Optical Quality Comparison of a Novel Pentafocal IOL with Quadrifocal and Trifocal IOLs Under Axial, Decentered, and Tilted Conditions

Optical Quality Comparison of a Novel Pentafocal IOL with Quadrifocal and Trifocal IOLs Under Axial, Decentered, and Tilted Conditions | 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 Optical Quality Comparison of a Novel Pentafocal IOL with Quadrifocal and Trifocal IOLs Under Axial, Decentered, and Tilted Conditions Linge Jian, Shanshan Wang, Huixue Wang, Jiali Ji, Qian Chen, Qinghua Qiu, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7489432/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background This study aimed to evaluate the optical performance of a novel pentafocal intraocular lens (IOL) and compare it with established quadrifocal and trifocal designs under controlled experimental conditions. Methods Three diffractive IOLs—pentafocal PMEA60, quadrifocal PanOptix, and trifocal AT LISA Tri 839MP—were assessed using optical bench testing simulating the human eye. Through-focus modulation transfer function (TF-MTF) was measured at 50 lp/mm and as an average across 0‒100 lp/mm at 3.0 mm and 4.5 mm pupil apertures. Optical quality was evaluated under axial alignment, 0.5 mm decentration, and 5° tilt across distance, intermediate, and near focal points. Root mean square error (RMSE) was used to quantify MTF deviations under misalignment. Results At a 3.0 mm pupil diameter, PMEA60 demonstrated consistent TF-MTF across all focal ranges, with enhanced intermediate-focus performance (0.162 ± 0.032) and stable MTF under decentration (0.154 ± 0.037). In comparison, PanOptix presented a decrease in distance MTF from 0.322 ± 0.041 to 0.277 ± 0.069, and AT LISA Tri showed a reduction from 0.323 ± 0.059 to 0.276 ± 0.071 under tilt conditions. At a 4.5 mm pupil diameter, PMEA60 exhibited five distinct focal peaks and maintained MTF stability (RMSE ≤ 0.087), whereas PanOptix and AT LISA Tri displayed notable MTF degradation under misalignment (RMSE ≤ 0.137 and ≤ 0.215, respectively). Near-focus MTF values were comparable among all tested models. Conclusions The pentafocal PMEA60 IOL provides better optical continuity and positional stability compared to quadrifocal and trifocal counterparts. Its broad MTF profile and reduced sensitivity to misalignment indicate its suitability as a full-range vision solution. These findings support its potential for clinical application, informing intraocular lens selection and aiding in the prediction of postoperative visual outcomes. Cataract Multifocal intraocular lenses (MIOLs) Optical performance Modulation transfer function (MTF) Pentafocal Intraocular Lens Figures Figure 1 Figure 2 Figure 3 Introduction The desire for clear vision and freedom from glasses after cataract surgery has driven the widespread use of multifocal intraocular lenses (MIOLs)[ 1 , 2 ]. These lenses distribute incident light across multiple focal points to provide vision at distant, intermediate, and near ranges[ 3 , 4 ]. However, the varied platform designs and energy distribution of MIOLs present inherent challenges. The transition between focal segments can cause dysphotopsia, such as halos or glare[ 5 – 7 ], prompting the development of extended depth of field (EDOF) lenses. Compared to traditional MIOLs, EDOF and enhanced monofocal IOLs offer improved far and intermediate vision with reduced halos and glare[ 8 ]. However, EDOF IOLs typically provide significantly poorer near vision compared to MIOLs, which can hinder younger patients in performing tasks like reading or desk work[ 9 ]. To address these limitations, researchers have developed full-range vision (FRV) or range-of-field (RoF) IOLs, designed to provide smoother transitions and functionally effective acuity across far, intermediate, and near distances[ 10 ]. To optimize continuity and optical quality in the intermediate and far focal segments while maintaining near vision benefits, advanced designs—such as chromatic correction, sinusoidal, quadrifocal, or pentafocal optics—have been introduced in next-generation FRV IOLs. In the development and implementation of advanced IOLs in clinical practice, it is imperative to rigorously assess their optical performance. The functionality of FRV IOLs is significantly influenced by various factors, including variations in pupil diameter, lens tilt and decentration subsequent to implantation[ 11 ]. Additionally, clinical evaluations are often constrained by uncontrollable variables, such as dynamic changes in pupil size and capsular contraction, which complicate the accurate quantification of the optical properties of different IOLs[ 12 ]. Consequently, the establishment of in vitro optical quality testing using an optical bench to simulate the human eye model emerges as a standard practice. This method facilitates precise control over critical variables, including pupil diameter, corneal spherical aberration, and lens positioning. Furthermore, it permits the evaluation of IOL performance through objective indicators, such as modulation transfer function (MTF) curves, thereby minimizing the interference of subjective differences among patients typically encountered in clinical settings. This approach also provides a standardized framework for optimizing lens design and guiding clinical selection. This study aims to compare the MTF performance of a novel pentafocal IOL (Universe PMEA60) with a quadrifocal IOL (Alcon PanOptix TFNT00) and a trifocal IOL (Zeiss AT LISA Tri 839MP) under varying pupil diameters (3.0 mm and 4.5 mm) as well as in axial, decentered, and tilted conditions. The primary objective is to evaluate the optical properties of these three diffractive MIOLs, thereby providing ophthalmologists with a solid experimental foundation for selecting appropriate IOLs, assessing surgical precision, and predicting postoperative visual quality across different lighting conditions. MATERIALS AND METHODS In this study, the optical performance of three diffractive MIOLs designs was systematically evaluated using bench laboratory. The lenses under investigation included the AT LISA Tri 839MP, the Alcon PanOptix TFNT00, and the PMEA60. Two samples with the same refractive power (20.00D) from each model were measured. Comprehensive details regarding the optical properties and manufacturing processes of these three IOLs are delineated in Table 1 . Table 1 Main characteristics of the three MIOLs evaluated in the current experimental study PanOptix TFNT00 AT LISA Tri839MP PMEA60 Manufacture Alcon Zeiss Universe Technology Quadrifocal Trifocal Pentafocal Diffractive zone (mm) 4.5 6.0 4.8 Material Hydrophobic acrylate Hydrophilic acrylic with hydrophobic surface properties. Hydrophilic acrylate Central zone Diffractive Diffractive Diffractive Optic type Nonapodized Nonapodized Nonapodized Optic diameter (mm) 6mm 6mm 6mm Near add power (D) + 3.25 + 3.33 + 3.20 (near), + 2.40 (intermediate-to-near) Intermediate add power (D) + 2.17 + 1.67 + 1.60 (intermediate), + 0.80 (far-to-intermediate) Active orders 0th, 2nd & 3rd 0th, 1st & 2nd -2nd, 0th, 2nd Asphericity (mm) -0.10 -0.18 0 um Color Yellow Clear Clear The PanOptix TFNT00 IOL (Alcon, Fort Worth, TX, USA) is a single-piece ultraviolet and blue light filtering, non-apodized, foldable IOL designed for presbyopia correction. It features a central optic measuring 6.0 mm and an overall diameter of 13.0 mm. The IOL’s posterior surface is spherical, while the anterior surface is aspheric, featuring a diffractive surface centered within the 4.5 mm optic zone. It uses the 0th order for distance vision, with suppression of the 1st diffraction order, characterized by a very low diffraction efficiency[ 13 ]. The proprietary Enlighten technology suppresses the 1st diffraction order (focused at 120 cm, 0.83 D), enhancing distance vision while redistributing light for intermediate (60 cm) and near vision according to a 3:2 power ratio. The AT LISA tri 839 MP (Carl Zeiss Meditec, Jena, Germany) is a single-piece diffractive trifocal IOL with an overall length of 11.0 mm and a 6.0 mm biconvex optic. It transitions to a bifocal lens between 4.3 and 6.0 mm (+ 1.66 D addition) [ 14 ]. The proprietary Smooth Micro Phase technology employs smoother diffractive profiles compared to traditional sawtooth patterns. This innovation serves to reduce light scattering, thereby minimizing photic phenomena and enhancing biocompatibility by decreasing the precipitation of debris[ 13 ]. The PMEA60 (Henan Universe IOL R&M Co., Ltd, Zhengzhou, Henan, P.R.China) is a single-piece diffractive MIOL with an overall length of 12.5 mm and a 6.0 mm biconvex optic. It features pentafocal functionality within a 4.8 mm IOL diameter (AddPower: + 0.8D & + 1.6 D & + 2.4D & + 3.2 D). The wavefront of the IOLs is composed of 12 Fourier harmonics (cosine functions). By optimizing the amplitude and phase of these harmonics and selecting appropriate fundamental frequencies, constructive interference of light fields is achieved across five target focal planes. This optimization facilitates the desired distribution of light energy, with the total light energy utilization rate among the five focal points approaching 100%. Experimental setup The optical performance of MIOLs was evaluated using an optical bench (OptiSpheric IOL Pro, Trioptics GmbH) equipped with a model eye featuring an aberration-free model cornea, compliant with International Organization for Standardization 11979-2 and 11979-9 requirements[ 15 , 16 ]. The assessment employed a light source with a wavelength of 546.1 nm[ 17 ]. The tested IOL was positioned to focus the projected target at its designated focal plane, which was subsequently captured by the measurement detector. This detector comprised an objective microscope lens and a high-resolution charge-coupled device (CCD) camera equipped with integrated autofocus functionality. The IOL was immersed in saline solution within the model eye, maintaining a refractive index of 1.334 at ambient temperature, closely resembling that of the aqueous and vitreous humors. The CCD camera can shift along the optical axis and record signal intensity peaks within the target focal range. A wavelength of 543 nm has been selected for performing this set of experiments. Measurements Through-focus MTF curves were measured with 50 line pairs