Monofocal intraocular lens based on the Bessel principle for improved intermediate vision: a comparative assessment

Monofocal intraocular lens based on the Bessel principle for improved intermediate vision: a comparative assessment | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Monofocal intraocular lens based on the Bessel principle for improved intermediate vision: a comparative assessment Frederick Kremser, Weijia Yan, Ramin Khoramnia, Gerd Uwe Auffarth, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9215734/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background: To compare the optical qualities of a novel enhanced monofocal intraocular lens (IOL), against a well-established IOL through in vitro benchmarking. Methods: Optical benchmarking was conducted using the OptiSpheric IOL PRO2 device in compliance with International Organization for Standardization (ISO) guidelines. Optical quality was assessed using the modulation transfer function (MTF), point spread function (PSF), area under the MTF (MTFa), and 1951 USAF test charts. Measurements were taken at 3.0 mm and 4.5 mm apertures using a model cornea that induced 0.13 µm of spherical aberration to simulate clinical performance. Results: Both IOLs demonstrated comparable optical performance. At a 3 mm aperture, the Extend IOLs produced an average MTF at 50 lp/mm of 0.38 ± 0.01, while the ICB00 produced 0.36 ± 0.01. The MTFa and derived logMAR visual acuity (VA) curves showed nearly complete overlap for defocus levels less than -1.25 D, with both lenses yielding identical VA at far focus (-0.09 logMAR). At higher defocus levels, the observed difference between the models accounted for <0.02 logMAR, which is negligible for standard VA testing. Point spread function assessments revealed comparable light distribution for both IOLs. Conclusion: Under laboratory conditions, the Hanita Extend IOL shows comparable results to the Tecnis Eyhance ICB00 regarding MTF function, USAF-Chart images, and PSF assessment. enhanced monofocal monofocal-plus intraocular lens Bessel principle Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Conventional monofocal intraocular lenses (IOLs) remain the most popular choice in cataract surgery today, offering excellent vision for a single focal point, though necessitating dependence on reading glasses. 1 However recently, there has been a noticeable transition towards monofocal+ (or enhanced monofocal) IOLs, with some even arguing that monofocal+ IOLs should become standard of care. 2,3 These lenses maintain the high visual quality of distance vision found in standard models, while enabling a broader range of focus. 4 Crucially, this lessened dependence on glasses is achieved without increasing the risk of photic phenomena or compromising contrast sensitivity, as has been shown in many studies. 4–6 The same studies quantify the increase of intermediate VA as approximately 0.1 logMAR at 1.5 to 2D vergence. 3,6–8 This gain of function is achieved through higher order aspheric optics or diffractive optics, but placed over a small pupil area, thus explaining the monofocal-like halo, glare and contrast sensitivity. 4,9,10 Within this category, the TECNIS Eyhance (DIB00/ICB00) (Johnson & Johnson Surgical Vision, Inc., Santa Ana, CA, USA) occupies a prominent position. Although not the first enhanced monofocal IOL introduced, it has become one of the most frequently implanted models. This widespread adoption is underpinned by extensive laboratory and clinical research, which has provided an in-depth understanding of the lens's capabilities. 5,6,11–15 Due to this robust volume of high-quality data, the Eyhance is now widely selected as the reference benchmark against which other emerging lenses are evaluated. 16–18 A novel entrant in this category is the Hanita Extend (Hanita Lenses R.C.A Ltd., Kibbutz, Israel). This IOL utilizes a Bessel beam generation function to achieve an elongated depth of focus, with additional optimization for intermediate vision. Specifically, the lens employs a conical axicon surface to create this elongation. While Bessel beam technology is frequently used in engineering for laser material treatment, its application here represents a distinct optical approach. Due to the current lack of scientific literature on the Hanita Extend, this study was conducted to compare the optical qualities of this new lens against the well-established Eyhance. We believe that this serves as the ideal candidate for in vitro benchmarking to provide valuable insights into the potential clinical optical performance of the Hanita Extend. Material and methods Intraocular lenses We studied two distinct monofocal IOLs, each having the same refractive power of + 20 D, designed to provide an extended depth of focus: The Tecnis Eyhance (ICB00) is a hydrophobic acrylic lens that possesses a refractive index of 1.47 at 35°C and an Abbe number of 55. Structurally, it features a continuous 360° posterior square edge (ProTEC frosted) with the haptics slightly shifted posteriorly relative to the central optic of the lens. The optical design incorporates a high-order aspheric anterior surface that generates continuous power progression. The IOL also corrects a spherical aberration (SA) of 0.27 µm at 6 mm. The Hanita Extend is composed of a glistening-free hydrophobic acrylic material with a 3% water content, a refractive index of 1.48 (at 35°C), and an Abbe number of 49. It features a spherical anterior surface and an aspheric posterior surface. The Hanita Extend corrects 0.13 µm of SA. 19 Unlike standard aspheric models, the Extend achieves this visual range extension through a central optical modification utilizing a conical axicon profile. This geometry generates a Bessel-like beam, effectively creating an elongated focal zone by modulating the central optical power relative to the periphery (Fig. 1 ). Optical metrology device and procedures Optical benchmarking was conducted using the OptiSpheric IOL PRO2 (Trioptics GmbH, Wedel, Germany) ensuring compliance with International Organization for Standardization (ISO) guidelines 20 . The IOLs were immersed in a balanced salt solution within a wet cell and aligned with a microscope objective and a charged-coupled device (CCD) camera. First, the effective focal length (EFL) was determined using the magnification method described in the ISO standard, utilizing monochromatic (546 nm) light at room temperature. The refractive power was calculated as the inverse of the EFL (P = 1/EFL). In the next step, image quality assessment was performed by means of the modulation transfer function (MTF) and the point spread function (PSF). To simulate clinical performance, measurements were performed using a model cornea inducing 0.13 µm of SA at a 5.15 mm diameter. A spectral filter approximating the Commission Internationale de l'Éclairage (CIE) photopic luminosity function was applied. The optical quality was assessed at aperture sizes of 3.0 mm and 4.5 mm. Once the point of best focus was established via maximum MTF, through-focus curves were generated over a defocus range of + 1.0 D to -3.0 D at the IOL plane (equivalent to + 0.75 D to -2.25 D at the spectacle plane). At every focal step, the sagittal and tangential MTFs were averaged. Additionally, resolution was visualized using 1951 USAF test charts recorded at the 3.0 mm aperture. The area under the MTF (MTFa) was calculated to quantify overall optical quality, integrating spatial frequencies from 1 to 50 lp/mm following the ANSI Z80.35-2018 recommendations. Unwanted visual effects To evaluate the potential for unwanted visual effects such as halos or glare, we analyzed the PSF using a 0.1-mm pinhole target at a 4.5-mm aperture. To visualize low-intensity light distribution (spurious images) beyond the PSF core, the dynamic range of the 8-bit camera was artificially extended by compositing images taken at varying shutter speeds. 