To log in, click the teal "Login" button in the upper right-hand corner of this page. If you are logged in but still do not have access, please check your 2026 Annual Meeting registration.
Moderator
Liliana Werner, MD, PhD
Panelists
John T LiVecchi, MD; Nick Mamalis, MD, ABO
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Seung Pil Bang, MD, PhD
Co-Authors
Hosik Hwang (MD, PhD), Chul Young Choi (PhD, MD), JongIn You (MD, PhD), Tun Kuan Yeo (FRCOphth), Seth Pantanelli (MD, MS)
Purpose
Scleral fixation techniques, including optic-piercing intrascleral fixation with C-loop or double C-loop haptics, are increasingly used for both monofocal and premium IOLs. This study evaluates the optical performance of refractive EDOF IOLs and simulates the effects of tilt and decentration commonly encountered with intrascleral fixation.
Methods
Three +20.0-D refractive EDOF IOLs — Vivity (Alcon), Eyhance (Johnson & Johnson Vision), and Galaxy (Rayner) — were evaluated using a Mach-Zehnder interferometer (NIMO TEMPO) and a PMTF optical bench (Lambda-X Ophthalmics) equipped with an aberration-neutral cornea model. Measurements were performed on-axis and with IOL tilts of 2.5° and 5°, and decentrations of 0.25, 0.50, 0.75, and 1.00 mm, using monochromatic 543-nm light. Optical path difference (OPD) maps were converted to wavefront profiles, point spread functions (PSFs), and modulation transfer functions (MTFs). Through-focus MTFs at 50 lp/mm were compared at a 3.0-mm pupil.
Results
The Galaxy IOL was robust to decentration up to 0.50 mm but showed deterioration of near-focus MTF with a 5° tilt, suggesting a trade-off with distance performance. Although Galaxy is not rotationally symmetric, the periodicity of its radial power profile resulted in comparable performance under tilt and decentration between the horizontal and vertical axes. Eyhance exhibited significant degradation in optical performance with tilt and decentration, whereas Vivity was minimally affected. The highest MTF values were observed for a well-centered Eyhance IOL.
Conclusion
Quantitative optical modeling of refractive EDOF IOLs reveals their functional behavior under tilt and decentration. Combining these data with patient-specific ocular parameters may support more personalized IOL selection and optimize visual outcomes when planning for intrascleral fixation.
Presenting Author
Morgan Micheletti, MD
Co-Authors
Liliana Werner (MD, PhD)
Purpose
To evaluate the structural and optical stability of intraocular lens (IOL) materials following 6 months of direct exposure on the exterior of the ISS, in order to identify degradation mechanisms and provide guidance for future packaging, transport, and surgical readiness for human spaceflight and planetary exploration.
Methods
A total of 135 IOLs representing different materials and optical designs, including hydrophobic acrylic, hydrophilic acrylic, silicone, collamer, and light adjustable models, were deployed for six months on the MISSE-20 platform outside the International Space Station. The IOLs were housed in CLAIRE modules at ram, zenith, and underdeck positions, with a WILLIAM module as the earthly atmospheric control. On orbit sensors recorded UV flux, atomic oxygen, ionizing radiation, and temperature cycling. Post flight analyses include gross inspection, light microscopy, spectrophotometry, SEM with EDS, and evaluation of optical performance to compare exposed IOLs with controls.
Results
Most remained clear (42 of 61). Dust/salt deposits were common; NaCl on EDS in hydrophilic/ICLs, with haze improving after water rinse/dry. Notable changes clustered in tray 1. Ram-facing: 8 lenses (5 hydrophobic acrylic, 2 hydrophilic acrylic, 1 ICL) had optic cracks/opacification with surface roughening on SEM, consistent with early polymer erosion; a tray-1 silicone lens did not. Zenith-facing: 5 lenses (2 hydrophobic acrylic, 3 silicone) yellowed with reduced 400-500 nm transmission. Underdeck: no major changes. All flown light-adjustable lenses (with/without ActivShield; n=6) developed diffuse cobblestone/bubble-wrap microtexture on both optic surfaces and edge, even in trays 4-5.