per millimeter (lp/mm) spatial frequencies equivalent to 20/40 Snellen visual acuity at pupil sizes of 3.0 mm and 4.5 mm to simulate both photopic conditions and mesopic conditions[ 18 ]. Within the specified focus range, MTF values corresponding to spatial frequencies from 0 to 100 lp/mm were measured at intervals of 0.25D. Subsequently, these MTF values were averaged and plotted as a curve (MTFa). For each IOL, the average MTF values were measured under both 3.0 mm and 4.5 mm apertures. Misalignment tests involved setting a lateral decentration of 0.5 mm and a tilt of 5° from the central axis. Before each measurement, the IOL was meticulously aligned with the optical bench’s central axis. MTF values at 50 lp/mm and 100 lp/mm were documented at three focal distances (far/infinity, intermediate/60 cm, and near/40 cm) under both axial alignment and deliberate misalignment conditions (0.5 mm decentration with 5° tilt) at 3.0 mm and 4.5 mm. To minimize errors, each condition’s MTF values were averaged over three tangential and three sagittal measurements. Data processing and analysis methods MTF data from two replicate measurements for each IOLs (n = 2 lenses per model) were imported into Microsoft Excel. Tangential and sagittal MTF values were averaged to obtain mean values for each testing condition. These averages were then transferred to GraphPad Prism 9.0 for plotting MTF curves (50–100 lp/mm) and bar charts. Initially, the homogeneity of variance was evaluated using Levene’s test with SPSS 26.0. For datasets showing homogeneous variances (p > 0.05), Tukey’s post hoc test was employed for pairwise comparisons. Conversely, for datasets with non-homogeneous variances, the Games-Howell test was applied. All statistical analyses were conducted within ANOVA frameworks to control for family-wise error rates. Additionally, root mean square error (RMSE) was calculated to quantify deviation between normal and misaligned conditions, with significance defined as P < 0.05. Results Modulation Transfer Function Measurements The through-focus modulation transfer function (TF-MTF) values at a spatial frequency of 50 lp/mm for three IOLs are presented in Fig. 1 . The results for two pupil apertures (3.0 mm and 4.5 mm) demonstrate how pupil size influences the performance of MIOLs. At a 3.0 mm aperture, both AT LISA Tri 839MP and PMEA60 exhibited trifocal characteristics, with discernible peaks at the intended focal points. The intermediate focus manifested a peak approximately at 1.60 diopters (D), while the near focus exhibited a peak ranging from 3.20 to 3.33 diopters (D), reflecting the additional intermediate and near power to each MIOLs design. In contrast, the TF-MTF analysis of PanOptix showed a merging of the intermediate and near foci, creating a plateau between 2.20D and 3.30D, attributed to its proprietary Enlighten technology. Accompanying this flat crest was a minor peak with an MTF score near 0.05 at the 0.80D defocus coordinate. At far focus, AT LISA Tri 839MP achieved the highest MTF score, followed by PanOptix and PMEA60. At intermediate focus, PMEA60 outperformed AT LISA Tri 839MP in terms of MTF value. Near focus MTF values appeared consistent across all evaluated lenses. At a 4.5 mm aperture, distinct focal peaks were evident for both AT LISA Tri 839MP and PanOptix at far, intermediate and near point. Notably, PMEA60 demonstrated five focal peaks, indicative of its pentafocal characteristics. This unique configuration included a new secondary peak at 0.8D and a fourth peak around 2.40D, situated between the intermediate and near peaks compared to its performance at 3.0 mm. This suggests that the broad second peak observed at the smaller aperture was an amalgamation of two focal points in the PMEA60’s MTF profile. At far focus, PanOptix achieved a superior MTF score compared to AT LISA Tri 839MP and PMEA60. However, MTF values across the three IOLs remained comparable at the near focus. The average MTF value from 0 to 100 lp/mm at 3.0 and 4.5mm was similar to the pattern of MTF with 50 lp/mm, and were shown in Figs. S1 and S2. Table 2 Comparison of MTF between axial, decentration, and tilt in distance/intermediate/near focus of one IOL at 3.0mm IOL Name Focus MTF(Mean ± SD)@3.0mm A D T PanOptix Distance 0.322 ± 0.041 0.277 ± 0.069* 0.260 ± 0.056* Intermediate 0.163 ± 0.037 0.125 ± 0.04* 0.159 ± 0.034 Near 0.176 ± 0.052 0.185 ± 0.051 0.170 ± 0.05 AT LISA Tri 839MP Distance 0.323 ± 0.059 0.336 ± 0.064 0.276 ± 0.071* Intermediate 0.113 ± 0.029 0.115 ± 0.014 0.090 ± 0.031* Near 0.183 ± 0.022 0.192 ± 0.021* 0.152 ± 0.037* PMEA60 Distance 0.301 ± 0.042 0.289 ± 0.052 0.280 ± 0.052* Intermediate 0.162 ± 0.032 0.154 ± 0.037 0.153 ± 0.048 Near 0.171 ± 0.025 0.170 ± 0.025 0.153 ± 0.035* Note: A: Axial, D: Decentration, T: Tilt *Comparing with Axial position, p < 0.05 At a 3.0 mm aperture, the MTF graphs illustrating the near, intermediate, and distal foci of the three MIOLs under axial, decentered, and tilted conditions are presented in Fig. 2 and Table 2 . For PMEA60, the intermediate focus exhibited a consistent pattern across all assessed conditions. In contrast, significant reductions were observed in the distance and near focus curves at higher spatial frequencies under tilt conditions compared to axial conditions. However, no significant differences were detected between the axial and decentration conditions (P > 0.05). For AT LISA Tri 839MP, the MTF graphs indicated a decline in performance under tilt conditions across all focal points, whereas the decentration condition did not lead to significant changes in any of the focus curves. For PanOptix, both decentration and tilt conditions adversely affected the distance focus curve. The intermediate curve was influenced solely by the decentration condition. Notably, the near focal point demonstrated consistently high optical performance across all tested conditions. Table 3 Comparison of MTF between axial, decentration, and tilt in distance/intermediate/near focus of one IOL at 4.5mm IOL Name Focus MTF(Mean ± SD)@4.5mm A D T PanOptix Distance 0.338 ± 0.059 0.216 ± 0.118* 0.211 ± 0.078* Intermediate 0.124 ± 0.025 0.202 ± 0.094* 0.056 ± 0.024* Near 0.166 ± 0.033 0.144 ± 0.064* 0.09 ± 0.039* AT LISA Tri 839MP Distance 0.265 ± 0.097 0.063 ± 0.027* 0.073 ± 0.034* Intermediate 0.093 ± 0.036 0.195 ± 0.054* 0.167 ± 0.088* Near 0.164 ± 0.049 0.158 ± 0.089 0.107 ± 0.051* PMEA60 Distance 0.278 ± 0.057 0.218 ± 0.052* 0.193 ± 0.074* Intermediate 0.168 ± 0.03 0.118 ± 0.034* 0.125 ± 0.046* Near 0.173 ± 0.019 0.169 ± 0.025 0.127 ± 0.036* Note: A: Axial, D: Decentration, T: Tilt * Comparing with Axial position, p < 0.05 At a 4.5mm aperture, MTF graphs of all IOLs demonstrated a decline under tilt conditions (Fig. 3 , Table 3 ). Notably, the MTF graphs of the near focus for both AT LISA Tri and PMEA60 exhibited no appreciable changes between axial and decentration conditions. Interestingly, the intermediate curve MTF values for AT LISA Tri and PanOptix showed an increase under decentration conditions. Statistical comparisons of the MTF curves (Table S1 , Table S2 ) revealed significant differences (p < 0.05) between centered and misalignment states for most conditions. AT LISA Tri 839MP displayed fewer significant differences at the distance focus (p = 0.562 for decentration vs. centered), while both PanOptix and PMEA60 exhibited minimal deviations in the near-focus MTF under misalignment (p > 0.05 for PanOptix near focus). Among the IOLs, PMEA60 demonstrated the least deviation when decentered by 0.5 mm, closely resembling the centered state (p > 0.05 for PMEA60 across all foci focus). RMSE analysis (Table 4 , Table 5 ) indicated that PMEA60 had the smallest deviations across all focal points under misalignment especially at 4.5mm aperture (RMSE ≤ 0.049), followed by PanOptix (RMSE ≤ 0.061). In contrast, AT LISA Tri 839MP exhibited greater sensitivity to tilt at intermediate and near focal points (RMSE up to 0.051). Table 4 RMSE value between axial, decentration, and tilt in distance/intermediate/near focus of one IOL at 3.0mm IOL Name RMSE Value Distance Intermediate Near A-D A-T A-D A-T A-D A-T PanOptix 0.052 0.061 0.049 0.013 0.012 0.009 AT LISA Tri 839MP 0.014 0.051 0.016 0.027 0.013 0.037 PMEA60 0.016 0.027 0.011 0.020 0.009 0.028 Table 5 RMSE value between axial, decentration, and tilt in distance/intermediate/near focus of one IOL at 4.5mm IOL Name RMSE Value Distance Intermediate Near A-D A-T A-D A-T A-D A-T PanOptix 0.137 0.130 0.110 0.071 0.040 0.078 AT LISA Tri 839MP 0.215 0.210 0.104 0.091 0.041 0.058 PMEA60 0.060 0.087 0.052 0.047 0.012 0.049 Discussion With the advent of new categories of simultaneous vision IOLs, RoF achievable by these lenses has evolved beyond traditional bifocal, trifocal, or extended depth-of-focus designs. In vitro through-focus evaluation has emerged as the standard method for characterizing IOL functionality. Previous studies have demonstrated that the through-focus MTF metric, or the area under the through-focus MTF curve (MTFa), exhibits a non-linear correlation with IOLs optical quality and the visual acuity (VA) defocus curves in pseudophakic patients[ 19 , 20 ]. This laboratory-based investigation aimed to compare the optical performance of a new pentafocal IOL (PMEA60) against two traditional diffractive MIOLs: the quadrifocal PanOptix and the trifocal AT LISA Tri 839MP. Utilizing an objective optical quality evaluation method, we also assessed the visual quality of these lenses under conditions of decentration and tilt. The through-focus MTF curve provides a simulation of the IOL profile concerning distance, intermediate, and near foci, thereby simultaneously evaluating the depth of field. As depicted in Fig. 1 , the through-focus modulation values for all IOLs concerning the distance focus (zero defocus diopter) at apertures of 3.0 or 4.5 mm ranged between 0.3 and 0.4. This aligns with previous literature. For example, diffractive MIOLs like the PanOptix typically achieve MTF values between 0.30 and 0.45 at far focus with a 3.0 mm aperture and spatial frequencies of 50–100 lp/mm. Conversely, monofocal aspherical IOLs, such as Tecnis ZCB00, can reach MTF values of 0.8 or higher at far focus, although this superior performance diminishes at larger pupils or higher spatial resolutions[ 21 – 25 ]. Notably, PanOptix