Misalignment and tilt effect on aspheric intraocular lens designs after a corneal refractive surgery

Purpose To numerically evaluate and compare the tolerance to misalignment and tilt of aspheric intraocular lenses (IOLs) designed for three eyes: with standard cornea and with simulated corneas after myopic and hyperopic laser ablation surgery. Methods Three aspheric IOLs of +20.00 diopter (D) with different spherical aberration (SA) (Z 4 0) values have been designed using a theoretical model eye. Drastic changes on the theoretical eye anterior corneal asphericity have been performed to simulate myopic and hyperopic refractive surgeries. The effect of IOL misalignment and tilt on the image quality has been evaluated using a commercial optical software design for the three eye models. Image quality was assessed from the modulation transfer function (MTF), root mean square (RMS) values of defocus, astigmatism, coma and spherical aberration (Z 4 0), and retinal images obtained from a visual simulator using an aleatory optotype of 0.00 LogMar visual acuity (VA). Results IOL misalignment and tilt reduced MTF values in general, and increased wavefront aberrations errors. Aberration-free IOLs maintained best the MTF values when misalignments were applied, together with good on-axis optical quality. IOLs with negative SA (Z 4 0) correction decreased the MTF value under 0.43 for misalignments values higher than 0.50 mm with the three corneas. The effect of misalignment on RMS astigmatism and coma was correlated with the IOL SA (Z 4 0) and with the three corneas. Conclusions This theoretical study shows that the largest degradation in image quality arises for the IOL with the highest amount of spherical aberration (Z 4 0). Moreover, it has been found that the aspherical design has a more influential role in misalignment tolerance than in tilt tolerance.