Conclusion
External ISS exposure produced directional effects that define failure modes for IOL logistics. These data support targeted shielding/packaging (vs climate-controlled crew cabin storage) to enable low-mass stockpiling of implants for exploration missions and to prioritize polymer-level follow-up studies to explain observed surface transformations.
Presenting Author
Ali Nowrouzi, MD, FEBO, FACS
Purpose
This study evaluates the visual function and patient satisfaction of the different multifocal IOLs models’ diffractive and refractive designs. Asqelio™ trifocal IOL (AST Products, Inc., Billerica, MA, USA) and Precizon Presbyopic NVA (Ophtec BV, Groningen, The Netherlands).
Methods
The study involved 60 eyes from 32 patients aged 45 and older with confirmed bilateral cataracts and regular corneal astigmatism of 0.75 diopters or less. Patients were randomized to receive either the Asqelio trifocal IOL or the Precizon multifocal IOL. The trifocal group included 29 eyes of 16 patients, while the multi-zonal refractive design IOL group included 31 eyes of 16 patients.
Results
Six months after surgery, no significant difference in uncorrected distance visual acuity (UCDVA) was observed between the two groups (P = 0.503), with 98% of patients achieving 20/20 or better. Both groups experienced significant reductions in corneal astigmatism. Patient satisfaction was high in both groups, with scores of 96.6 ± 1.25 for the Asqelio group and 98.4 ± 0.5 for the Precizon group. The Asqelio group showed greater independence for near-vision tasks, while dysphotopsias were more common in the Asqelio group, particularly at night.
Conclusion
Both IOLs provided excellent visual outcomes and high patient satisfaction. While the Asqelio IOL was advantageous for delicate near-vision tasks, the Precizon IOL demonstrated fewer photic disturbances.
Presenting Author
Billy R. Hammond, Jr., PhD
Co-Authors
Lisa Renzi-Hammond (PhD), Jacob Harth (PhD), Yaw Buabeng (OD, MS)
Purpose
Several studies have suggested that blue-light filtering (BLF) can enhance the perception of brightness. The present study tested whether a common BLF profile used in intraocular lens (IOL) designs would influence brightness perception of natural images in pseudophakic individuals.
Methods
Forty pseudophakic participants (M=71.15±2.27 years), recruited from local ophthalmic practices, with 20/40 or better best uncorrected visual acuity implanted with clear IOL implants completed a brightness matching task. Participants viewed a series of natural images through both a clear extraocular filter and a BLF (counterbalanced, randomized) and adjusted a short-wave deficient comparison field until the natural scene and the comparison field were perceived as equally bright. Matched luminance values (log relative energy, LRE) were recorded across three trials per image, across short-, mid and long-wave dominant images, and an achromatic image.
Results
Averaged across all images, the clear lens (X?=2.74±0.14) resulted in significantly lower (t[78] = -2.529, p = 0.007) LRE values compared to the BLF test lens (X?=2.82±0.15). When the natural scenes were tested independently, this brightness enhancement effect was consistent across four of five images tested, independent of image contrast or chromatic content.
Conclusion
The BLF modestly (~17%), but consistently, increased perceived brightness in pseudophakic adults. These results support the notion that selective spectral filtering can enhance brightness perception, potentially by altering photoreceptor contributions within the luminance pathway.
Presenting Author
Lisa M. Renzi-Hammond, PhD
Co-Authors
Billy Hammond (PhD), Jacob Harth (PhD), Spencer Smith (MPH)
Purpose
This study tested the hypothesis that a commercially available blue-light filtering (BLF) lens can improve visual range under simulated blue haze conditions in older pseudophakic adults. Blue haze has been shown to reduce contrast and prior models suggest contrast sensitivity under these conditions can be improved by short-wave filtering.
Methods
Forty older pseudophakic adults (M = 71.15 ± 5.82 years) were tested using a single-blind, cross-over design. Participants with 20/40 or better best uncorrected visual acuity and a clear intraocular lens (IOL) implanted were recruited from local ophthalmic practices. Visual range was assessed via a custom two-channel optical system presenting a sinusoidal grating target veiled by adjustable blue haze (CCT = 9424 K). Participants viewed the target through a clear control or a test BLF lenses in randomized order. Visual range thresholds, defined as the maximum blue haze energy tolerated before target detection failed, were determined using the psychophysical method of limits.