4 , 21 To isolate the IOL design geometry from confounding aberration factors, this specific assessment was performed in monochromatic green light using model corneas matched to the specific spherical aberration correction of each lens (Extend: matched with 0.13 µm SA; ICB00: matched with 0.28 µm SA). The resulting light intensity profiles were plotted logarithmically against the visual angle. Data analysis The analysis of optical-quality data and images was performed with custom-made software developed in MATLAB (MathWorks, USA). Results Power measurements All the studied IOLs had their nominal powers labelled according to the ISO standard. Table 1 shows the nominal-power results presented as a mean ± SD (standard deviation). Table 1. Measured nominal powers of the studied IOL models. SD = standard deviation Extend (Hanita) ICB00 (J&J) Mean [D] 20.32 19.76 SD [D] 0.06 0.06 MTF metrics and USAF-chart images Figure 2 presents the MTF curves of all IOL samples measured at the best focus through the 3- and 4.5-mm apertures. Figure 2: MTF levels of the studied IOLs at the best focus for 3- and 4.5-mm apertures. The dotted lines show the values of each lens separately; the solid lines refer to the average of two IOLs. At 3 mm, both the Extend and the ICB00 demonstrated comparable optical performance. The Extend IOLs produced an average MTF @ 50 lp/mm of 0.38 ± 0.01, while for the ICB00, it was 0.36 ± 0.01. At 4.5 mm, the Extend's MTF was 0.32 ± 0.00, which was minimally higher than that of the ICB00 (0.29 ± 0.00) at 50 lp/mm. However, for lower spatial frequencies, the two models were comparable. Figure 3 reports the MTFa change for the enhanced-monofocal IOLs. The MTFa of the Extend and the ICB00 were virtually the same for studied defocus, showing one peak extended towards negative (intermediate-range) values. Figure 3: The MTFa curve of the two studied IOLs measured at the defocus range from +0.5 D to -2 D at the spectacle plane. LogMAR VA (Figure 4) was derived from the MTFa according to the empirical model as described in the Materials and Methods section. The Extend and the ICB00 yielded identical VA at far focus (-0.09 logMAR). Although for lower defocus. i.e., less than -1.25 D, the two curves show a nearly complete overlap; above this level, the ICB00 appears to produce minimally better VA. However, the observed difference accounts for <0.02 logMAR, which is below the accuracy level of standard VA testing. Figure 4: The logMAR VA of three studied IOLs measured at the defocus range from +0.5 D to -2 D (spectacle plane). The dotted lines show each lens' values separately; the solid lines refer to the average of two samples. The resolution-test images presented in Figure 5 confirm the comparable MTFa results of the two models. Figure 5: USAF-resolution targets recorded at a defocus range of +0.5D to -2.0D (spectacle plane) and the 3-mm aperture. PSF assessment Figure 6 demonstrates the PSF's horizontal and vertical cross-sections of the two models. The Extend and the ICB00 presented a similar light-intensity decline with a slight and localized increase at about 2 arcmins seen with the Extend IOLs. Figure 6: The horizontal (left panel) and vertical (right panel) cross-section of the PSF's intensity profile of the two IOL models. The dotted lines show each lens' values separately; the solid lines refer to the average of two samples. PSF images at two different exposure levels are presented in Table 2. Both IOLs showed comparable light distribution with a speckle-like pattern outside the PSF core, and minimally broader halo-patter in the Extend projection. Table 2 . PSF images taken at two different light intensity levels (optimally and oversaturated) at a pupil diameter of 4.5 mm IOL Model Optimally saturated Maximum saturation Extend ICB00 Discussion This study demonstrates that the Extend IOL provides a good optical performance comparable to the established ICB00 IOL. The two models showed nearly equivalent MTF levels at the 3-mm pupil as well as lower defocus values. Although minimal differences in the MTFa and predicted VA were observed at higher defocus, it was estimated to be < 0.02 logMAR. Such a small difference can only be detected using high-precision optical methods rather than clinical ones; therefore, it can be considered negligible. The large amount of data available for the DIB00 shows a good agreement with our laboratory prediction. Studies show a monocular depth of focus of 1.23 D for ICB00 compared to around 0.9 D for standard monofocal lenses, with an increase of 2–5 ETDRS letters at levels of -1.25 and − 1.5 D. The defocus curve usually shows a VA of 0.2 logMAR or better from 0 D to approximately − 1.5 D both in monocular and binocular conditions. 8,15,17 The clinical data for the DIB00 also extends towards populations of eyes with comorbidities, which show that the IOL is generally suitable for these cases. 12,13 As mentioned, there is no clinical data available for the Hanita Extend as of today. Given the optical similarities shown in our laboratory analysis, we can assume that both lenses should also have similar optical qualities in a clinical/real-world setting. Clinical data on the DIB00 continuously shows a level of dysphotopsias that is comparable to standard monofocal IOLs. [4] Halo and Glare are very rarely reported. 16,17 Looking at the PSF-Analysis one notices that depending on the cross-section, the PSF of the Extend does appear to be slightly elevated compared to the Eyhance. These findings still greatly differ from PSF-analysis found in EDoF or trifocal IOLs 22 , 23 , so one may question whether these minute differences will translate into a tangible clinical difference between the two monofocal+ IOLs. 9 We suspect the Extend IOL to have a similar dysphotophsia profile compared to the DIB00. This of course necessitates clinical validation of our laboratory findings. An interesting point to discuss is why the Eyhance DIB00 is not labelled as an EDoF-IOL. IOL Classification has been an important topic of discussion ever since models with an increased focus range were first introduced. 24 This was further expanded with the addition of monofocal+ IOLs, which are usually regarded as a separate category in between standard monofocal and EDoF IOLs. The ISO 11979-7, 2024 categorizes IOLs into 4 groups: monofocal, toric, simultaneous vision lenses (SVLs) and accommodating lenses. These SVLs are further classified into multifocal IOLs (mIOL), extended depth of field (EDF) and full visual range (FVR) which interestingly shows that monofocal+ lenses are not individually represented by ISO, but instead would (probably) be counted as a monofocal IOL. 20 In August 2024 the ESCRS Functional vision working group published an evidence-based nomenclature, that tried to improve distinction between EDoF and monofocal-plus IOLs based on clinical evidence for these IOLs. Monofocal+ would then be considered a partial-RoF IOL with enhanced RoF, defined as a RoF in 0.2 logMAR between 1.2 and 1.58 D, while an EDoF-IOL would have to prove a VA of 0.2 LogMAR from 1.58 to 2.3 D at most. Both models would show no VA increase from Intermediate to near. 24 Although in some patients, the DIB00 may reach a RoF that goes beyond 1.58 D and therefore be categorized into “extended” category, 24 only the consistency of this effect, confirmed through randomized clinical trials, can determine its accurate classification. It is of great importance for all further classifications and improvements that the intrasubject variability due to aberrations and pupil size variation is kept in mind, when defining strict numerical cutoffs. 25–28 Apart from their comparable optical and thus expected visual function, these two lenses share other similarities: both IOLs are C-Loop models that have an optical and overall diameter of 6 and 13mm, respectively. Furthermore, both lenses are made out of a hydrophobic acrylic material that block violet and ultraviolet rays of light. Another feature both IOLs share are the squared 360° edges. Both IOLs are offered from + 5 to + 34 D, though the Hanita Extend currently offers only 1 D increments for IOL powers of + 30 D and above. It may also be noted that the Hanita Extend has a different A-constant for optical biometry or ultrasound for preoperative IOL calculation. Conclusion In conclusion, the Hanita Extend IOL shows comparable results to the Tecnis Eyhance ICB00 in a a laboratory setting regarding MTF function, USAF-Chart images and the PSF assessment. Using these metrics, both IOLs showed comparable optical performance, as well as laboratory-derived VA, visual range and amount of dysphotopsia. These findings suggest that the Hanita Extend IOL has the potential to provide similar visual outcomes – a hypothesis that still requires validation through prospective clinical studies. Declarations Ethics approval and consent to participate Due to the in vitro nature of this study, without the involvement of any patients nor their personal data need for approval was waived. