Impact of pupil size on defocus curve, contrast sensitivity and patient satisfaction in a diffractive, simultaneous vision intraocular lens

PURPOSE: To evaluate the relationship between pupil size (PS) and defocus curve, contrast sensitivity (CS), spectacle independence and patient satisfaction after implantation of a diffractive, simultaneous vision intraocular lens (SVL; AcrySof® IQ PanOptix®, Alcon). SETTING: Department of Ophthalmology, Goethe-University, Frankfurt, Germany. DESIGN: Post-hoc analysis of prospective studies. METHODS: Patients were included three months after bilateral implantation of a diffractive SVL. Exclusion criteria included any ocular pathologies or previous ocular surgeries besides cataract or refractive lens exchange. Monocular defocus curve and infrared-based-pupillometry (PupilX, Albomed) in mesopic (MC) and photopic conditions (PC) and binocular visual acuity (VA) in various distances, CS, satisfaction in daily activities (driving day/night, TV, theater, home, PC, newspaper, cooking, domestic work) and spectacle independence for distance, intermediate and near were obtained. PS was analyzed continuously and categorized in small (≤4mm (MC); ≤2.5mm (PC)), medium (>4 - 5mm (MC); >2.5 - 4 mm (PC)) and large (>5mm (MC); >4 mm (PC)). RESULTS: Fifty-two patients (mean age 68 years) were included. Three months postoperatively PS was 4.24 (2.60-6.10) mm in MC and 3.38 (1.20-5.60) mm in PC. Besides correlations with extreme ends of the defocus curve, especially photopic PS weakly correlated with near-visual and partially with the intermediate range. Smaller photopic PS led partially to more near-spectacle independence. Photopic and mesopic PS moderately correlated with RoF ≤0.2 and 0.3 logMAR. Smaller pupils yielded better VA across the defocus curve, bigger RoF and a trend of being more satisfied with newspaper reading. In the other parameters, PS was not significant. CONCLUSIONS: PS especially affected the near-visual range, near-spectacle independence and RoF in a diffractive, SVL.