PURPOSE: To compare the optical quality of two Refractive Full Range of Vision (R-FRoV) intraocular lenses (IOLs) in presence of tilt and decentration, a common situation after uneventful IOL implantation.

METHODS: Robustness against misalignment of Bausch & Lomb LuxLife™ (refractive trifocal, RT-FRoV) and Rayner RaynerOne Galaxy™ (refractive spiral, RS-FRoV) was compared on a model eye (ISO 2, corneal spherical aberration of +0.27 µm for 5.15 mm IOL-plane aperture) using green light (550 ±5 nm). The modulation transfer function (MTF) and area under the MTF (0 to 50 cycles/mm, MTFa) were assessed at far with 3.0 mm pupil in centered, decentered (0.25, 0.50 mm) and tilted (3.0°, 5.0°) conditions.

RESULTS: The RT-FRoV showed consistent higher MTF than the RS-FRoV in all conditions (Figure 1). In distance vision and centered, the RT-FRoV had larger MTFa (28.71 versus 23.84). When tilted, both designs exhibited similar mild reduction of the MTFa (7.7% RT-FRoV, 6.0% RS-FRoV). However, the RT-FRoV showed significant greater robustness against decentration than the RS-FRoV IOL, with MTFa decrease of only 0.5% versus 15.8% respectively (Figure 2, Table).

CONCLUSIONS: On-bench comparison of new IOL designs under controlled tilt and decentration conditions is relevant because they pose significant challenges for accurate clinical assessment. For far vision, the RT-FRoV LuxLife™ demonstrated superior MTF than RS-FRoV Galaxy™ in centered and misaligned conditions. While tilt induced similar mild optical quality reduction on both IOLs, the RT-FRoV design proved significant greater robustness against decentration. The impact of these findings on visual outcomes has yet to be studied and deserves further clinical investigation. The limitations of this study stems from the use of narrowband green light, a single average corneal spherical aberration, which may not capture clinical variability, and the restricted analysis to far vision with a 3.0 mm pupil.