exhibited improved performance with aperture enlargement, whereas AT LISA Tri 839MP showed decreased values. PMEA60 demonstrated consistency across these conditions, yet these relative differences in modulation did not significantly impact distance visual acuity. The additional power incorporated in MIOL designs is a fundamental feature differentiating these IOLs. Our study’s findings, detailed in Fig. 1 , illustrate distinct object vergences among the IOLs evaluated. AT LISA Tri 839MP and PMEA60 both displayed intermediate foci around 1.60D and near foci around 3.30D, aligning with their near-adding power design. PanOptix presented a flat peak extending from 2.20D to 3.30D due to the proximity of its third and fourth foci, indicating an intermediate and near focus range approximately from 60 cm to 42 cm. Notably, we observed an MTF score at the 0.8 defocus point despite the removal of a second focus at 120 cm in this quadrifocal IOL—an observation consistent with other bench studies[ 26 , 27 ]. Under a 4.5 mm test pupil, each IOL exhibited distinct and independent peaks at their respective intermediate and near foci. The pentafocal PMEA60’s distinguishing feature is the additional two peaks emerging between the far-to-intermediate and intermediate-to-near foci, constituting the second and fourth foci. This patented design accommodates a broader focus range, endorsing the forthcoming concept of FULL-RoF IOL. According to the global consensus of the ESCRS Functional Vision Working Group, there are three subcategories describing the transition in VA from intermediate to near: continuous FULL-RoF with an increase below 0.05 logMAR, smooth transition between 0.05 logMAR and below 0.14 logMAR, and steep transition for increases of 0.14 logMAR or higher[ 10 ]. The transition trough was observed from less than 1.0D to over 2.0D in the defocus curve, which categorizes AT LISA Tri 839MP and PanOptix as “Smooth transition” IOLs in this study[ 28 – 30 ]. At a 3.0 mm aperture, the pentafocal IOL provides a broader wave crest and a deeper wave trough ranging from 0.7 to 4.0D compared to the trifocal IOL, with a modulation MTF above 0.05—surpassing the detectable spatial frequency threshold by the human retina[ 31 ]. At 4.5 mm, wave crests of different foci produced a wider modulation curve than the other two IOLs, suggesting the pentafocal IOL might offer a solution for continuous FULL-RoF capability. The trifocal AT LISA presents a tri-peak structure in the MTF response curve between distance, intermediate, and near peaks, intermediate focus energy distribution peaks at a pupil diameter of 3–4 mm. In contrast, EDOF IOLs, such as the Tecnis Symfony, realize continuous depth from far to intermediate ranges with often lower near MTF values (typically < 0.2) than the PMEA60[ 32 – 34 ]. The PMEA60 maintains multifocal MTF curve consistency under a large 4.5 mm aperture via a five-focus design and stepwise light energy distribution, indicating a potential for “continuous transition RoF”. Yet, clinical evaluations are necessary to assess the translation of this optical property into practical benefits, considering the subjective visual quality outcome associated with PMEA60’s defocus curve stability. Apart from varying additive power designs, the allocation of light energy to different foci is crucial. All IOLs in the study demonstrate through-focus transitions from far to near. The similarity of the AT LISA Tri 839MP and PanOptix TFNT00 through-focus curves with earlier reported findings reaffirm their optical quality. The PMEA60, under a 3.0 mm pupil, resembles the Zeiss 839MP curve, although with a larger MTF area suggesting superior optical quality. Differing from the sharp Zeiss 839MP curve between intermediate and near peaks, the PMEA60 exhibits a functional MTF curve that may enhance its comparative performance, potentially classifying it within continuous transition FULL-RoF IOLs. Future clinical visual acuity research focusing on defocus curves is necessary to substantiate these hypotheses. The inherent optical performance of MIOLs is notably impacted by implantation-induced positional errors, such as decentration and tilt[ 12 , 35 ]. Positional stability is vital for determining postoperative visual quality, as these errors amplify wavefront aberrations like coma and astigmatism, particularly affecting high spatial frequency contrast sensitivity[ 6 , 22 , 36 ]. Our study highlights distinct responses among the three MIOLs evaluated. At a decentration of 0.5 mm, PMEA60 demonstrated superior optical stability. It showed minimal variation in MTF values across most foci, with negligible attenuation at near focus at 3.0 and 4.5mm aperture. Conversely, the AT LISA Tri 839MP and PanOptix exhibited pronounced declines in MTF values at far focus with larger apertures. PanOptix’s near-focus performance slightly lower with increasing pupil size. RMSE analysis confirmed PMEA60’s lowest combined bias across all focus and excursion conditions, indicating optimal energy distribution uniformity and resistance to offset compared to other lenses. The AT LISA Tri 839MP showed enhanced MTF values at the mid-focus under decentration conditions at 4.5mm aperture, potentially attributable to the redistribution of light energy causing unintended diffraction into the mid-focal region. This “focus-shifting” effect, typical in diffractive MIOLs, can result in patient glare and blurred vision[ 37 ]. Consistent with prior studies, our findings reveal that AT LISA Tri 839MP and PanOptix experience MTF decreases at far focal distances, exacerbated by larger apertures under tilt condition. Both the intermediate focus of the AT LISA Tri and the far focus of PanOptix are sensitive to tilting at 3.0mm, leading to significant decreases in optical quality[ 14 ]. The PMEA60’s continuous diffraction gradient disperses energy across five consecutive foci, avoiding the quivering of light energy present in traditional multifocal designs. Aberration-free IOLs exhibit minimal sensitivity to eccentricity and tilt, maintaining image quality despite positional misalignments[ 22 ]. At a tilt of 5°, PMEA60 displays a notably lower decrease in MTF values across all focal lengths, particularly mid and far, likely due to its axisymmetric sinusoidal diffraction structure, which minimizes tilt-induced optical aberrations and maintains imaging quality[ 22 ]. While tilt impacts the MTF values of PanOptix and AT LISA Tri 839MP, the extent of decline varies based on focal length and pupil aperture[ 38 ]. The PanOptix exhibits pronounced MTF reduction at mid-focal distances, especially at larger apertures. Although PanOptix’s far-focus MTF slightly improves with larger aperture under axial conditions, its performance degrades markedly under misalignment. The AT LISA Tri’s far focus remains less influenced by tilt at 3.0 mm aperture, possibly due to the emergence of higher-order aberrations leading to MTF attenuation. Moreover, mesofocal distances show heightened sensitivity due to overlapping optical zones[ 14 , 39 ]. It should be noted that this study has some limitations. Firstly, in vitro experiments replicated offsets of 0.5 mm/5°, unlike potential patient scenarios where capsular bag relaxation might result in offsets up to 1.0 mm. Secondly, measurements were conducted using monochromatic light, which may differ from real-world white light observations, although adherence to ISO standards was maintained for comprehensive IOL behavior characterization. Additionally, only two samples of each IOL type were assessed, suggesting that further validation through additional samples could be beneficial. This necessitates future experimental studies to evaluate and compare MIOL optical behavior comprehensively. Lastly, as a laboratory-based study, the presented experimental data have yet to be corroborated with clinical insights. Establishing correlations between optical bench findings and clinical visual performance represents a promising avenue for future research. Conclusion The findings of this study indicate that the novel pentafocal IOL PMEA60 exhibits superior optical continuity and positional stability compared to the trifocal AT LISA Tri 839MP and quadrifocal PanOptix designs. The PMEA60 achieves a broader MTF curve and sustains effective MTF values across an extended range of defocus under larger apertures. Its distinctive five-peak configuration effectively bridges the technological divide between conventional MIOLs and EDOF IOLs. These characteristics suggest its potential as a continuous, FULL-RoF solution, with diminished sensitivity to tilt and decentration, enhancing its suitability for varied clinical applications. Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding This work was supported by research grants from the National Key Research and Development Program of China (2022YFC2502800 and 2024YFC2510800), the National Natural Science Foundation of China (82271069, 82371040, 82122017, 81870642, 81970780, 81470613 and 81670835), Special Project of Shanghai Public Health Research (2024 GKQ36), Science and Technology Innovation Action Plan of Shanghai Science and Technology Commission (23Y11909800), Outstanding Youth Medical Talents of Shanghai “Rising Stars of Medical Talents” Youth Development Program, Clinical Research Plan of Shanghai Shenkang Hospital Development Center (2024ZZ1025 and 20244Z0015). This work has also been supported by the Fundamental Research Funds for the Central Universities (YG2024LC13), the Research Fund of Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine (2023DHYGJC-YBA06) and the National Natural Science Foundation of China (82371072). Authors’ contributions X.C., X.Z. and Q.Q. contributed in the conceptualization and writing (reviewing and editing) of this study. L.J. contributed in the data curation, investigation, visualization, and writing (both original draft and reviewing/editing) of this study. S.W. contributed in the data curation, formal analysis, investigation, visualization, and writing (original draft) of this study. K.Z. and S.L. contributed to the methodology of this study. Q.C., J.J. and H.W. contributed in the supervision and project administration of this study. All authors read and approved the final manuscript. Acknowledgements Not applicable. 