PURPOSE: Patients with large pupils tend to experience more glare and halos after cataract surgery. This study aimed to evaluate the relationship between preoperative photopic and mesopic pupil size and the frequency, severity, and bothersomeness of glare and halos in patients implanted with a novel full range of vision (FROV) IOL.

METHODS: This study included pooled data from 2 clinical trials of FROV IOL implantation (enVista Envy, Bausch and Lomb). The Envy IOL optics are designed with small and smooth diffractive steps, which reduce in height towards the periphery of the lens, resulting in a change in the energy balance. This asymmetric energy distribution makes the IOL distance dominant. As such, the energy focused on intermediate and near foci decreases as the pupil size increases. All patients completed a Quality of Vision questionnaire, which included questions on the frequency, severity, and bothersomeness of glare and halo. A logistic regression model assessed the relationship between pupil size and glare and halos.

RESULTS: No statistically significant relationship was observed between pupil size and the frequency, severity, and bothersomeness of glare and halos (all p>0.05). The logistic regression model showed that the risk of reporting a severe response to the frequency, severity, and bothersomeness of glare was not affected by pupil size (Photopic pupil: odds ratio (OR) =0.66, p=0.1595; mesopic pupil: OR =0.92, p=0.7389). Likewise, the risk of reporting severe response to the frequency, severity, and bothersomeness of halos was not statistically significant (Photopic pupil: OR =1.3, p=0.0851; mesopic pupil: OR =1.3, p=0.0737).

CONCLUSION: This study showed that pupil size has little or no effect on the frequency, severity, and bothersomeness of glare and halos following envista Envy FROV IOL implantation, indicating good tolerance of the novel FROV IOL to the photic phenomena.