PURPOSE: To evaluate the visual performance of an enhanced monofocal intraocular lens (IOL) and the influence of pupil size.

METHODS: This prospective, observational, single-center study was conducted at Hospital Clínico San Carlos (Madrid, Spain). Patients undergoing cataract surgery with an enhanced monofocal IOL (enVista Aspire; Bausch + Lomb, Inc) were included. Postoperative monocular assessments were performed under photopic conditions at 3 months. Uncorrected and corrected visual acuity were measured at distance (4 m), intermediate (66 cm), and near (40 cm). Defocus curves and photopic contrast sensitivity were assessed, and automated refraction was compared with manifest refraction. Defocus curves were analyzed using area-under-the-curve and depth-of-focus metrics, and visual outcomes were stratified by photopic pupil size (<3.5 vs ≥3.5 mm). Agreement between autorefractometry and subjective refraction was evaluated using Bland–Altman analysis.

RESULTS: Twenty-two eyes of 22 patients were included. Mean postoperative uncorrected and corrected distance visual acuity was 0.09 ± 0.12 and −0.02 ± 0.07 logarithm of the minimum angle of resolution (logMAR), respectively; 19 eyes (86.4%) achieved uncorrected distance visual acuity of 0.2 logMAR or better and all eyes achieved corrected distance visual acuity of 0.1 logMAR or better. Mean corrected intermediate and near visual acuity were 0.32 ± 0.13 and 0.52 ± 0.18 logMAR, respectively. Contrast sensitivity showed a normal band-pass profile. Agreement between autorefractometry and manifest refraction showed a small mean bias for spherical equivalent (+0.08 diopters). Pupil size showed no overall main effect on defocus curves or contrast sensitivity, although a defocus-specific interaction was observed.

CONCLUSIONS: This enhanced monofocal IOL provided excellent distance visual acuity, functional intermediate vision, preserved contrast sensitivity, and limited overall dependence on pupil size.