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Changes in Optical Quality Induced by Tilt and Decentration of a Trifocal IOL and a Novel Extended Depth of Focus IOL in Eyes With Corneal Myopic Ablations. J Refract Surg. 2021;37:532–7. https://doi.org/10.3928/1081597X-20210518-03. Yan W, Auffarth GU, Khoramnia R, Łabuz G. A Comparative Analysis of the Effects of Misaligning Different Trifocal Intraocular Lenses. JCM. 2024;14:187. https://doi.org/10.3390/jcm14010187. Velasco-Barona C, Corredor-Ortega C, Mendez-Leon A, Casillas-Chavarín NL, Valdepeña-López Velarde D, Cervantes-Coste G, et al. Influence of Angle κ and Higher-Order Aberrations on Visual Quality Employing Two Diffractive Trifocal IOLs. J Ophthalmol. 2019;2019:1–8. https://doi.org/10.1155/2019/7018937. Additional Declarations No competing interests reported. Supplementary Files AdditionalFile1.docx Additional file 1 (Table of contents): Table S1. P value between axial, decentration, and tilt in distance/intermediate/near focus of one IOL at 3.0mm Table S2. P value between axial, decentration, and tilt in distance/intermediate/near focus of one IOL at 4.5mm Additionalfile2.pdf Additional file 2 (Figure of contents): Figure S1. Average MTF curve at 3.0mm aperture. Figure S2. Average MTF curve at 4.5mm aperture. Cite Share Download PDF Status: Posted Version 1 posted 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. 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2","display":"","copyAsset":false,"role":"figure","size":1327856,"visible":true,"origin":"","legend":"\u003cp\u003eMTF graph of PanOptix (2A), AT LISA Tri 839MP (2B) and PMEA60 (2C) in distance/intermediate/near focus with different condition at 3.0 mm\u003c/p\u003e","description":"","filename":"fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7489432/v1/8135dc0257ff3d9e1a7d5226.jpg"},{"id":93748733,"identity":"979a0ee9-7746-4707-8481-7da24ce163dd","added_by":"auto","created_at":"2025-10-17 07:19:07","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1278598,"visible":true,"origin":"","legend":"\u003cp\u003eMTF graph of PanOptix (3A), AT LISA Tri 839MP (3B) and PMEA60 (3C) in distance/intermediate/near focus with different condition at 4.5 mm\u003c/p\u003e","description":"","filename":"fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7489432/v1/d375b60f59decafde9cab6f6.jpg"},{"id":96916199,"identity":"d9cd8a21-7ac9-4c33-8ed4-8eb6c1e763f4","added_by":"auto","created_at":"2025-11-27 14:08:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3836497,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7489432/v1/985dc17b-9c05-4594-981f-e20833817695.pdf"},{"id":93748726,"identity":"cd088c94-e988-4d67-adb2-a398c57897e6","added_by":"auto","created_at":"2025-10-17 07:19:07","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15284,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 1 (Table of contents):\u003c/p\u003e\n\u003cp\u003eTable S1. P value between axial, decentration, and tilt in distance/intermediate/near focus of one IOL at 3.0mm\u003c/p\u003e\n\u003cp\u003eTable S2. P value between axial, decentration, and tilt in distance/intermediate/near focus of one IOL at 4.5mm\u003c/p\u003e","description":"","filename":"AdditionalFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7489432/v1/add1aa8c84013d99c732ed8a.docx"},{"id":93748728,"identity":"e17735d7-aee7-4c16-bed2-7c4880c1c634","added_by":"auto","created_at":"2025-10-17 07:19:07","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":224022,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 2 (Figure of contents):\u003c/p\u003e\n\u003cp\u003eFigure S1. Average MTF curve at 3.0mm aperture.\u003c/p\u003e\n\u003cp\u003eFigure S2. Average MTF curve at 4.5mm aperture.\u003c/p\u003e","description":"","filename":"Additionalfile2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7489432/v1/9c8605feb30d9576fd9ad956.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Optical Quality Comparison of a Novel Pentafocal IOL with Quadrifocal and Trifocal IOLs Under Axial, Decentered, and Tilted Conditions","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe desire for clear vision and freedom from glasses after cataract surgery has driven the widespread use of multifocal intraocular lenses (MIOLs)[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These lenses distribute incident light across multiple focal points to provide vision at distant, intermediate, and near ranges[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, the varied platform designs and energy distribution of MIOLs present inherent challenges. The transition between focal segments can cause dysphotopsia, such as halos or glare[\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], prompting the development of extended depth of field (EDOF) lenses. Compared to traditional MIOLs, EDOF and enhanced monofocal IOLs offer improved far and intermediate vision with reduced halos and glare[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, EDOF IOLs typically provide significantly poorer near vision compared to MIOLs, which can hinder younger patients in performing tasks like reading or desk work[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo address these limitations, researchers have developed full-range vision (FRV) or range-of-field (RoF) IOLs, designed to provide smoother transitions and functionally effective acuity across far, intermediate, and near distances[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. To optimize continuity and optical quality in the intermediate and far focal segments while maintaining near vision benefits, advanced designs\u0026mdash;such as chromatic correction, sinusoidal, quadrifocal, or pentafocal optics\u0026mdash;have been introduced in next-generation FRV IOLs. In the development and implementation of advanced IOLs in clinical practice, it is imperative to rigorously assess their optical performance. The functionality of FRV IOLs is significantly influenced by various factors, including variations in pupil diameter, lens tilt and decentration subsequent to implantation[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Additionally, clinical evaluations are often constrained by uncontrollable variables, such as dynamic changes in pupil size and capsular contraction, which complicate the accurate quantification of the optical properties of different IOLs[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Consequently, the establishment of in vitro optical quality testing using an optical bench to simulate the human eye model emerges as a standard practice. This method facilitates precise control over critical variables, including pupil diameter, corneal spherical aberration, and lens positioning. Furthermore, it permits the evaluation of IOL performance through objective indicators, such as modulation transfer function (MTF) curves, thereby minimizing the interference of subjective differences among patients typically encountered in clinical settings. This approach also provides a standardized framework for optimizing lens design and guiding clinical selection.\u003c/p\u003e\u003cp\u003eThis study aims to compare the MTF performance of a novel pentafocal IOL (Universe PMEA60) with a quadrifocal IOL (Alcon PanOptix TFNT00) and a trifocal IOL (Zeiss AT LISA Tri 839MP) under varying pupil diameters (3.0 mm and 4.5 mm) as well as in axial, decentered, and tilted conditions. The primary objective is to evaluate the optical properties of these three diffractive MIOLs, thereby providing ophthalmologists with a solid experimental foundation for selecting appropriate IOLs, assessing surgical precision, and predicting postoperative visual quality across different lighting conditions.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eIn this study, the optical performance of three diffractive MIOLs designs was systematically evaluated using bench laboratory. The lenses under investigation included the AT LISA Tri 839MP, the Alcon PanOptix TFNT00, and the PMEA60. Two samples with the same refractive power (20.00D) from each model were measured. Comprehensive details regarding the optical properties and manufacturing processes of these three IOLs are delineated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMain characteristics of the three MIOLs evaluated in the current experimental study\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePanOptix TFNT00\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAT LISA Tri839MP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePMEA60\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManufacture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlcon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eZeiss\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUniverse\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTechnology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQuadrifocal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTrifocal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePentafocal\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiffractive zone (mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaterial\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHydrophobic acrylate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHydrophilic acrylic with hydrophobic surface properties.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHydrophilic acrylate\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCentral zone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiffractive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDiffractive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDiffractive\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOptic type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNonapodized\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNonapodized\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNonapodized\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOptic diameter (mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6mm\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNear add power (D)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e+\u0026thinsp;3.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e+\u0026thinsp;3.