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests FK: none WY: none RK reports grants, personal fees, nonfinancial support and consulting fees from Alcon, during the conduct of the study; grants, personal fees and nonfinancial support from Hoya and Johnson&Johnson, grants and personal fees from Bausch+Lomb, personal fees and nonfinancial support from Carl Zeiss Meditec and Ophtec, personal fees from Heidelberg Engineering, Oculus and Rayner, outside the submitted work GUA reports grants, personal fees, nonfinancial support and consulting fees from Alcon, Johnson & Johnson, Carl Zeiss Meditec, Rayner and SIFI, grants, personal fees, and nonfinancial support from Hoya, Kowa, Teleon and Santen, grants, personal fees and consulting fees from Cristalens and VSY, grants and personal fees from Bausch+Lomb, Biotech and Oculus, personal fees from Eyebright, grants from Contamac, Croma, Hanita, Ophtec and Physiol, outside the submitted work. GŁ: non-financial support from Alcon and Contamac. The University of Heidelberg holds a patent application (No. EP22187235) entitled “Lens with extended depth of focus by inducing an excess of longitudinal chromatic aberration”, with GUA and GŁ as inventors Funding Supported by a research grant from Fitlens Laboratory Ltd., Nesher, Israel. The David J Apple Laboratory receives support from the Klaus Tschira Foundation, Heidelberg, Germany. Authors’ contributions FK drafted, wrote and edited the manuscript with input from all authors. Designed figures. WY carried out the experiments. RK contributed to the design and implementation of the research and reviewed the manuscript. GUA contributed to the concept, design and implementation of the research and reviewed the manuscript. GŁ contributed to the concept, design and implementation of the research; caried out data processing and analysis; and reviewed the manuscript. Acknowledgments None References Cicinelli MV, Buchan JC, Nicholson M, Varadaraj V, Khanna RC, Cataracts. Lancet. 2023;401(10374):377–89. 10.1016/S0140-6736(22)01839-6 . Wan KH, Au ACK, Kua WN, et al. Enhanced Monofocal Versus Conventional Monofocal Intraocular Lens in Cataract Surgery: A Meta-analysis. J Refract Surg. 2022;38(8):538–46. 10.3928/1081597X-20220707-01 . Fernández J, Ribeiro F, Burguera N, Rodríguez-Calvo-de-Mora M, Rodríguez-Vallejo M. Visual and patient-reported outcomes of an enhanced versus monofocal intraocular lenses in cataract surgery: a systematic review and meta-analysis. Eye (Lond). 2025;39(5):883–98. 10.1038/s41433-025-03625-4 . Łabuz G, Son H-S, Naujokaitis T, Yildirim TM, Khoramnia R, Auffarth GU. Laboratory Investigation of Preclinical Visual-Quality Metrics and Halo-Size in Enhanced Monofocal Intraocular Lenses. Ophthalmol Ther. 2021;10(4):1093–104. 10.1007/s40123-021-00411-9 . Mencucci R, Romualdi G, Carnicci A, Panini F, Buzzi M, Giansanti F. Long-Term Effectiveness of a Monofocal Intraocular Lens (IOL) Enhanced for Intermediate Vision: A 5-Year Follow-Up Study. J Clin Med. 2025;14(16). 10.3390/jcm14165831 . Baur ID, Khoramnia R, Weindler J, Naujokaitis T, Poompokawat P, Auffarth GU. Clinical Outcomes of a New Hybrid Monofocal IOL With Extended Depth of Focus. J Refract Surg. 2021;37(9):601–8. 10.3928/1081597X-20210610-03 . Choi WK, Han HJ, Son H-S, Khoramnia R, Auffarth GU, Choi CY. Clinical outcomes of bilateral implantation of new generation monofocal IOL enhanced for intermediate distance and conventional monofocal IOL in a Korean population. BMC Ophthalmol. 2023;23(1):157. 10.1186/s12886-023-02897-2 . Danzinger V, Schartmüller D, Lisy M, et al. Intraindividual Comparison of an Enhanced Monofocal and an Aspheric Monofocal Intraocular Lens of the Same Platform. Am J Ophthalmol. 2024;261:95–102. 10.1016/j.ajo.2023.11.006 . Baur ID, Khoramnia R, Son H-S, Auffarth GU, Łabuz G. Ray Visualization and Through-Focus Optical Quality of Diffractive Enhanced Monofocal and Extended-Depth-of-Focus Intraocular Lenses. Clin Ophthalmol. 2025;19:1673–82. 10.2147/OPTH.S520086 . Łabuz G, Khoramnia R, Naujokaitis T, Auffarth GU. Optische Bank-Evaluierung für spezielle Intraokularlinsenoptiken. Ophthalmologie. 2024;121(9):698–705. 10.1007/s00347-024-02064-y . Kabura R, Takeshita T, Furushima K, et al. Comparative evaluation of clinical results and patient-reported outcomes of enhanced monofocal and conventional monofocal intraocular lenses. J Cataract Refract Surg. 2025;51(6):520–4. 10.1097/j.jcrs.0000000000001641 . Ota J, Matsunaga M, Haga F, et al. Enhanced Monofocal IOLs Improve Patient Satisfaction in Phaco-Vitrectomy for ERM. Clin Ophthalmol. 2025;19:3283–93. 10.2147/OPTH.S541269 . Dorronzoro-Ramirez E, Sanchez-Tena MA, Alvarez-Peregrina C, Cardenas Rebollo JM, Flores Cervantes D, Sánchez-Ramos C. Visual Outcomes of a Non-Diffractive Extended Depth-of-Focus Intraocular Lens in Patients with Early-Stage Age-Related Macular Degeneration. J Clin Med. 2025;14(17). 10.3390/jcm14175953 . Mayordomo-Cerdá F, Ortega-Usobiaga J, Bilbao-Calabuig R, et al. Satisfaction and Visual and Refractive Outcomes Combining an Enhanced Monofocal and a Trifocal Intraocular Lens in Patients with Specific Visual Demands. Clin Ophthalmol. 2025;19:3515–26. 10.2147/OPTH.S549693 . Singh G, Sidhharthan KS, Reddy JK, Sundaram V, Thulasidas M. Comparison of visual outcomes in patients implanted with Tecnis Eyhance ICB00 and 1-Piece ZCB00 monofocal intraocular lenses. Indian J Ophthalmol. 2024;72(2):181–4. 10.4103/IJO.IJO_681_23 . Hayashi S, Yoshida M, Hayashi K, Negishi K. Comparison of visual performance among three higher-order aspheric enhanced monofocal intraocular lenses and a standard aspheric monofocal lens. J Cataract Refract Surg. 2025;51(11):979–85. 10.1097/j.jcrs.0000000000001734 . Mencucci R, Morelli A, Cennamo M, Roszkowska AM, Favuzza E. Enhanced Monofocal Intraocular Lenses: A Retrospective, Comparative Study between Three Different Models. J Clin Med. 2023;12(10). 10.3390/jcm12103588 . Donoso R, Torres A, Klagges J, et al. Enhanced vs conventional monofocal intraocular lens clinical results in patients with cataract: randomized clinical trial. J Cataract Refract Surg. 2023;49(8):818–25. 10.1097/j.jcrs.0000000000001224 . Auffarth GU, Łabuz G, Khoramnia R, Yildirim TM. Übersicht über Intraokularlinsen mit Presbyopie-korrigierenden Optiken. Ophthalmologie. 2024;121(9):685–97. 10.1007/s00347-024-02071-z . The International Organization for Standardization. ISO-11979-2, Ophthalmic implants - intraocular lenses - Part 2: Optical properties and test methods. 2024. Alarcon A, Cánovas C, Koopman B, Weeber H, Auffarth GU, Piers PA. Enhancing the Intermediate Vision of Monofocal Intraocular Lenses Using a Higher Order Aspheric Optic. J Refract Surg. 2020;36(8):520–7. 10.3928/1081597X-20200612-01 . Baur ID, Auffarth GU, Yan W, Łabuz G, Khoramnia R. Visualization of Ray Propagation through Extended Depth-of-Focus Intraocular Lenses. Diagnostics (Basel). 2022;12(11). 10.3390/diagnostics12112667 . Yan W, Łabuz G, Khoramnia R, Auffarth GU. Trifocal Intraocular Lens Selection: Predicting Visual Function From Optical Quality Measurements. J Refract Surg. 2023;39(2):111–8. 10.3928/1081597X-20221207-02 . Ribeiro F, Dick HB, Kohnen T, et al. Evidence-based functional classification of simultaneous vision intraocular lenses: seeking a global consensus by the ESCRS Functional Vision Working Group. J Cataract Refract Surg. 2024;50(8):794–8. 10.1097/j.jcrs.0000000000001502 . Micheletti JM, McCauley MB, Duncan N, Hall B. Biometric Indicators for Maximizing Intermediate Vision with a Monofocal IOL. Clin Ophthalmol. 2023;17:3739–46. 10.2147/OPTH.S441172 . Barišić A, Patel S, Gabric N, Feinbaum CG. The clinical depth of field achievable with trifocal and monofocal intraocular lenses: theoretical considerations and proof of concept clinical results. Graefes Arch Clin Exp Ophthalmol. 2017;255(2):367–73. 10.1007/s00417-016-3566-9 . Alfonso JF, Fernández-Vega L, Baamonde MB, Montés-Micó R. Correlation of pupil size with visual acuity and contrast sensitivity after implantation of an apodized diffractive intraocular lens. J Cataract Refract Surg. 2007;33(3):430–8. 10.1016/j.jcrs.2006.10.051 . Zapata-Díaz JF, Marín-Franch I, Radhakrishnan H, López-Gil N. Impact of higher-order aberrations on depth-of-field. J Vis. 2018;18(12):5. 10.1167/18.12.5 . Alfonso-Bartolozzi B, Martinez-Alberquilla I, Fernández-Vega-Cueto L, et al. Optical and Visual Outcomes of a New Refractive Extended Depth of Focus Intraocular Lens. J Refract Surg. 2025;41(4):e333–41. 10.3928/1081597X-20250221-02 . Niknahad A, Wu Z, Son H-S, Auffarth GU, Khoramnia R, Łabuz G. Evaluation of Clareon Vivity and PureSee intraocular lenses: optical quality, depth of focus and misalignment effects. Sci Rep. 2025;15(1):26943. 10.1038/s41598-025-07970-y . Alarcon A, Del Aguila Carrasco A, Gounou F, Weeber H, Cánovas C, Piers P. Optical and clinical simulated performance of a new refractive extended depth of focus intraocular lens. Eye (Lond). 2024;38(Suppl 1):4–8. 10.1038/s41433-024-03041-0 . Schmid R, Borkenstein AF. Optical Bench Evaluation of the Latest Refractive Enhanced Depth of Focus Intraocular Lens. Clin Ophthalmol. 2024;18:1921–32. 10.2147/OPTH.S469849 . Corbett D, Black D, Roberts TV, et al. Quality of vision clinical outcomes for a new fully-refractive extended depth of focus Intraocular Lens. Eye (Lond). 2024;38(Suppl 1):9–14. 10.1038/s41433-024-03039-8 . Black DA, Bala C, Alarcon A, Vilupuru S. Tolerance to refractive error with a new extended depth of focus intraocular lens. Eye (Lond). 