Results
Participants tolerated significantly greater average blue haze energy with the BLF lens (3.46 log relative energy [LRE]) than with the clear control lens (3.37 LRE) (Z = -5.40, p < 0.001). On average, the BLF lens allowed participants to withstand approximately 19% more veiling luminance before target obscuration.
Conclusion
Consistent with theoretical predictions and prior findings in younger adults, short-wave filtering significantly enhanced visual range in older pseudophakic participants under simulated blue haze conditions. These findings suggest that BLF lenses offer functional visual benefits in older adults, especially in populations with clear IOL implants.
Presenting Author
Vance M. Thompson, MD
Co-Authors
Kelly Liu (OD), Eugene Osae Appenteng (PhD), Linda Tsai (MPH)
Purpose
To evaluate the clinical tolerance to refractive error of a new purely refractive TECNIS EDOF IOL as compared to a standard aspheric monofocal IOL.
Methods
This was a prospective, multicenter, randomized, subject/evaluator masked clinical study conducted in the U.S. (9 sites). Subjects were bilaterally implanted with a purely refractive EDOF IOL or monofocal control, TECNIS 1-piece Monofocal IOL. The defocus curve was generated using a direct testing method to assess visual acuity across a range of +1.0 to -2.5 D for 113 EDOF and 110 control subjects at the 6-months visit. Sub-group analysis was also done on subjects with absolute post-op spherical equivalent (SEQ) > 0.25 D in one or both eyes. Mean binocular uncorrected distance visual acuity (UDVA), patient satisfaction with distance vision, and need for distance glasses are presented.
Results
Binocular defocus testing showed that comparable percentages of EDOF and control subjects (?94%) saw DCVA 20/25 or better with induced defocus of ±0.25 and ±0.5 D. The following sub-group analysis outcomes included 62 EDOF and 54 control subjects. Mean absolute SEQ pooling first and second eye data was 0.40 ± 0.27 D for EDOF and 0.36 ± 0.23 D for control group. Mean binocular UDVA were -0.01 ± 0.08 for EDOF and -0.04 ± 0.11 logMAR for control subjects. 97% of EDOF and 94% of control subjects were completely or mostly satisfied with their uncorrected overall vision. 92% of EDOF and 87% of control subjects did not need spectacle correction for distance.
Conclusion
The new purely refractive EDOF IOL demonstrated high tolerance to residual refractive error. Patients with the refractive EDOF IOL showed excellent uncorrected distance VA, high spectacle independence for distance, and high satisfaction with distance vision, comparable to a monofocal IOL, even in the presence of refractive error.
Presenting Author
Sonal Shah, DOMS
Purpose
To assess the effect of glare on contrast sensitivity in eyes implanted with asymmetric refractive EDOF and trifocal IOLs
Methods
A retrospective study where subjects implanted with asymmetric refractive EDOF (Lentis Comfort,Teleon Surgical BV) and trifocal (PanOptix, Alcon) IOLs, aged between 40-70 years and best corrected visual acuity better than 0.1 logMAR were enrolled. Subjects with intra operative complications, ocular disease were excluded. Effect of glare on contrast sensitivity was measured at post operation 1 month ± 7 days using CSV- 1000 HGT (Vector Vision). Contrast sensitivity at 4 spatial frequencies (3, 6, 12 and 18 cycles per degree (CPD)) measured with and without glare sources were measured and analyzed.
Results
44 and 34 eyes were implanted with asymmetric refractive EDOF and trifocal IOL. The Mean±SD age of the subjects implanted with asymmetric refractive and non diffractive EDOF IOL was 58.82±10.07 and 57.88±8.5 years respectively. The contrast sensitivity with and without glare was found to be similar at all spatial frequencies (Paired t Test, p>0.05) in both the IOLs.
Conclusion
We did not find any effect of glare on contrast sensitivity in eyes implanted with asymmetric refractive EDOF and trifocal IOL.
Presenting Author
Jimmy Y Hu, MD
Purpose
To evaluate visual outcomes and patient satisfaction in patients with a history of myopic LASIK or PRK after having undergone cataract surgery with a non-diffractive extended depth of focus (EDoF) intraocular lens (IOL).