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u0026thinsp;3.20 (near), +\u0026thinsp;2.40 (intermediate-to-near)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntermediate add power (D)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e+\u0026thinsp;2.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e+\u0026thinsp;1.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u0026thinsp;1.60 (intermediate), +\u0026thinsp;0.80 (far-to-intermediate)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eActive orders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0th, 2nd \u0026amp; 3rd\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0th, 1st \u0026amp; 2nd\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-2nd, 0th, 2nd\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAsphericity (mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 um\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eColor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYellow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eClear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eClear\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe PanOptix TFNT00 IOL (Alcon, Fort Worth, TX, USA) is a single-piece ultraviolet and blue light filtering, non-apodized, foldable IOL designed for presbyopia correction. It features a central optic measuring 6.0 mm and an overall diameter of 13.0 mm. The IOL\u0026rsquo;s posterior surface is spherical, while the anterior surface is aspheric, featuring a diffractive surface centered within the 4.5 mm optic zone. It uses the 0th order for distance vision, with suppression of the 1st diffraction order, characterized by a very low diffraction efficiency[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The proprietary Enlighten technology suppresses the 1st diffraction order (focused at 120 cm, 0.83 D), enhancing distance vision while redistributing light for intermediate (60 cm) and near vision according to a 3:2 power ratio.\u003c/p\u003e\u003cp\u003eThe AT LISA tri 839 MP (Carl Zeiss Meditec, Jena, Germany) is a single-piece diffractive trifocal IOL with an overall length of 11.0 mm and a 6.0 mm biconvex optic. It transitions to a bifocal lens between 4.3 and 6.0 mm (+\u0026thinsp;1.66 D addition) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The proprietary Smooth Micro Phase technology employs smoother diffractive profiles compared to traditional sawtooth patterns. This innovation serves to reduce light scattering, thereby minimizing photic phenomena and enhancing biocompatibility by decreasing the precipitation of debris[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe PMEA60 (Henan Universe IOL R\u0026amp;M Co., Ltd, Zhengzhou, Henan,\u003c/p\u003e\u003cp\u003eP.R.China) is a single-piece diffractive MIOL with an overall length of 12.5 mm and a 6.0 mm biconvex optic. It features pentafocal functionality within a 4.8 mm IOL diameter (AddPower: + 0.8D \u0026amp; + 1.6 D \u0026amp; + 2.4D \u0026amp; + 3.2 D). The wavefront of the IOLs is composed of 12 Fourier harmonics (cosine functions). By optimizing the amplitude and phase of these harmonics and selecting appropriate fundamental frequencies, constructive interference of light fields is achieved across five target focal planes. This optimization facilitates the desired distribution of light energy, with the total light energy utilization rate among the five focal points approaching 100%.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eExperimental setup\u003c/h2\u003e\u003cp\u003eThe optical performance of MIOLs was evaluated using an optical bench (OptiSpheric IOL Pro, Trioptics GmbH) equipped with a model eye featuring an aberration-free model cornea, compliant with International Organization for Standardization 11979-2 and 11979-9 requirements[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The assessment employed a light source with a wavelength of 546.1 nm[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The tested IOL was positioned to focus the projected target at its designated focal plane, which was subsequently captured by the measurement detector. This detector comprised an objective microscope lens and a high-resolution charge-coupled device (CCD) camera equipped with integrated autofocus functionality. The IOL was immersed in saline solution within the model eye, maintaining a refractive index of 1.334 at ambient temperature, closely resembling that of the aqueous and vitreous humors. The CCD camera can shift along the optical axis and record signal intensity peaks within the target focal range. A wavelength of 543 nm has been selected for performing this set of experiments.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMeasurements\u003c/h3\u003e\n\u003cp\u003eThrough-focus MTF curves were measured with 50 line pairs per millimeter (lp/mm) spatial frequencies equivalent to 20/40 Snellen visual acuity at pupil sizes of 3.0 mm and 4.5 mm to simulate both photopic conditions and mesopic conditions[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Within the specified focus range, MTF values corresponding to spatial frequencies from 0 to 100 lp/mm were measured at intervals of 0.25D. Subsequently, these MTF values were averaged and plotted as a curve (MTFa). For each IOL, the average MTF values were measured under both 3.0 mm and 4.5 mm apertures.\u003c/p\u003e\u003cp\u003eMisalignment tests involved setting a lateral decentration of 0.5 mm and a tilt of 5\u0026deg; from the central axis. Before each measurement, the IOL was meticulously aligned with the optical bench\u0026rsquo;s central axis. MTF values at 50 lp/mm and 100 lp/mm were documented at three focal distances (far/infinity, intermediate/60 cm, and near/40 cm) under both axial alignment and deliberate misalignment conditions (0.5 mm decentration with 5\u0026deg; tilt) at 3.0 mm and 4.5 mm. To minimize errors, each condition\u0026rsquo;s MTF values were averaged over three tangential and three sagittal measurements.\u003c/p\u003e\n\u003ch3\u003eData processing and analysis methods\u003c/h3\u003e\n\u003cp\u003eMTF data from two replicate measurements for each IOLs (n\u0026thinsp;=\u0026thinsp;2 lenses per model) were imported into Microsoft Excel. Tangential and sagittal MTF values were averaged to obtain mean values for each testing condition. These averages were then transferred to GraphPad Prism 9.0 for plotting MTF curves (50\u0026ndash;100 lp/mm) and bar charts.\u003c/p\u003e\u003cp\u003eInitially, the homogeneity of variance was evaluated using Levene\u0026rsquo;s test with SPSS 26.0. For datasets showing homogeneous variances (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), Tukey\u0026rsquo;s post hoc test was employed for pairwise comparisons. Conversely, for datasets with non-homogeneous variances, the Games-Howell test was applied. All statistical analyses were conducted within ANOVA frameworks to control for family-wise error rates. Additionally, root mean square error (RMSE) was calculated to quantify deviation between normal and misaligned conditions, with significance defined as P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eModulation Transfer Function Measurements\u003c/h2\u003e\u003cp\u003eThe through-focus modulation transfer function (TF-MTF) values at a spatial frequency of 50 lp/mm for three IOLs are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The results for two pupil apertures (3.0 mm and 4.5 mm) demonstrate how pupil size influences the performance of MIOLs.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAt a 3.0 mm aperture, both AT LISA Tri 839MP and PMEA60 exhibited trifocal characteristics, with discernible peaks at the intended focal points. The intermediate focus manifested a peak approximately at 1.60 diopters (D), while the near focus exhibited a peak ranging from 3.20 to 3.33 diopters (D), reflecting the additional intermediate and near power to each MIOLs design. In contrast, the TF-MTF analysis of PanOptix showed a merging of the intermediate and near foci, creating a plateau between 2.20D and 3.30D, attributed to its proprietary Enlighten technology. Accompanying this flat crest was a minor peak with an MTF score near 0.05 at the 0.80D defocus coordinate.\u003c/p\u003e\u003cp\u003eAt far focus, AT LISA Tri 839MP achieved the highest MTF score, followed by PanOptix and PMEA60. At intermediate focus, PMEA60 outperformed AT LISA Tri 839MP in terms of MTF value. Near focus MTF values appeared consistent across all evaluated lenses.\u003c/p\u003e\u003cp\u003eAt a 4.5 mm aperture, distinct focal peaks were evident for both AT LISA Tri 839MP and PanOptix at far, intermediate and near point. Notably, PMEA60 demonstrated five focal peaks, indicative of its pentafocal characteristics. This unique configuration included a new secondary peak at 0.8D and a fourth peak around 2.40D, situated between the intermediate and near peaks compared to its performance at 3.0 mm. This suggests that the broad second peak observed at the smaller aperture was an amalgamation of two focal points in the PMEA60\u0026rsquo;s MTF profile.\u003c/p\u003e\u003cp\u003eAt far focus, PanOptix achieved a superior MTF score compared to AT LISA Tri 839MP and PMEA60. However, MTF values across the three IOLs remained comparable at the near focus.\u003c/p\u003e\u003cp\u003eThe average MTF value from 0 to 100 lp/mm at 3.0 and 4.5mm was similar to the pattern of MTF with 50 lp/mm, and were shown in Figs. S1 and S2.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of MTF between axial, decentration, and tilt in distance/intermediate/near focus of one IOL at 3.0mm\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eIOL Name\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFocus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eMTF(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)@3.0mm\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eT\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePanOptix\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDistance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.322\u0026thinsp;\u0026plusmn;\u0026thinsp;0.