2024;38(Suppl 1):15–20. 10.1038/s41433-024-03040-1 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 20 Apr, 2026 Reviews received at journal 11 Apr, 2026 Reviews received at journal 07 Apr, 2026 Reviewers agreed at journal 06 Apr, 2026 Reviewers agreed at journal 03 Apr, 2026 Reviewers agreed at journal 31 Mar, 2026 Reviewers invited by journal 31 Mar, 2026 Editor invited by journal 28 Mar, 2026 Editor assigned by journal 26 Mar, 2026 Submission checks completed at journal 26 Mar, 2026 First submitted to journal 24 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9215734","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":617041387,"identity":"e475891b-280b-4a27-8546-23d9a5c4c1ab","order_by":0,"name":"Frederick Kremser","email":"","orcid":"","institution":"University of Heidelberg","correspondingAuthor":false,"prefix":"","firstName":"Frederick","middleName":"","lastName":"Kremser","suffix":""},{"id":617041388,"identity":"aa257e55-379f-4aa5-adf8-182b7ad1c8d2","order_by":1,"name":"Weijia Yan","email":"","orcid":"","institution":"University of Heidelberg","correspondingAuthor":false,"prefix":"","firstName":"Weijia","middleName":"","lastName":"Yan","suffix":""},{"id":617041389,"identity":"a450ed1d-6b8d-4bb7-b42b-eddea0954eda","order_by":2,"name":"Ramin Khoramnia","email":"","orcid":"","institution":"University of Heidelberg","correspondingAuthor":false,"prefix":"","firstName":"Ramin","middleName":"","lastName":"Khoramnia","suffix":""},{"id":617041390,"identity":"3d9a4359-e6c1-46c5-a24b-cb35c56f16e4","order_by":3,"name":"Gerd Uwe Auffarth","email":"data:image/png;base64,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","orcid":"","institution":"University of Heidelberg","correspondingAuthor":true,"prefix":"","firstName":"Gerd","middleName":"Uwe","lastName":"Auffarth","suffix":""},{"id":617041391,"identity":"cae8571f-1390-4567-870f-23525f6581d9","order_by":4,"name":"Grzegorz Łabuz","email":"","orcid":"","institution":"University of Heidelberg","correspondingAuthor":false,"prefix":"","firstName":"Grzegorz","middleName":"","lastName":"Łabuz","suffix":""}],"badges":[],"createdAt":"2026-03-24 19:53:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9215734/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9215734/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106300044,"identity":"c3bbe5ce-b6b6-454b-81de-456c560d46f8","added_by":"auto","created_at":"2026-04-07 09:12:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":701984,"visible":true,"origin":"","legend":"\u003cp\u003eThe conical axicon surface provides an elongated DOF with an additional optimization for intermediate vision. The Bessel beam generation function elongates the DOF. In diameters larger than 3.5mm, there is an aspheric surface optimization giving maximal energy to far vision in large apertures.\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-9215734/v1/9fbacf379b718d43595b7b9d.png"},{"id":106299839,"identity":"4426fe49-4159-4e5d-8a33-217a308ba340","added_by":"auto","created_at":"2026-04-07 09:11:29","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1222382,"visible":true,"origin":"","legend":"\u003cp\u003eMTF levels of the studied IOLs at the best focus for 3- and 4.5-mm apertures. The dotted lines show the values of each lens separately; the solid lines refer to the average of two IOLs.\u003c/p\u003e","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-9215734/v1/dd4e7b64860491f4f787ca85.png"},{"id":106299908,"identity":"09ca6863-ac66-4510-972f-4588a9f6abae","added_by":"auto","created_at":"2026-04-07 09:11:35","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":725101,"visible":true,"origin":"","legend":"\u003cp\u003eThe MTFa curve of the two studied IOLs measured at the defocus range from +0.5 D to -2 D at the spectacle plane.\u003c/p\u003e","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-9215734/v1/9ad1328436fdfcf2a4dd9ab9.png"},{"id":106299868,"identity":"9868321e-15f4-40db-a4d2-04c1b54812eb","added_by":"auto","created_at":"2026-04-07 09:11:33","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":480995,"visible":true,"origin":"","legend":"\u003cp\u003eThe logMAR VA of three studied IOLs measured at the defocus range from +0.5 D to -2 D (spectacle plane). The dotted lines show each lens' values separately; the solid lines refer to the average of two samples.\u003c/p\u003e","description":"","filename":"Fig4.png","url":"https://assets-eu.researchsquare.com/files/rs-9215734/v1/5ce06d9b8e604d4ef91efe99.png"},{"id":106299907,"identity":"26c04a52-b79d-420e-876f-3f4f961d6acd","added_by":"auto","created_at":"2026-04-07 09:11:35","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":1025573,"visible":true,"origin":"","legend":"\u003cp\u003eUSAF-resolution targets recorded at a defocus range of +0.5D to -2.0D (spectacle plane) and the 3-mm aperture.\u003c/p\u003e","description":"","filename":"Fig5.png","url":"https://assets-eu.researchsquare.com/files/rs-9215734/v1/21abc14f782ad25b0357b295.png"},{"id":106300071,"identity":"eea85962-6e0a-4613-9391-91273f2059bb","added_by":"auto","created_at":"2026-04-07 09:12:30","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":526084,"visible":true,"origin":"","legend":"\u003cp\u003eThe horizontal (left panel) and vertical (right panel) cross-section of the PSF's intensity profile of the two IOL models. The dotted lines show each lens' values separately; the solid lines refer to the average of two samples.\u003c/p\u003e","description":"","filename":"Fig6.png","url":"https://assets-eu.researchsquare.com/files/rs-9215734/v1/4e64b459181d54b182e9fd95.png"},{"id":106300485,"identity":"b660730f-de12-4053-b385-68de929e3ec1","added_by":"auto","created_at":"2026-04-07 09:13:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5489484,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9215734/v1/2505ac12-a355-44fa-bb9b-309d4633654f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Monofocal intraocular lens based on the Bessel principle for improved intermediate vision: a comparative assessment","fulltext":[{"header":"Introduction","content":"\u003cp\u003eConventional monofocal intraocular lenses (IOLs) remain the most popular choice in cataract surgery today, offering excellent vision for a single focal point, though necessitating dependence on reading glasses. \u003csup\u003e1\u003c/sup\u003e However recently, there has been a noticeable transition towards monofocal+ (or enhanced monofocal) IOLs, with some even arguing that monofocal+ IOLs should become standard of care. \u003csup\u003e2,3\u003c/sup\u003e These lenses maintain the high visual quality of distance vision found in standard models, while enabling a broader range of focus. \u003csup\u003e4\u003c/sup\u003e Crucially, this lessened dependence on glasses is achieved without increasing the risk of photic phenomena or compromising contrast sensitivity, as has been shown in many studies. \u003csup\u003e4\u0026ndash;6\u003c/sup\u003e The same studies quantify the increase of intermediate VA as approximately 0.1 logMAR at 1.5 to 2D vergence. \u003csup\u003e3,6\u0026ndash;8\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis gain of function is achieved through higher order aspheric optics or diffractive optics, but placed over a small pupil area, thus explaining the monofocal-like halo, glare and contrast sensitivity. \u003csup\u003e4,9,10\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWithin this category, the TECNIS Eyhance (DIB00/ICB00) (Johnson \u0026amp; Johnson Surgical Vision, Inc., Santa Ana, CA, USA) occupies a prominent position. Although not the first enhanced monofocal IOL introduced, it has become one of the most frequently implanted models. This widespread adoption is underpinned by extensive laboratory and clinical research, which has provided an in-depth understanding of the lens's capabilities. \u003csup\u003e5,6,11\u0026ndash;15\u003c/sup\u003e Due to this robust volume of high-quality data, the Eyhance is now widely selected as the reference benchmark against which other emerging lenses are evaluated. \u003csup\u003e16\u0026ndash;18\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eA novel entrant in this category is the Hanita Extend (Hanita Lenses R.C.A Ltd., Kibbutz, Israel). This IOL utilizes a Bessel beam generation function to achieve an elongated depth of focus, with additional optimization for intermediate vision. Specifically, the lens employs a conical axicon surface to create this elongation. While Bessel beam technology is frequently used in engineering for laser material treatment, its application here represents a distinct optical approach.