Methods
This was a prospective, non-interventional, single-arm observational study of visual outcomes of subjects who had a history of either post-myopic LASIK or post-myopic PRK and underwent uncomplicated cataract surgery, with implantation of a non-diffractive EDoF IOL (Alcon Vivity). Outcomes measures included monocular and binocular uncorrected and distance corrected visual acuities at distance (UDVA, CDVA), distance-corrected visual acuities at intermediate (DCIVA; 66cm), and near (DCNVA; 40cm), binocular defocus curve, and administration of lifestyle satisfaction questionnaire (IOLSAT) and non-directed questions for visual disturbances.
Results
The study analyzed 40 eyes from 24 patients (16 bilateral, 8 unilateral). Mean monocular CDVA was 0.009 ± 0.0417 logMAR (approx. 20/20). Mean binocular UDVA was 0.053 ± 0.0995 logMAR (approx. 20/22), DCIVA was 0.123 ± 0.0883 logMAR (approx. 20/25), and DCNVA was 0.296 ± 0.0712 logMAR (approx. 20/40). Mean binocular 25% low-contrast CDVA was 0.071 ± 0.0594 logMAR (approx. 20/25). Patient-reported satisfaction was high. Of binocular patients, 87.5%, 100%, and 43.75% reported spectacle independence at distance, intermediate, and near. Patient-reported satisfaction was high, with 93.75% of participants reporting they would choose the same lens again.
Conclusion
Implantation of the non-diffractive EDOF Vivity IOL in eyes with prior myopic LASIK/PRK provides excellent distance and intermediate vision, functional near vision, and a high level of patient satisfaction. These outcomes suggest this IOL is a viable and effective option for achieving a broad range of vision in this patient population.
Presenting Author
Ramin Khoramnia, FEBO
Co-Authors
Kamal Das (PhD, MBA), William Dolla (PhD), Arun Suryanarayanan (PhD)
Purpose
It is known to the ophthalmic community that IOLs can move axially post implant. Axial displacement is the key indicator of IOL instability and potential refractive outcomes (PREs). The purpose of this study is to evaluate the PRE outcomes for five widely used Monofocal IOLs based on the axial displacement in three different capsular bag sizes.
Methods
In this study, three different human capsule models of 9.0, 9.5, and 10.0 mm diameter were developed based on clinical data to mimic human eye physiology using ANSYS. The IOLs used in this evaluation are Alcon Acrysof SN60WF and Clareon CNA0T0, JnJ Tecnis ZCB00, B&L enVista MX60, and Hoya Vivinex XY1. The PRE values were computed based in a ZEMAX ray trace model using IOL power calculation formula and axial shift for each lens in all three capsule sizes.
Results
The PRE for both SN60WF and CNA0T0 are less than 0.25 D in three capsule models. The XY1 and ZCB00 show 0.31 D and 0.45 D of PRE in the average capsule model. Both XY1 and ZCB00 show a PRE of about 0.53 D in the small capsule. The MX60 demonstrated the highest amount of PRE of about 2.13 D in human capsular bag models compared to all other IOLs.
Conclusion
CNA0T0 is the most stable IOL geometry in three human capsule computational models, which is like the historically most stable SN60WF platform. The PRE for both XY1 and ZCB00 IOLs is twice as large as compared to CNA0T0. MX60 IOL demonstrated the highest amount of displacement and resulted in the most PRE in the human capsule computational models.
Presenting Author
Zhaoxing Dai, MD
Purpose
To evaluate the safety and efficacy of a novel diffractive five-focus aspheric intraocular lens (IOL) based on Fourier harmonic wavefront modulation. This IOL was developed to provide full-range vision correction in presbyopic and cataract patients, extending depth of focus across five discrete focal points.
Methods
A prospective, multicenter, randomized, controlled clinical trial was conducted at 8 hospitals across China from April 2023 to October 2024. A total of 188 subjects were enrolled and randomized into a test group (PMEA60, n=94) and a control group (AT LISA Tri 839MP, n=94). The primary endpoints were the proportion of eyes achieving CDVA (distance vision at 4m), DCIVA (intermediate vision at 80cm), and DCNVA (near vision at 40cm) of 0.5 (decimal acuity) or better at 6 months postoperatively. Non-inferiority was tested with a −10% margin. Secondary endpoints included defocus curves, spectacle independence, visual function, satisfaction, contrast sensitivity, and adverse events.