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.277\u0026thinsp;\u0026plusmn;\u0026thinsp;0.069*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.260\u0026thinsp;\u0026plusmn;\u0026thinsp;0.056*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntermediate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.163\u0026thinsp;\u0026plusmn;\u0026thinsp;0.037\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.125\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.159\u0026thinsp;\u0026plusmn;\u0026thinsp;0.034\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.176\u0026thinsp;\u0026plusmn;\u0026thinsp;0.052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.185\u0026thinsp;\u0026plusmn;\u0026thinsp;0.051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.170\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAT LISA Tri 839MP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDistance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.323\u0026thinsp;\u0026plusmn;\u0026thinsp;0.059\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.336\u0026thinsp;\u0026plusmn;\u0026thinsp;0.064\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.276\u0026thinsp;\u0026plusmn;\u0026thinsp;0.071*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntermediate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.113\u0026thinsp;\u0026plusmn;\u0026thinsp;0.029\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.115\u0026thinsp;\u0026plusmn;\u0026thinsp;0.014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.090\u0026thinsp;\u0026plusmn;\u0026thinsp;0.031*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.183\u0026thinsp;\u0026plusmn;\u0026thinsp;0.022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.192\u0026thinsp;\u0026plusmn;\u0026thinsp;0.021*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.152\u0026thinsp;\u0026plusmn;\u0026thinsp;0.037*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePMEA60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDistance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.301\u0026thinsp;\u0026plusmn;\u0026thinsp;0.042\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.289\u0026thinsp;\u0026plusmn;\u0026thinsp;0.052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.280\u0026thinsp;\u0026plusmn;\u0026thinsp;0.052*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntermediate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.162\u0026thinsp;\u0026plusmn;\u0026thinsp;0.032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.154\u0026thinsp;\u0026plusmn;\u0026thinsp;0.037\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.153\u0026thinsp;\u0026plusmn;\u0026thinsp;0.048\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.171\u0026thinsp;\u0026plusmn;\u0026thinsp;0.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.170\u0026thinsp;\u0026plusmn;\u0026thinsp;0.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.153\u0026thinsp;\u0026plusmn;\u0026thinsp;0.035*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: A: Axial, D: Decentration, T: Tilt\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Comparing with Axial position, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAt a 3.0 mm aperture, the MTF graphs illustrating the near, intermediate, and distal foci of the three MIOLs under axial, decentered, and tilted conditions are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. For PMEA60, the intermediate focus exhibited a consistent pattern across all assessed conditions. In contrast, significant reductions were observed in the distance and near focus curves at higher spatial frequencies under tilt conditions compared to axial conditions. However, no significant differences were detected between the axial and decentration conditions (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFor AT LISA Tri 839MP, the MTF graphs indicated a decline in performance under tilt conditions across all focal points, whereas the decentration condition did not lead to significant changes in any of the focus curves.\u003c/p\u003e\u003cp\u003eFor PanOptix, both decentration and tilt conditions adversely affected the distance focus curve. The intermediate curve was influenced solely by the decentration condition. Notably, the near focal point demonstrated consistently high optical performance across all tested conditions.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of MTF between axial, decentration, and tilt in distance/intermediate/near focus of one IOL at 4.5mm\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eIOL Name\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFocus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eMTF(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)@4.5mm\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eT\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePanOptix\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDistance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.338\u0026thinsp;\u0026plusmn;\u0026thinsp;0.059\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.216\u0026thinsp;\u0026plusmn;\u0026thinsp;0.118*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.211\u0026thinsp;\u0026plusmn;\u0026thinsp;0.078*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntermediate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.124\u0026thinsp;\u0026plusmn;\u0026thinsp;0.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.202\u0026thinsp;\u0026plusmn;\u0026thinsp;0.094*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.056\u0026thinsp;\u0026plusmn;\u0026thinsp;0.024*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.166\u0026thinsp;\u0026plusmn;\u0026thinsp;0.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.144\u0026thinsp;\u0026plusmn;\u0026thinsp;0.064*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.039*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAT LISA Tri 839MP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDistance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.265\u0026thinsp;\u0026plusmn;\u0026thinsp;0.097\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.063\u0026thinsp;\u0026plusmn;\u0026thinsp;0.027*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.073\u0026thinsp;\u0026plusmn;\u0026thinsp;0.034*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntermediate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.093\u0026thinsp;\u0026plusmn;\u0026thinsp;0.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.195\u0026thinsp;\u0026plusmn;\u0026thinsp;0.054*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.167\u0026thinsp;\u0026plusmn;\u0026thinsp;0.088*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.164\u0026thinsp;\u0026plusmn;\u0026thinsp;0.049\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.158\u0026thinsp;\u0026plusmn;\u0026thinsp;0.089\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.107\u0026thinsp;\u0026plusmn;\u0026thinsp;0.051*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePMEA60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDistance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.278\u0026thinsp;\u0026plusmn;\u0026thinsp;0.057\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.218\u0026thinsp;\u0026plusmn;\u0026thinsp;0.052*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.193\u0026thinsp;\u0026plusmn;\u0026thinsp;0.074*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntermediate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.168\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.118\u0026thinsp;\u0026plusmn;\u0026thinsp;0.034*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.125\u0026thinsp;\u0026plusmn;\u0026thinsp;0.046*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.173\u0026thinsp;\u0026plusmn;\u0026thinsp;0.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.169\u0026thinsp;\u0026plusmn;\u0026thinsp;0.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.127\u0026thinsp;\u0026plusmn;\u0026thinsp;0.036*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: A: Axial, D: Decentration, T: Tilt\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e* Comparing with Axial position, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAt a 4.5mm aperture, MTF graphs of all IOLs demonstrated a decline under tilt conditions (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Notably, the MTF graphs of the near focus for both AT LISA Tri and PMEA60 exhibited no appreciable changes between axial and decentration conditions. Interestingly, the intermediate curve MTF values for AT LISA Tri and PanOptix showed an increase under decentration conditions.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eStatistical comparisons of the MTF curves (Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e, Table \u003cspan refid=\"MOESM2\" class=\"InternalRef\"\u003eS2\u003c/span\u003e) revealed significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) between centered and misalignment states for most conditions. AT LISA Tri 839MP displayed fewer significant differences at the distance focus (p\u0026thinsp;=\u0026thinsp;0.562 for decentration vs. centered), while both PanOptix and PMEA60 exhibited minimal deviations in the near-focus MTF under misalignment (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for PanOptix near focus). Among the IOLs, PMEA60 demonstrated the least deviation when decentered by 0.5 mm, closely resembling the centered state (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for PMEA60 across all foci focus).\u003c/p\u003e\u003cp\u003eRMSE analysis (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) indicated that PMEA60 had the smallest deviations across all focal points under misalignment especially at 4.5mm aperture (RMSE\u0026thinsp;\u0026le;\u0026thinsp;0.049), followed by PanOptix (RMSE\u0026thinsp;\u0026le;\u0026thinsp;0.061). In contrast, AT LISA Tri 839MP exhibited greater sensitivity to tilt at intermediate and near focal points (RMSE up to 0.051).