\u003c/p\u003e \u003cp\u003eDue to the current lack of scientific literature on the Hanita Extend, this study was conducted to compare the optical qualities of this new lens against the well-established Eyhance. We believe that this serves as the ideal candidate for in vitro benchmarking to provide valuable insights into the potential clinical optical performance of the Hanita Extend.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eIntraocular lenses\u003c/h2\u003e \u003cp\u003eWe studied two distinct monofocal IOLs, each having the same refractive power of +\u0026thinsp;20 D, designed to provide an extended depth of focus:\u003c/p\u003e \u003cp\u003eThe Tecnis Eyhance (ICB00) is a hydrophobic acrylic lens that possesses a refractive index of 1.47 at 35\u0026deg;C and an Abbe number of 55. Structurally, it features a continuous 360\u0026deg; posterior square edge (ProTEC frosted) with the haptics slightly shifted posteriorly relative to the central optic of the lens. The optical design incorporates a high-order aspheric anterior surface that generates continuous power progression. The IOL also corrects a spherical aberration (SA) of 0.27 \u0026micro;m at 6 mm.\u003c/p\u003e \u003cp\u003eThe Hanita Extend is composed of a glistening-free hydrophobic acrylic material with a 3% water content, a refractive index of 1.48 (at 35\u0026deg;C), and an Abbe number of 49. It features a spherical anterior surface and an aspheric posterior surface. The Hanita Extend corrects 0.13 \u0026micro;m of SA. \u003csup\u003e19\u003c/sup\u003e Unlike standard aspheric models, the Extend achieves this visual range extension through a central optical modification utilizing a conical axicon profile. This geometry generates a Bessel-like beam, effectively creating an elongated focal zone by modulating the central optical power relative to the periphery (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eOptical metrology device and procedures\u003c/h3\u003e\n\u003cp\u003eOptical benchmarking was conducted using the OptiSpheric IOL PRO2 (Trioptics GmbH, Wedel, Germany) ensuring compliance with International Organization for Standardization (ISO) guidelines \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. The IOLs were immersed in a balanced salt solution within a wet cell and aligned with a microscope objective and a charged-coupled device (CCD) camera. First, the effective focal length (EFL) was determined using the magnification method described in the ISO standard, utilizing monochromatic (546 nm) light at room temperature. The refractive power was calculated as the inverse of the EFL (P\u0026thinsp;=\u0026thinsp;1/EFL). In the next step, image quality assessment was performed by means of the modulation transfer function (MTF) and the point spread function (PSF). To simulate clinical performance, measurements were performed using a model cornea inducing 0.13 \u0026micro;m of SA at a 5.15 mm diameter. A spectral filter approximating the Commission Internationale de l'\u0026Eacute;clairage (CIE) photopic luminosity function was applied. The optical quality was assessed at aperture sizes of 3.0 mm and 4.5 mm. Once the point of best focus was established via maximum MTF, through-focus curves were generated over a defocus range of +\u0026thinsp;1.0 D to -3.0 D at the IOL plane (equivalent to +\u0026thinsp;0.75 D to -2.25 D at the spectacle plane). At every focal step, the sagittal and tangential MTFs were averaged. Additionally, resolution was visualized using 1951 USAF test charts recorded at the 3.0 mm aperture. The area under the MTF (MTFa) was calculated to quantify overall optical quality, integrating spatial frequencies from 1 to 50 lp/mm following the ANSI Z80.35-2018 recommendations.\u003c/p\u003e\n\u003ch3\u003eUnwanted visual effects\u003c/h3\u003e\n\u003cp\u003eTo evaluate the potential for unwanted visual effects such as halos or glare, we analyzed the PSF using a 0.1-mm pinhole target at a 4.5-mm aperture. To visualize low-intensity light distribution (spurious images) beyond the PSF core, the dynamic range of the 8-bit camera was artificially extended by compositing images taken at varying shutter speeds.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eTo isolate the IOL design geometry from confounding aberration factors, this specific assessment was performed in monochromatic green light using model corneas matched to the specific spherical aberration correction of each lens (Extend: matched with 0.13 \u0026micro;m SA; ICB00: matched with 0.28 \u0026micro;m SA). The resulting light intensity profiles were plotted logarithmically against the visual angle.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe analysis of optical-quality data and images was performed with custom-made software developed in MATLAB (MathWorks, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003ch2\u003ePower measurements\u003c/h2\u003e\n\u003cp\u003eAll the studied IOLs had their nominal powers labelled according to the ISO standard. Table 1 shows the nominal-power results presented as a mean \u0026plusmn; SD (standard deviation). \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eMeasured nominal powers of the studied IOL models. SD = standard deviation\u003c/p\u003e\n\u003ctable style=\"width: 3.1e+2pt\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eExtend (Hanita)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eICB00 (J\u0026amp;J)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMean [D]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSD [D]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eMTF metrics and USAF-chart images\u003c/h2\u003e\n\u003cp\u003eFigure 2 presents the MTF curves of all IOL samples measured at the best focus through the 3- and 4.5-mm apertures.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFigure 2:\u0026nbsp;\u003c/strong\u003eMTF levels of the studied IOLs at the best focus for 3- and 4.5-mm apertures. The dotted lines show the values of each lens separately; the solid lines refer to the average of two IOLs.\u003c/p\u003e\n\u003cp\u003eAt 3\u0026thinsp;mm, both the Extend and the ICB00 demonstrated comparable optical performance. The Extend IOLs produced an average MTF @ 50\u0026thinsp;lp/mm of 0.38 \u0026plusmn; 0.01, while for the ICB00, it was 0.36 \u0026plusmn; 0.01.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAt 4.5\u0026thinsp;mm, the Extend\u0026apos;s MTF was 0.32 \u0026plusmn; 0.00, which was minimally higher than that of the ICB00 (0.29 \u0026plusmn; 0.00) at 50\u0026thinsp;lp/mm. However, for lower spatial frequencies, the two models were comparable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFigure 3 reports the MTFa change for the enhanced-monofocal IOLs. The MTFa of the Extend and the ICB00 were virtually the same for studied defocus, showing one peak extended towards negative (intermediate-range) values.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 3:\u0026nbsp;\u003c/strong\u003eThe MTFa curve of the two studied IOLs measured at the defocus range from +0.5 D to -2 D at the spectacle plane.\u003c/p\u003e\n\u003cp\u003eLogMAR VA (Figure 4) was derived from the MTFa according to the empirical model as described in the Materials and Methods section. The Extend and the ICB00 yielded identical VA at far focus (-0.09 logMAR). Although for lower defocus. i.e., less than -1.25 D, the two curves show a nearly complete overlap; above this level, the ICB00 appears to produce minimally better VA. However, the observed difference accounts for \u0026lt;0.02 logMAR, which is below the accuracy level of standard VA testing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 4:\u003c/strong\u003e The logMAR VA of three studied IOLs measured at the defocus range from +0.5 D to -2 D (spectacle plane). The dotted lines show each lens\u0026apos; values separately; the solid lines refer to the average of two samples.\u003c/p\u003e\n\u003cp\u003eThe resolution-test images presented in Figure 5 confirm the comparable MTFa results of the two models.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFigure 5:\u003c/strong\u003e USAF-resolution targets recorded at a defocus range of +0.5D to -2.0D (spectacle plane) and the 3-mm aperture.\u003c/p\u003e\n\u003ch2\u003ePSF assessment\u003c/h2\u003e\n\u003cp\u003eFigure 6 demonstrates the PSF\u0026apos;s horizontal and vertical cross-sections of the two models. The Extend and the ICB00 presented a similar light-intensity decline with a slight and localized increase at about 2 arcmins seen with the Extend IOLs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 6:\u003c/strong\u003e The horizontal (left panel) and vertical (right panel) cross-section of the PSF\u0026apos;s intensity profile of the two IOL models. The dotted lines show each lens\u0026apos; values separately; the solid lines refer to the average of two samples.