Results
The test IOL achieved non-inferiority to the trifocal control across all primary visual acuity endpoints. The defocus curve of the PMEA60 was smoother and flatter, indicating improved continuity of vision from 40cm to infinity, with visual acuity exceeding 0.2 logMAR across the full range. At 6 months, 91.4% of patients in the test group reported partial or complete spectacle independence, 87.1% reported significant improvement in visual quality, and 91.4% expressed high satisfaction. No significant differences were observed in safety profiles, including endothelial cell density, intraocular pressure, and contrast sensitivity. No new visual disturbances were reported.
Conclusion
The novel five-focus diffractive aspheric IOL based on Fourier harmonic design provides safe, effective, and continuous full-range vision. Compared to conventional trifocal lenses, this design significantly improves intermediate vision and defocus profile without introducing additional safety risks.
Presenting Author
Damien Gatinel, PhD, MD
Co-Authors
Benjamin Stern (MD)
Purpose
Intraocular lens (IOL) design is rapidly advancing, with refractive, diffractive, and EDOF options. Optimizing outcomes requires understanding subtle optical properties. We introduce a novel high-resolution wavefront reconstruction method using a Mach-Zehnder interferometer to assess monochromatic transmission of multiple IOL designs at 543 nm.
Methods
While the instrument's software provides sagittal cross-sectional metrics, we leveraged comprehensive raw data acquisition to enable a three-dimensional, high-resolution reconstruction of the transmitted wavefront in monochromatic light (543nm). Additionally, multiple custom-made wavefront fitting algorithms were applied to isolate fine variations in the optical path and reveal intricate features, including potential spiral (vortex) signatures. These measurements can then be used to study the optical behavior of the implants and how they modulate the retinal image. These data also enable patient-specific through-focus MTF simulations, bridging bench testing with clinical visual performance.
Results
Wavefront reconstruction encompassed diameters up to 6mm, incorporating over 10million data points. This unprecedented resolution allowed us to delineate the diffracted wavefront component in various monofocal, EDOF, and multifocal IOLs. Patient-specific corneal models were integrated to generate realistic through-focus MTF curves, linking bench IOL data with individualized optical performance. Certain EDOF IOLs—marketed as non-diffractive—displayed subtle phase shifts consistent with a "step" or partial diffractive structure. Meanwhile, analysis of a spiral lens showed no vortex or spiral pattern but exhibited a pronounced negative spherical aberration.
Conclusion
Our 3-dimensional, high-resolution wavefront analysis reveals subtle refractive, diffractive, and hybrid features that conventional methods often miss. This objective characterization across IOL designs strengthens the basis for refining lens technology, improving surgical outcomes, and enabling more realistic digital retinal image simulations.
Presenting Author
Francisco S�nchez de Le�n, MD
Co-Authors
Jaime Martiz (MD), Edwin Sarver (PhD), Matthew Schuster (BSc), Rocio Sanchez Sanoja (MD)
Purpose
To assess the safety and effectiveness of a novel small-diameter extended depth-of-focus intraocular lens (IOL) (Z+ IOL; Z Optics Inc., Reno, NV), engineered to provide good distance vision quality with acceptable intermediate and near visual acuity, and a low incidence of dysphotopsias.
Methods
This was a prospective, open-label, consecutive case series of 33 subjects aged 40-75 years, who underwent bilateral cataract surgeries with IOL implantation by a single surgeon at an ophthalmology surgical center in Mexico during 2023-2024. Vision and safety outcomes were evaluated through 6 months. Main safety outcomes were intraoperative and postoperative AEs and dysphotopsia type/severity. Main effectiveness outcomes were percent of eyes with monocular BCDVA of 0.3 logMAR (20/40 Snellen) or better, and binocular uncorrected acuity of 0.2 logMAR (20/32 Snellen) or better, at all distances. Secondary effectiveness outcomes included acuity under low-contrast and mesopic conditions.