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRMSE value between axial, decentration, and tilt in distance/intermediate/near focus of one IOL at 3.0mm\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eIOL Name\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e\u003cp\u003eRMSE Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eDistance\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eIntermediate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003eNear\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA-D\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eA-T\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eA-D\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eA-T\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eA-D\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eA-T\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePanOptix\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.061\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.049\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAT LISA Tri 839MP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.027\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.037\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePMEA60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.027\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.028\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRMSE value between axial, decentration, and tilt in distance/intermediate/near focus of one IOL at 4.5mm\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eIOL Name\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e\u003cp\u003eRMSE Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eDistance\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eIntermediate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eNear\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA-D\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eA-T\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eA-D\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eA-T\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eA-D\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eA-T\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePanOptix\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.071\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.040\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.078\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAT LISA Tri 839MP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.215\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.091\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.058\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePMEA60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.060\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.087\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.049\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eWith the advent of new categories of simultaneous vision IOLs, RoF achievable by these lenses has evolved beyond traditional bifocal, trifocal, or extended depth-of-focus designs. In vitro through-focus evaluation has emerged as the standard method for characterizing IOL functionality. Previous studies have demonstrated that the through-focus MTF metric, or the area under the through-focus MTF curve (MTFa), exhibits a non-linear correlation with IOLs optical quality and the visual acuity (VA) defocus curves in pseudophakic patients[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis laboratory-based investigation aimed to compare the optical performance of a new pentafocal IOL (PMEA60) against two traditional diffractive MIOLs: the quadrifocal PanOptix and the trifocal AT LISA Tri 839MP. Utilizing an objective optical quality evaluation method, we also assessed the visual quality of these lenses under conditions of decentration and tilt.\u003c/p\u003e\u003cp\u003eThe through-focus MTF curve provides a simulation of the IOL profile concerning distance, intermediate, and near foci, thereby simultaneously evaluating the depth of field. As depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the through-focus modulation values for all IOLs concerning the distance focus (zero defocus diopter) at apertures of 3.0 or 4.5 mm ranged between 0.3 and 0.4. This aligns with previous literature. For example, diffractive MIOLs like the PanOptix typically achieve MTF values between 0.30 and 0.45 at far focus with a 3.0 mm aperture and spatial frequencies of 50\u0026ndash;100 lp/mm. Conversely, monofocal aspherical IOLs, such as Tecnis ZCB00, can reach MTF values of 0.8 or higher at far focus, although this superior performance diminishes at larger pupils or higher spatial resolutions[\u003cspan additionalcitationids=\"CR22 CR23 CR24\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Notably, PanOptix exhibited improved performance with aperture enlargement, whereas AT LISA Tri 839MP showed decreased values. PMEA60 demonstrated consistency across these conditions, yet these relative differences in modulation did not significantly impact distance visual acuity.\u003c/p\u003e\u003cp\u003eThe additional power incorporated in MIOL designs is a fundamental feature differentiating these IOLs. Our study\u0026rsquo;s findings, detailed in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, illustrate distinct object vergences among the IOLs evaluated. AT LISA Tri 839MP and PMEA60 both displayed intermediate foci around 1.60D and near foci around 3.30D, aligning with their near-adding power design. PanOptix presented a flat peak extending from 2.20D to 3.30D due to the proximity of its third and fourth foci, indicating an intermediate and near focus range approximately from 60 cm to 42 cm. Notably, we observed an MTF score at the 0.8 defocus point despite the removal of a second focus at 120 cm in this quadrifocal IOL\u0026mdash;an observation consistent with other bench studies[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Under a 4.5 mm test pupil, each IOL exhibited distinct and independent peaks at their respective intermediate and near foci.\u003c/p\u003e\u003cp\u003eThe pentafocal PMEA60\u0026rsquo;s distinguishing feature is the additional two peaks emerging between the far-to-intermediate and intermediate-to-near foci, constituting the second and fourth foci. This patented design accommodates a broader focus range, endorsing the forthcoming concept of FULL-RoF IOL. According to the global consensus of the ESCRS Functional Vision Working Group, there are three subcategories describing the transition in VA from intermediate to near: continuous FULL-RoF with an increase below 0.05 logMAR, smooth transition between 0.05 logMAR and below 0.14 logMAR, and steep transition for increases of 0.14 logMAR or higher[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The transition trough was observed from less than 1.0D to over 2.0D in the defocus curve, which categorizes AT LISA Tri 839MP and PanOptix as \u0026ldquo;Smooth transition\u0026rdquo; IOLs in this study[\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAt a 3.0 mm aperture, the pentafocal IOL provides a broader wave crest and a deeper wave trough ranging from 0.7 to 4.0D compared to the trifocal IOL, with a modulation MTF above 0.05\u0026mdash;surpassing the detectable spatial frequency threshold by the human retina[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. At 4.5 mm, wave crests of different foci produced a wider modulation curve than the other two IOLs, suggesting the pentafocal IOL might offer a solution for continuous FULL-RoF capability.\u003c/p\u003e\u003cp\u003eThe trifocal AT LISA presents a tri-peak structure in the MTF response curve between distance, intermediate, and near peaks, intermediate focus energy distribution peaks at a pupil diameter of 3\u0026ndash;4 mm. In contrast, EDOF IOLs, such as the Tecnis Symfony, realize continuous depth from far to intermediate ranges with often lower near MTF values (typically\u0026thinsp;\u0026lt;\u0026thinsp;0.2) than the PMEA60[\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The PMEA60 maintains multifocal MTF curve consistency under a large 4.5 mm aperture via a five-focus design and stepwise light energy distribution, indicating a potential for \u0026ldquo;continuous transition RoF\u0026rdquo;. Yet, clinical evaluations are necessary to assess the translation of this optical property into practical benefits, considering the subjective visual quality outcome associated with PMEA60\u0026rsquo;s defocus curve stability.\u003c/p\u003e\u003cp\u003eApart from varying additive power designs, the allocation of light energy to different foci is crucial. All IOLs in the study demonstrate through-focus transitions from far to near. The similarity of the AT LISA Tri 839MP and PanOptix TFNT00 through-focus curves with earlier reported findings reaffirm their optical quality. The PMEA60, under a 3.0 mm pupil, resembles the Zeiss 839MP curve, although with a larger MTF area suggesting superior optical quality. Differing from the sharp Zeiss 839MP curve between intermediate and near peaks, the PMEA60 exhibits a functional MTF curve that may enhance its comparative performance, potentially classifying it within continuous transition FULL-RoF IOLs. Future clinical visual acuity research focusing on defocus curves is necessary to substantiate these hypotheses.\u003c/p\u003e\u003cp\u003eThe inherent optical performance of MIOLs is notably impacted by implantation-induced positional errors, such as decentration and tilt[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Positional stability is vital for determining postoperative visual quality, as these errors amplify wavefront aberrations like coma and astigmatism, particularly affecting high spatial frequency contrast sensitivity[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Our study highlights distinct responses among the three MIOLs evaluated.