\u003c/p\u003e\n\u003cp\u003ePSF images at two different exposure levels are presented in Table 2. Both IOLs showed comparable light distribution with a speckle-like pattern outside the PSF core, and minimally broader halo-patter in the Extend projection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e. PSF images taken at two different light intensity levels (optimally and oversaturated) at a pupil diameter of 4.5 mm\u003c/p\u003e\n\u003ctable style=\"width: 4.2e+2pt\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u003cstrong\u003eIOL Model\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u003cstrong\u003eOptimally saturated\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaximum saturation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u003cstrong\u003eExtend\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/69519_bce2c0439cd956a6/69519_custom_files/img1775503919.png\" alt=\"image\"\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/69519_bce2c0439cd956a6/69519_custom_files/img177550391922.png\" alt=\"image\"\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u003cstrong\u003eICB00\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/69519_bce2c0439cd956a6/69519_custom_files/img177550391956.png\" alt=\"image\"\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/69519_bce2c0439cd956a6/69519_custom_files/img177550391913.png\" alt=\"image\"\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrates that the Extend IOL provides a good optical performance comparable to the established ICB00 IOL. The two models showed nearly equivalent MTF levels at the 3-mm pupil as well as lower defocus values. Although minimal differences in the MTFa and predicted VA were observed at higher defocus, it was estimated to be \u0026lt;\u0026thinsp;0.02 logMAR. Such a small difference can only be detected using high-precision optical methods rather than clinical ones; therefore, it can be considered negligible.\u003c/p\u003e \u003cp\u003eThe large amount of data available for the DIB00 shows a good agreement with our laboratory prediction. Studies show a monocular depth of focus of 1.23 D for ICB00 compared to around 0.9 D for standard monofocal lenses, with an increase of 2\u0026ndash;5 ETDRS letters at levels of -1.25 and \u0026minus;\u0026thinsp;1.5 D. The defocus curve usually shows a VA of 0.2 logMAR or better from 0 D to approximately\u0026thinsp;\u0026minus;\u0026thinsp;1.5 D both in monocular and binocular conditions. \u003csup\u003e8,15,17\u003c/sup\u003e The clinical data for the DIB00 also extends towards populations of eyes with comorbidities, which show that the IOL is generally suitable for these cases. \u003csup\u003e12,13\u003c/sup\u003e As mentioned, there is no clinical data available for the Hanita Extend as of today. Given the optical similarities shown in our laboratory analysis, we can assume that both lenses should also have similar optical qualities in a clinical/real-world setting.\u003c/p\u003e \u003cp\u003eClinical data on the DIB00 continuously shows a level of dysphotopsias that is comparable to standard monofocal IOLs. [4] Halo and Glare are very rarely reported. \u003csup\u003e16,17\u003c/sup\u003e Looking at the PSF-Analysis one notices that depending on the cross-section, the PSF of the Extend does appear to be slightly elevated compared to the Eyhance. These findings still greatly differ from PSF-analysis found in EDoF or trifocal IOLs \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e, so one may question whether these minute differences will translate into a tangible clinical difference between the two monofocal+ IOLs. \u003csup\u003e9\u003c/sup\u003e We suspect the Extend IOL to have a similar dysphotophsia profile compared to the DIB00. This of course necessitates clinical validation of our laboratory findings.\u003c/p\u003e \u003cp\u003eAn interesting point to discuss is why the Eyhance DIB00 is not labelled as an EDoF-IOL. IOL Classification has been an important topic of discussion ever since models with an increased focus range were first introduced. \u003csup\u003e24\u003c/sup\u003e This was further expanded with the addition of monofocal+ IOLs, which are usually regarded as a separate category in between standard monofocal and EDoF IOLs. The ISO 11979-7, 2024 categorizes IOLs into 4 groups: monofocal, toric, simultaneous vision lenses (SVLs) and accommodating lenses. These SVLs are further classified into multifocal IOLs (mIOL), extended depth of field (EDF) and full visual range (FVR) which interestingly shows that monofocal+ lenses are not individually represented by ISO, but instead would (probably) be counted as a monofocal IOL. \u003csup\u003e20\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn August 2024 the ESCRS Functional vision working group published an evidence-based nomenclature, that tried to improve distinction between EDoF and monofocal-plus IOLs based on clinical evidence for these IOLs. Monofocal+ would then be considered a partial-RoF IOL with enhanced RoF, defined as a RoF in 0.2 logMAR between 1.2 and 1.58 D, while an EDoF-IOL would have to prove a VA of 0.2 LogMAR from 1.58 to 2.3 D at most. Both models would show no VA increase from Intermediate to near. \u003csup\u003e24\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAlthough in some patients, the DIB00 may reach a RoF that goes beyond 1.58 D and therefore be categorized into \u0026ldquo;extended\u0026rdquo; category,\u003csup\u003e24\u003c/sup\u003e only the consistency of this effect, confirmed through randomized clinical trials, can determine its accurate classification. It is of great importance for all further classifications and improvements that the intrasubject variability due to aberrations and pupil size variation is kept in mind, when defining strict numerical cutoffs. \u003csup\u003e25\u0026ndash;28\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eApart from their comparable optical and thus expected visual function, these two lenses share other similarities: both IOLs are C-Loop models that have an optical and overall diameter of 6 and 13mm, respectively. Furthermore, both lenses are made out of a hydrophobic acrylic material that block violet and ultraviolet rays of light. Another feature both IOLs share are the squared 360\u0026deg; edges. Both IOLs are offered from +\u0026thinsp;5 to +\u0026thinsp;34 D, though the Hanita Extend currently offers only 1 D increments for IOL powers of +\u0026thinsp;30 D and above. It may also be noted that the Hanita Extend has a different A-constant for optical biometry or ultrasound for preoperative IOL calculation.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the Hanita Extend IOL shows comparable results to the Tecnis Eyhance ICB00 in a a laboratory setting regarding MTF function, USAF-Chart images and the PSF assessment. Using these metrics, both IOLs showed comparable optical performance, as well as laboratory-derived VA, visual range and amount of dysphotopsia. These findings suggest that the Hanita Extend IOL has the potential to provide similar visual outcomes \u0026ndash; a hypothesis that still requires validation through prospective clinical studies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eDue to the in vitro nature of this study, without the involvement of any patients nor their personal data need for approval was waived.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eFK: none\u003cbr\u003e\u0026nbsp;WY: none\u003c/p\u003e\n\u003cp\u003eRK\u0026nbsp;reports grants, personal fees, nonfinancial support and consulting fees from Alcon, during the conduct of the study; grants, personal fees and nonfinancial support from Hoya and Johnson\u0026amp;Johnson, grants and personal fees from Bausch+Lomb, personal fees and nonfinancial support from Carl Zeiss Meditec and Ophtec, personal fees from Heidelberg Engineering, Oculus and Rayner, outside the submitted work\u003c/p\u003e\n\u003cp\u003eGUA\u0026nbsp;reports grants, personal fees, nonfinancial support and consulting fees from Alcon, Johnson \u0026amp; Johnson, Carl Zeiss Meditec, Rayner and SIFI, grants, personal fees, and nonfinancial support from Hoya, Kowa, Teleon and Santen, grants, personal fees and consulting fees from Cristalens and VSY, grants and personal fees from Bausch+Lomb, Biotech and Oculus, personal fees from Eyebright, grants from Contamac, Croma, Hanita, Ophtec and Physiol, outside the submitted work.\u003c/p\u003e\n\u003cp\u003eGŁ: non-financial support from Alcon and Contamac.\u003c/p\u003e\n\u003cp\u003eThe University of Heidelberg holds a patent application (No. EP22187235) entitled “Lens with extended depth of focus by inducing an excess of longitudinal chromatic aberration”, with GUA and GŁ as inventors\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eSupported by a research grant from Fitlens Laboratory Ltd., Nesher, Israel. The David J Apple Laboratory receives support from the Klaus Tschira Foundation, Heidelberg, Germany.