Results
Data are from 66 eyes/33 subjects of mean age=64.1 years. No serious AE occurred in any eye/subject; 100% of subjects were halo-free and 79% were glare-free at 6 months. All eyes achieved BCDVA equal to/better than 0.3 logMAR, averaging 0.06±0.06 logMAR; 47% reached 20/20 Snellen BCDVA. Mean UCDVA was 0.16±0.08 logMAR. Mean UCNVA was 0.17±0.12 logMAR. Mean mesopic acuity was barely reduced: UCDVA=0.18±0.11 logMAR, BCDVA=0.08±0.08 logMAR, and UCNVA=0.18±0.11 logMAR (p>0.05 for all photopic comparisons). At 10% contrast, 58% of eyes showed UCIVA better than 0.3 logMAR (20/40 Snellen). Binocular VA was equal to/better than 0.2 logMAR (20/32 Snellen) in all subjects at all focal ranges.
Conclusion
The Z+ IOL safely provided outstanding distance vision outcomes, and also good acuity at intermediate and near focus distances, with well-maintained acuity under mesopic lighting and acceptable low-contrast acuity. Patient satisfaction was high, halos did not occur, and glare was markedly reduced from preoperative levels.
Presenting Author
Lional Raj Daniel Raj Ponniah, MD, PhD
Purpose
To evaluate post-operative visual outcomes of enhanced monofocal IOL (XY1-EM with central 2mm nano-thin optical elements with smooth surface profiling) - in terms of distant, intermediate, and near visual acuities, refractive outcomes, contrast sensitivity, objective ocular optical quality, in addition to patient experiences.
Methods
A Single-center, nonrandomized, ambidirectional cohort, from the records of adult patients who underwent uneventful sequential bilateral implantation of enhanced monofocal IOL (XY1-EM with central 2-mm nano-thin optical elements with smooth surface profiling), was postoperatively evaluated prospectively for visual performances, including defocus functions, aberrometry, contrast sensitivity (FACT sine wave tests), and objective evaluation of the ocular optical quality in addition to patient-reported outcomes for intermediate vision and NEI-VFQ25. The study included 136 eyes from 68 subjects.
Results
The Mean UCVA-distance was 0.03+/-0.01 Log MAR, UCVA-Intermediate (Defocus at 1.5D) was 0.13+/- 0.02, and UCVA for near was 0.35+/- 0.16. HOAs at mesopic conditions (5 mm pupil) were 0.22+/- 0.09 mic. The Mean of contrast sensitivity functions at 3,6,12,18 CPD were 1.76,1.98,1.63,1.23 Log CS under photopic conditions, & 1.71,1.94,1.61,1.21 Log CS under mesopic conditions, respectively. Over 86% of study subjects reported good driving comforts, and 92% subjects reported good uncorrected intermediate vision. The vision targeted composite score was 94% amongst subjects in the cohort.
Conclusion
XY1-EM Enhanced monofocal IOL showed excellent distance, intermediate visual outcomes, aberrometry, and photic phenomena perception. They represent an interesting option in the standard treatment of cataracts because they provide good spectacle independence for intermediate distances, while preserving excellent performance for distance vision.
Presenting Author
Ruth Sahler, MSc, ScD
Purpose
To evaluate how assumptions about corneal spherical aberration profiles influence modulation transfer function (MTF) outcomes when assessing intraocular lenses (IOLs).
Methods
Two commercially available IOLs with opposite spherical aberration correction designs were measured on a Lambda-X PMTF optical bench. MTF values were obtained at 100 lp/mm using two standardized corneal models, ISO1 and ME2, at a 4.5 mm aperture. Outcomes were compared to determine the dependence of reported optical quality on the corneal model used.
Results
The ME2-optimized IOL measured 0.50 MTF with the ME2 model but decreased to 0.26 with ISO1. The ISO1-optimized IOL measured 0.45 with ISO1 but only 0.20 with ME2. Differences exceeded 50% depending on the assumed corneal profile.
Conclusion
MTF performance varies significantly depending on corneal spherical aberration. Accurate assessment of the patient’s corneal profile is critical when selecting an IOL to achieve the best visual quality.
