Tolerance to IOL Decentration and Tilt in five Presbyopia-Correcting IOLs: A SS-AS-OCT-based study

Purpose: To compare the impact of intraocular lens (IOL) decentration and tilt on the visual performance of five presbyopia-correcting IOLs in patients after cataract surgery. Setting: Zhongshan Ophthalmic Center, Guangzhou, China. Design: Prospective, observational study Methods: Cataract patients undergoing uncomplicated phacoemulsification with extended depth-of-focus (EDOF) IOLs (Vivity, ZXR00) and FULL-Range of Field (RoF) IOLs (ZMB00, TFNT00, ZFR00V) were enrolled. Each IOL group was stratified by the third quartile (Q3) of IOL tilt and decentration measured by CASIA2. Intraocular higher-order aberrations (HOAs), contrast sensitivity (CS), modulation transfer function (MTF), Strehl ratio and patient-reported outcomes 3 months postoperatively were compared between subgroups. Results: A total of 260 patients (260 eyes) were included. Based on the Q3 values, eyes were categorized into tilt subgroups T1 (<5.63°) and T2 (≥5.63°), and decentration subgroups D1 (<0.24 mm) and D2 (≥0.24 mm). No significant differences in visual quality were observed between Vivity and ZXR00 subgroups. In contrast, T2 subgroups of TFNT00, ZMB00 and ZFR00V exhibited higher HOAs and coma, and lower CS, than their T1 subgroups (all P<0.05). The D2 subgroup of ZFR00V showed increased HOAs and coma, and reduced CS under photopic and mesopic conditions with glare (all P<0.05). The D2 subgroup of ZMB00 demonstrated higher HOAs and coma, as well as lower MTF (all P<0.05). The D2 subgroup of TFNT00 reported significantly lower patient satisfaction (3.25±0.46 vs 3.83±0.38, P=0.008). Conclusion: EDOF IOLs (ZXR00, Vivity) demonstrated greater tolerance to tilt and decentration compared to FULL-RoF IOLs (ZMB00, TFNT00, ZFR00V).