\u003c/p\u003e\n\u003ch2\u003eAuthors’ contributions\u003c/h2\u003e\n\u003cp\u003eFK drafted, wrote and edited the manuscript with input from all authors. Designed figures.\u003cbr\u003e\u0026nbsp;WY carried out the experiments.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRK contributed to the design and implementation of the research and reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003eGUA contributed to the concept, design and implementation of the research and reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003eGŁ contributed to the concept, design and implementation of the research; caried out data processing and analysis; and reviewed the manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgments\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eNone\u003cbr clear=\"all\"\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCicinelli MV, Buchan JC, Nicholson M, Varadaraj V, Khanna RC, Cataracts. Lancet. 2023;401(10374):377\u0026ndash;89. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(22)01839-6\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(22)01839-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWan KH, Au ACK, Kua WN, et al. Enhanced Monofocal Versus Conventional Monofocal Intraocular Lens in Cataract Surgery: A Meta-analysis. J Refract Surg. 2022;38(8):538\u0026ndash;46. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3928/1081597X-20220707-01\u003c/span\u003e\u003cspan address=\"10.3928/1081597X-20220707-01\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFern\u0026aacute;ndez J, Ribeiro F, Burguera N, Rodr\u0026iacute;guez-Calvo-de-Mora M, Rodr\u0026iacute;guez-Vallejo M. Visual and patient-reported outcomes of an enhanced versus monofocal intraocular lenses in cataract surgery: a systematic review and meta-analysis. Eye (Lond). 2025;39(5):883\u0026ndash;98. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41433-025-03625-4\u003c/span\u003e\u003cspan address=\"10.1038/s41433-025-03625-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eŁabuz G, Son H-S, Naujokaitis T, Yildirim TM, Khoramnia R, Auffarth GU. Laboratory Investigation of Preclinical Visual-Quality Metrics and Halo-Size in Enhanced Monofocal Intraocular Lenses. Ophthalmol Ther. 2021;10(4):1093\u0026ndash;104. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s40123-021-00411-9\u003c/span\u003e\u003cspan address=\"10.1007/s40123-021-00411-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMencucci R, Romualdi G, Carnicci A, Panini F, Buzzi M, Giansanti F. Long-Term Effectiveness of a Monofocal Intraocular Lens (IOL) Enhanced for Intermediate Vision: A 5-Year Follow-Up Study. J Clin Med. 2025;14(16). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm14165831\u003c/span\u003e\u003cspan address=\"10.3390/jcm14165831\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaur ID, Khoramnia R, Weindler J, Naujokaitis T, Poompokawat P, Auffarth GU. Clinical Outcomes of a New Hybrid Monofocal IOL With Extended Depth of Focus. J Refract Surg. 2021;37(9):601\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3928/1081597X-20210610-03\u003c/span\u003e\u003cspan address=\"10.3928/1081597X-20210610-03\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChoi WK, Han HJ, Son H-S, Khoramnia R, Auffarth GU, Choi CY. Clinical outcomes of bilateral implantation of new generation monofocal IOL enhanced for intermediate distance and conventional monofocal IOL in a Korean population. BMC Ophthalmol. 2023;23(1):157. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12886-023-02897-2\u003c/span\u003e\u003cspan address=\"10.1186/s12886-023-02897-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDanzinger V, Schartm\u0026uuml;ller D, Lisy M, et al. Intraindividual Comparison of an Enhanced Monofocal and an Aspheric Monofocal Intraocular Lens of the Same Platform. Am J Ophthalmol. 2024;261:95\u0026ndash;102. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ajo.2023.11.006\u003c/span\u003e\u003cspan address=\"10.1016/j.ajo.2023.11.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaur ID, Khoramnia R, Son H-S, Auffarth GU, Łabuz G. Ray Visualization and Through-Focus Optical Quality of Diffractive Enhanced Monofocal and Extended-Depth-of-Focus Intraocular Lenses. Clin Ophthalmol. 2025;19:1673\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/OPTH.S520086\u003c/span\u003e\u003cspan address=\"10.2147/OPTH.S520086\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eŁabuz G, Khoramnia R, Naujokaitis T, Auffarth GU. Optische Bank-Evaluierung f\u0026uuml;r spezielle Intraokularlinsenoptiken. Ophthalmologie. 2024;121(9):698\u0026ndash;705. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00347-024-02064-y\u003c/span\u003e\u003cspan address=\"10.1007/s00347-024-02064-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKabura R, Takeshita T, Furushima K, et al. Comparative evaluation of clinical results and patient-reported outcomes of enhanced monofocal and conventional monofocal intraocular lenses. J Cataract Refract Surg. 2025;51(6):520\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/j.jcrs.0000000000001641\u003c/span\u003e\u003cspan address=\"10.1097/j.jcrs.0000000000001641\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOta J, Matsunaga M, Haga F, et al. Enhanced Monofocal IOLs Improve Patient Satisfaction in Phaco-Vitrectomy for ERM. Clin Ophthalmol. 2025;19:3283\u0026ndash;93. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/OPTH.S541269\u003c/span\u003e\u003cspan address=\"10.2147/OPTH.S541269\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDorronzoro-Ramirez E, Sanchez-Tena MA, Alvarez-Peregrina C, Cardenas Rebollo JM, Flores Cervantes D, S\u0026aacute;nchez-Ramos C. Visual Outcomes of a Non-Diffractive Extended Depth-of-Focus Intraocular Lens in Patients with Early-Stage Age-Related Macular Degeneration. J Clin Med. 2025;14(17). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm14175953\u003c/span\u003e\u003cspan address=\"10.3390/jcm14175953\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMayordomo-Cerd\u0026aacute; F, Ortega-Usobiaga J, Bilbao-Calabuig R, et al. Satisfaction and Visual and Refractive Outcomes Combining an Enhanced Monofocal and a Trifocal Intraocular Lens in Patients with Specific Visual Demands. Clin Ophthalmol. 2025;19:3515\u0026ndash;26. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/OPTH.S549693\u003c/span\u003e\u003cspan address=\"10.2147/OPTH.S549693\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh G, Sidhharthan KS, Reddy JK, Sundaram V, Thulasidas M. Comparison of visual outcomes in patients implanted with Tecnis Eyhance ICB00 and 1-Piece ZCB00 monofocal intraocular lenses. Indian J Ophthalmol. 2024;72(2):181\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/IJO.IJO_681_23\u003c/span\u003e\u003cspan address=\"10.4103/IJO.IJO_681_23\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHayashi S, Yoshida M, Hayashi K, Negishi K. Comparison of visual performance among three higher-order aspheric enhanced monofocal intraocular lenses and a standard aspheric monofocal lens. J Cataract Refract Surg. 2025;51(11):979\u0026ndash;85. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/j.jcrs.0000000000001734\u003c/span\u003e\u003cspan address=\"10.1097/j.jcrs.0000000000001734\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMencucci R, Morelli A, Cennamo M, Roszkowska AM, Favuzza E. Enhanced Monofocal Intraocular Lenses: A Retrospective, Comparative Study between Three Different Models. J Clin Med. 2023;12(10). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm12103588\u003c/span\u003e\u003cspan address=\"10.3390/jcm12103588\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDonoso R, Torres A, Klagges J, et al. Enhanced vs conventional monofocal intraocular lens clinical results in patients with cataract: randomized clinical trial. J Cataract Refract Surg. 2023;49(8):818\u0026ndash;25. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/j.jcrs.0000000000001224\u003c/span\u003e\u003cspan address=\"10.1097/j.jcrs.0000000000001224\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAuffarth GU, Łabuz G, Khoramnia R, Yildirim TM. \u0026Uuml;bersicht \u0026uuml;ber Intraokularlinsen mit Presbyopie-korrigierenden Optiken. Ophthalmologie. 2024;121(9):685\u0026ndash;97. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00347-024-02071-z\u003c/span\u003e\u003cspan address=\"10.1007/s00347-024-02071-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe International Organization for Standardization. ISO-11979-2, Ophthalmic implants - intraocular lenses - Part 2: Optical properties and test methods. 