A Comparative Analysis of the Effects of Misaligning Different Trifocal Intraocular Lenses

This laboratory study aims to assess the effects of misaligning different trifocal intraocular lenses (IOLs) under varying spectral and corneal spherical aberration (SA) conditions. With an IOL metrology device under monochromatic and polychromatic conditions, the following models were studied: AT ELANA 841P, AT LISA Tri 839MP, FineVision HP POD F, Acrysof IQ PanOptix, and Tecnis Synergy ZFR00V. The SA was simulated using an aberration-free and average-SA cornea. The modulation transfer function (MTF) was measured at different pupil sizes for the on- and off-axis lens positions. The IOLs exhibited varying responses to decentration up to 1 mm, showing the lowest impact in polychromatic light. The least affected was AT ELANA, with an MTF loss of 15.7% to 28.4% at 50 lp/mm across the studied conditions. It was followed by PanOptix and FineVision, with the MTF loss ranging from 19.1% to 36.0% and from 21.2% to 46.6%. AT LISA showed a more substantial reduction, i.e., 41.2% to 64.8%, but it was still lower than that of Synergy (51.1% to 78.8%). When decentration was induced at a 4.5 mm distance, its effect was more evident in conditions that were closer to each IOL's SA correction. A tilt of 5° had a lesser impact than 1 mm decentration, with the effect being more severe at 4.5 mm. The off-axis position affects the optical quality of trifocal IOLs. Low- rather than high-SA-correcting trifocals perform better under misalignment. In polychromatic light, the impact of misalignment is less evident, suggesting a potential mitigating effect of chromatic aberration.