\u003c/p\u003e\u003cp\u003eAt a decentration of 0.5 mm, PMEA60 demonstrated superior optical stability. It showed minimal variation in MTF values across most foci, with negligible attenuation at near focus at 3.0 and 4.5mm aperture. Conversely, the AT LISA Tri 839MP and PanOptix exhibited pronounced declines in MTF values at far focus with larger apertures. PanOptix\u0026rsquo;s near-focus performance slightly lower with increasing pupil size. RMSE analysis confirmed PMEA60\u0026rsquo;s lowest combined bias across all focus and excursion conditions, indicating optimal energy distribution uniformity and resistance to offset compared to other lenses. The AT LISA Tri 839MP showed enhanced MTF values at the mid-focus under decentration conditions at 4.5mm aperture, potentially attributable to the redistribution of light energy causing unintended diffraction into the mid-focal region. This \u0026ldquo;focus-shifting\u0026rdquo; effect, typical in diffractive MIOLs, can result in patient glare and blurred vision[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eConsistent with prior studies, our findings reveal that AT LISA Tri 839MP and PanOptix experience MTF decreases at far focal distances, exacerbated by larger apertures under tilt condition. Both the intermediate focus of the AT LISA Tri and the far focus of PanOptix are sensitive to tilting at 3.0mm, leading to significant decreases in optical quality[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe PMEA60\u0026rsquo;s continuous diffraction gradient disperses energy across five consecutive foci, avoiding the quivering of light energy present in traditional multifocal designs. Aberration-free IOLs exhibit minimal sensitivity to eccentricity and tilt, maintaining image quality despite positional misalignments[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. At a tilt of 5\u0026deg;, PMEA60 displays a notably lower decrease in MTF values across all focal lengths, particularly mid and far, likely due to its axisymmetric sinusoidal diffraction structure, which minimizes tilt-induced optical aberrations and maintains imaging quality[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. While tilt impacts the MTF values of PanOptix and AT LISA Tri 839MP, the extent of decline varies based on focal length and pupil aperture[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The PanOptix exhibits pronounced MTF reduction at mid-focal distances, especially at larger apertures. Although PanOptix\u0026rsquo;s far-focus MTF slightly improves with larger aperture under axial conditions, its performance degrades markedly under misalignment. The AT LISA Tri\u0026rsquo;s far focus remains less influenced by tilt at 3.0 mm aperture, possibly due to the emergence of higher-order aberrations leading to MTF attenuation. Moreover, mesofocal distances show heightened sensitivity due to overlapping optical zones[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIt should be noted that this study has some limitations. Firstly, in vitro experiments replicated offsets of 0.5 mm/5\u0026deg;, unlike potential patient scenarios where capsular bag relaxation might result in offsets up to 1.0 mm. Secondly, measurements were conducted using monochromatic light, which may differ from real-world white light observations, although adherence to ISO standards was maintained for comprehensive IOL behavior characterization. Additionally, only two samples of each IOL type were assessed, suggesting that further validation through additional samples could be beneficial. This necessitates future experimental studies to evaluate and compare MIOL optical behavior comprehensively. Lastly, as a laboratory-based study, the presented experimental data have yet to be corroborated with clinical insights. Establishing correlations between optical bench findings and clinical visual performance represents a promising avenue for future research.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study indicate that the novel pentafocal IOL PMEA60 exhibits superior optical continuity and positional stability compared to the trifocal AT LISA Tri 839MP and quadrifocal PanOptix designs. The PMEA60 achieves a broader MTF curve and sustains effective MTF values across an extended range of defocus under larger apertures. Its distinctive five-peak configuration effectively bridges the technological divide between conventional MIOLs and EDOF IOLs. These characteristics suggest its potential as a continuous, FULL-RoF solution, with diminished sensitivity to tilt and decentration, enhancing its suitability for varied clinical applications.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by research grants from the National Key Research and Development Program of China (2022YFC2502800 and 2024YFC2510800), the National Natural Science Foundation of China (82271069, 82371040, 82122017, 81870642, 81970780, 81470613 and 81670835), Special Project of Shanghai Public Health Research (2024 GKQ36), Science and Technology Innovation Action Plan of Shanghai\u0026nbsp;Science and Technology Commission (23Y11909800), Outstanding Youth Medical Talents of Shanghai \u0026ldquo;Rising Stars of Medical Talents\u0026rdquo; Youth Development Program, Clinical Research Plan of Shanghai Shenkang Hospital Development Center (2024ZZ1025 and 20244Z0015). This work has also been supported by the Fundamental Research Funds for the Central Universities (YG2024LC13), the Research Fund of Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine (2023DHYGJC-YBA06) and the National Natural Science Foundation of China (82371072).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eX.C., X.Z. and Q.Q. contributed in the conceptualization and writing (reviewing and editing) of this study. L.J. contributed in the data curation, investigation, visualization, and writing (both original draft and reviewing/editing) of this study. S.W. contributed in the data curation, formal analysis, investigation, visualization, and writing (original draft) of this study. K.Z. and S.L. contributed to the methodology of this study. Q.C., J.J. and H.W. contributed in the supervision and project administration of this study.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eClinical outcomes with a new microincisional diffractive multifocal IOL. SciSpace - Paper. 2015;2:2\u0026ndash;2. https://doi.org/10.1186/S40662-015-0012-8.\u003c/li\u003e\n\u003cli\u003eMcAlinden C, Moore JE. Multifocal intraocular lens with a surface-embedded near section: Short-term clinical outcomes. J Cataract Refract Surg. 2011;37:441\u0026ndash;5. https://doi.org/10.1016/j.jcrs.2010.08.055.\u003c/li\u003e\n\u003cli\u003eMultifocal intraocular lens. SciSpace - Paper. 2020. https://scispace.com/papers/multifocal-intraocular-lens-2u0v4xhnjd. 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J Cataract Refract Surg. 2024;50:794\u0026ndash;8. https://doi.org/10.1097/j.jcrs.0000000000001502.\u003c/li\u003e\n\u003cli\u003eEffect of Pupil, Spherical Aberration, Decentration, and Tilt on the Optical Performance of Five Different Monofocal IOLs | Journal of Refractive Surgery. https://journals.healio.com/doi/epdf/10.3928/1081597X-20250129-02. Accessed 19 May 2025.\u003c/li\u003e\n\u003cli\u003eMcKelvie J, McArdle B, McGhee C. The influence of tilt, decentration, and pupil size on the higher-order aberration profile of aspheric intraocular lenses. Ophthalmology. 2011;118:1724\u0026ndash;31. https://doi.org/10.1016/j.ophtha.2011.02.025.\u003c/li\u003e\n\u003cli\u003eOsipov V, Doskolovich LL, Bezus EA, Drew T, Zhou K, Sawalha K, et al. Application of nanoimprinting technique for fabrication of trifocal diffractive lens with sine-like radial profile. 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ResearchGate. https://www.researchgate.net/publication/294413459_Characterization_of_intraocular_lenses_Different_measurement_methods. Accessed 4 Apr 2025.\u003c/li\u003e\n\u003cli\u003eTandogan T, Auffarth GU, Choi CY, Liebing S, Mayer C, Khoramnia R. In vitro comparative optical bench analysis of a spherical and aspheric optic design of the same IOL model. BMC Ophthalmol. 2017;17:9. https://doi.org/10.1186/s12886-017-0407-5.\u003c/li\u003e\n\u003cli\u003ePreclinical metrics to predict through-focus visual acuity for pseudophakic patients - PubMed. https://pubmed.ncbi.nlm.nih.gov/27231628/. Accessed 18 July 2025.\u003c/li\u003e\n\u003cli\u003eVega F, Mill\u0026aacute;n MS, Garz\u0026oacute;n N, Altemir I, Poyales F, Larrosa JM. Visual acuity of pseudophakic patients predicted from in-vitro measurements of intraocular lenses with different design. Biomed Opt Express. 2018;9:4893. https://doi.org/10.1364/BOE.9.004893.\u003c/li\u003e\n\u003cli\u003eLee S, Choi M, Xu Z, Zhao Z, Alexander E, Liu Y. Optical bench performance of a novel trifocal intraocular lens compared with a multifocal intraocular lens. OPTH. 2016;:1031. https://doi.org/10.2147/OPTH.S106646.\u003c/li\u003e\n\u003cli\u003eEppig T, Scholz K, L\u0026ouml;ffler A, Me\u0026szlig;ner A, Langenbucher A. Effect of decentration and tilt on the image quality of aspheric intraocular lens designs in a model eye. J Cataract Refract Surg. 2009;35:1091\u0026ndash;100. https://doi.org/10.1016/j.jcrs.2009.01.034.\u003c/li\u003e\n\u003cli\u003ePiskała M, Lubiński W. Trifocal and extended depth of focus intraocular lenses \u0026ndash; comparative analysis. Klin Oczna. 2023;125:137\u0026ndash;45. https://doi.org/10.5114/ko.2023.131904.\u003c/li\u003e\n\u003cli\u003eAltmann GE, Nichamin LD, Lane SS, Pepose JS. Optical performance of 3 intraocular lens designs in the presence of decentration. J Cataract Refract Surg. 2005;31:574\u0026ndash;85. https://doi.org/10.1016/j.jcrs.2004.09.024.\u003c/li\u003e\n\u003cli\u003eSon HS, Tandogan T, Liebing S, Merz P, Choi CY, Khoramnia R, et al. In vitro optical quality measurements of three intraocular lens models having identical platform. BMC Ophthalmol. 2017;17:108. https://doi.org/10.1186/s12886-017-0460-0.\u003c/li\u003e\n\u003cli\u003eKohnen T, Herzog M, Hemkeppler E, Sch\u0026ouml;nbrunn S, De Lorenzo N, Petermann K, et al. Visual Performance of a Quadrifocal (Trifocal) Intraocular Lens Following Removal of the Crystalline Lens. Am J Ophthalmol. 2017;184:52\u0026ndash;62. https://doi.org/10.1016/j.ajo.2017.09.016.\u003c/li\u003e\n\u003cli\u003ePan R-L, Tan Q-Q, Liao X, Xie L-X, Qin S-Y, Tang Y-L, et al. Effect of decentration and tilt on the in vitro optical quality of monofocal and trifocal intraocular lenses. Graef Arch Clin Exp. 2024;262:3229\u0026ndash;42. https://doi.org/10.1007/s00417-024-06490-1.\u003c/li\u003e\n\u003cli\u003eB\u0026ouml;hm M, Petermann K, Hemkeppler E, Kohnen T. Defocus curves of 4 presbyopia-correcting IOL designs: Diffractive panfocal, diffractive trifocal, segmental refractive, and extended-depth-of-focus. J Cataract Refract Surg. 2019;45:1625\u0026ndash;36. https://doi.org/10.1016/j.jcrs.2019.07.014.\u003c/li\u003e\n\u003cli\u003eNegah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Science, Tehran 1544914599, Iran; Tehran University of Medical Science, Tehran 1544914599, Iran, Doroodgar F, Sanginabadi A, Department of Optometry Iran University of Medical Science, Tehran 1544914599, Iran, Karimian F, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences and Health Services, Chamran Highway, