric design, as well as IOLs with a diameter adapted to axial length (7.5 mm for 8–15 D to 6.0 mm for 25.5–30 D), showed markedly smaller ring reflexes and better central and peripheral image quality. Dual-optic accommodating IOLs demonstrated greater axial displacement and better accommodative capacity than single-optic systems, but near vision and long-term stability remain limited, mainly due to capsular fibrosis and posterior capsular opacification. Conclusion: IOL designs that imitate the asymmetric curvature of the natural lens and adapt optic diameter to ocular anatomy improve peripheral image quality and reduce glare. Accommodating and modular systems, particularly a movable optic within an artificial capsular bag, represent a promising future direction beside all EDOF and advanced IOL-concepts using AI. Further controlled studies of all of them are required.