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlarcon A, C\u0026aacute;novas C, Koopman B, Weeber H, Auffarth GU, Piers PA. Enhancing the Intermediate Vision of Monofocal Intraocular Lenses Using a Higher Order Aspheric Optic. J Refract Surg. 2020;36(8):520\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3928/1081597X-20200612-01\u003c/span\u003e\u003cspan address=\"10.3928/1081597X-20200612-01\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaur ID, Auffarth GU, Yan W, Łabuz G, Khoramnia R. Visualization of Ray Propagation through Extended Depth-of-Focus Intraocular Lenses. Diagnostics (Basel). 2022;12(11). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/diagnostics12112667\u003c/span\u003e\u003cspan address=\"10.3390/diagnostics12112667\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYan W, Łabuz G, Khoramnia R, Auffarth GU. Trifocal Intraocular Lens Selection: Predicting Visual Function From Optical Quality Measurements. J Refract Surg. 2023;39(2):111\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3928/1081597X-20221207-02\u003c/span\u003e\u003cspan address=\"10.3928/1081597X-20221207-02\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRibeiro F, Dick HB, Kohnen T, et al. Evidence-based functional classification of simultaneous vision intraocular lenses: seeking a global consensus by the ESCRS Functional Vision Working Group. J Cataract Refract Surg. 2024;50(8):794\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/j.jcrs.0000000000001502\u003c/span\u003e\u003cspan address=\"10.1097/j.jcrs.0000000000001502\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMicheletti JM, McCauley MB, Duncan N, Hall B. Biometric Indicators for Maximizing Intermediate Vision with a Monofocal IOL. Clin Ophthalmol. 2023;17:3739\u0026ndash;46. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/OPTH.S441172\u003c/span\u003e\u003cspan address=\"10.2147/OPTH.S441172\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarišić A, Patel S, Gabric N, Feinbaum CG. The clinical depth of field achievable with trifocal and monofocal intraocular lenses: theoretical considerations and proof of concept clinical results. Graefes Arch Clin Exp Ophthalmol. 2017;255(2):367\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00417-016-3566-9\u003c/span\u003e\u003cspan address=\"10.1007/s00417-016-3566-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlfonso JF, Fern\u0026aacute;ndez-Vega L, Baamonde MB, Mont\u0026eacute;s-Mic\u0026oacute; R. Correlation of pupil size with visual acuity and contrast sensitivity after implantation of an apodized diffractive intraocular lens. J Cataract Refract Surg. 2007;33(3):430\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jcrs.2006.10.051\u003c/span\u003e\u003cspan address=\"10.1016/j.jcrs.2006.10.051\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZapata-D\u0026iacute;az JF, Mar\u0026iacute;n-Franch I, Radhakrishnan H, L\u0026oacute;pez-Gil N. Impact of higher-order aberrations on depth-of-field. J Vis. 2018;18(12):5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1167/18.12.5\u003c/span\u003e\u003cspan address=\"10.1167/18.12.5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlfonso-Bartolozzi B, Martinez-Alberquilla I, Fern\u0026aacute;ndez-Vega-Cueto L, et al. Optical and Visual Outcomes of a New Refractive Extended Depth of Focus Intraocular Lens. J Refract Surg. 2025;41(4):e333\u0026ndash;41. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3928/1081597X-20250221-02\u003c/span\u003e\u003cspan address=\"10.3928/1081597X-20250221-02\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNiknahad A, Wu Z, Son H-S, Auffarth GU, Khoramnia R, Łabuz G. Evaluation of Clareon Vivity and PureSee intraocular lenses: optical quality, depth of focus and misalignment effects. Sci Rep. 2025;15(1):26943. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41598-025-07970-y\u003c/span\u003e\u003cspan address=\"10.1038/s41598-025-07970-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlarcon A, Del Aguila Carrasco A, Gounou F, Weeber H, C\u0026aacute;novas C, Piers P. Optical and clinical simulated performance of a new refractive extended depth of focus intraocular lens. Eye (Lond). 2024;38(Suppl 1):4\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41433-024-03041-0\u003c/span\u003e\u003cspan address=\"10.1038/s41433-024-03041-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchmid R, Borkenstein AF. Optical Bench Evaluation of the Latest Refractive Enhanced Depth of Focus Intraocular Lens. Clin Ophthalmol. 2024;18:1921\u0026ndash;32. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/OPTH.S469849\u003c/span\u003e\u003cspan address=\"10.2147/OPTH.S469849\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorbett D, Black D, Roberts TV, et al. Quality of vision clinical outcomes for a new fully-refractive extended depth of focus Intraocular Lens. Eye (Lond). 2024;38(Suppl 1):9\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41433-024-03039-8\u003c/span\u003e\u003cspan address=\"10.1038/s41433-024-03039-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlack DA, Bala C, Alarcon A, Vilupuru S. Tolerance to refractive error with a new extended depth of focus intraocular lens. Eye (Lond). 2024;38(Suppl 1):15\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41433-024-03040-1\u003c/span\u003e\u003cspan address=\"10.1038/s41433-024-03040-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"enhanced monofocal, monofocal-plus, intraocular lens, Bessel principle","lastPublishedDoi":"10.21203/rs.3.rs-9215734/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9215734/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eTo compare the optical qualities of a novel enhanced monofocal intraocular lens (IOL), against a well-established IOL through in vitro benchmarking.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Optical benchmarking was conducted using the OptiSpheric IOL PRO2 device in compliance with International Organization for Standardization (ISO) guidelines. Optical quality was assessed using the modulation transfer function (MTF), point spread function (PSF), area under the MTF (MTFa), and 1951 USAF test charts. Measurements were taken at 3.0 mm and 4.5 mm apertures using a model cornea that induced 0.13 µm of spherical aberration to simulate clinical performance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Both IOLs demonstrated comparable optical performance. At a 3 mm aperture, the Extend IOLs produced an average MTF at 50 lp/mm of 0.38 ± 0.01, while the ICB00 produced 0.36 ± 0.01. The MTFa and derived logMAR visual acuity (VA) curves showed nearly complete overlap for defocus levels less than -1.25 D, with both lenses yielding identical VA at far focus \u003cbr\u003e\n(-0.09 logMAR). At higher defocus levels, the observed difference between the models accounted for \u0026lt;0.02 logMAR, which is negligible for standard VA testing. Point spread function assessments revealed comparable light distribution for both IOLs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Under laboratory conditions, the Hanita Extend IOL shows comparable results to the Tecnis Eyhance ICB00 regarding MTF function, USAF-Chart images, and PSF assessment.\u003c/p\u003e","manuscriptTitle":"Monofocal intraocular lens based on the Bessel principle for improved intermediate vision: a comparative assessment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-07 09:08:18","doi":"10.21203/rs.3.rs-9215734/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-20T05:55:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-12T03:23:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-07T20:14:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"197008065158010830080121464090269487022","date":"2026-04-06T10:52:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"188986254390250671523643877159267017093","date":"2026-04-03T08:49:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"126424359192793787433383885924091852389","date":"2026-03-31T19:38:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-31T14:36:39+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-28T09:45:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-26T14:36:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-26T14:36:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2026-03-24T19:45:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cc551777-4f16-4d27-8e6f-38695c2ce0d9","owner":[],"postedDate":"April 7th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-17T14:08:11+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-07 09:08:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9215734","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9215734","identity":"rs-9215734","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}