PURPOSE: To determine the robustness to tilt and decentration of several monofocal and enhanced monofocal intraocular lenses (IOLs). This study aims to assess how lens misalignments affect optical imaging performance, providing insight into the stability of visual outcomes.

METHODS: Optical bench testing complying with ANSI Z80.35-2018 was conducted using quasimonochromatic green light (550±5 nm) to evaluate the robustness of various monofocal (B+L enVista MX60E) and enhanced monofocal (B+L enVista Aspire and J&J Tecnis Eyhance) IOLs. The corneal spherical aberration was 0.27 μm for a 5.15 mm pupil at the IOL plane, and measurements were taken using a 3.0 mm aperture at the IOL plane. The modulation transfer function (MTF) and the area under the MTF (MTFa) between 0 and 50c/mm at zero defocus was assessed with IOLs aligned, tilted at 3.0° and 5.0° and decentered by 0.25 mm and 0.50 mm to estimate the impact on the image quality.

RESULTS: The MTF values in the case of a centered IOL show that Aspire has better performance than MX60E and Eyhance. All three lenses exhibited a similar reduction in MTFa when subjected to tilt (11 to 15% reduction for 5°). However, the MX60E demonstrated greater robustness to decentration than the other two lenses. The Aspire lens closely followed in performance, while the Eyhance lens was found to be the most sensitive to decentration. Tilt and decentration of IOLs are not typically measured in clinical evaluations, making designing lenses robust to physiological misalignment essential for stable optical performance.

CONCLUSIONS: The robustness of IOLs to physiological levels of tilt and decentration is an important factor in estimating their performance when implanted in the general population. Designing IOLs with improved tolerance to misalignment can help ensure consistent and reliable visual outcomes for patients. Both enVista IOLs demonstrated greater robustness to decentration compared to Eyhance, while the latter has a slightly better tolerance to tilt.