Article
A comparative study of intraocular lens simulations and objective quality metrics
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Authors
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Zhiyi Wu
- David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Universitäts-Augenklinik Heidelberg; Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou/CHN
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A. Zielińska
- David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Universitäts-Augenklinik Heidelberg; Institute of Physics, Nicolaus Copernicus University, Torun/PL
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A. Rayamajhi
- David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Universitäts-Augenklinik Heidelberg; Light Technology Institute, Karlsruhe Institute of Technology, Karlsruhe
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L. Britz
- David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Universitäts-Augenklinik Heidelberg
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R. Khoramnia
- David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Universitäts-Augenklinik Heidelberg
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G. Labuz
- David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Universitäts-Augenklinik Heidelberg
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G.U. Auffarth
- David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Universitäts-Augenklinik Heidelberg
| Published: | June 3, 2025 |
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Outline
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Background: Patient selection for presbyopia-correcting intraocular lenses is key to achieving high postoperative satisfaction. Although detailed preoperative counselling is often required, introducing a simulator that allows patients to experience their postoperative vision may simplify this process. The RALV (DEZIMAL GmbH) is a newly developed look-through IOL simulator that integrates a physical IOL into its optical system. To date, no studies have validated how accurately this device simulates the objective properties of IOLs, which this investigation aims to address.
Methods: Basis Z Monofocal, extended-depth-of-focus (EDoF), and Trifocal IOLs, all from 1stQ GmbH, were evaluated. First, the optical quality of the IOLs was assessed by means of the modulation transfer function, and the through-focus weighted optical transfer function (wOTF) at 3-, 3.5-, and 4-mm apertures, measured with the OptiSpheric IOL Pro 2 optical metrology system (Trioptics GmbH). Five phakic observers, under cycloplegia, performed visual acuity and defocus curve tests using the RALV, with IOLs mounted in the device via a lens shuttle. Landolt C optotypes were presented in random order on an integrated external screen.
Results: The defocus curves obtained with the RALV revealed an extended range of vision for the EDoF and trifocal IOLs. Visual acuity at 67 cm improved by 0.4 logMAR for the EDoF and 0.5 logMAR for the trifocal compared to the monofocal control. At 40 cm, improvements were 0.64 logMAR (EDoF) and 1.4 logMAR (trifocal). Strong and statistically significant agreement (P<.001) was found between RALV-generated defocus curves and the objective wOTF measurements, with R² values near or above 0.9 for 3- and 3.5-mm apertures. At a 4-mm aperture, the agreement decreased, with R² ranging from 0.6 to 0.7.
Conclusions: We demonstrated that IOL simulations using the RALV device can differentiate between various IOL types. The strong agreement between the RALV and optical-bench metrics indicates its accuracy in reproducing the optical properties of IOLs, particularly for photopic pupil sizes.
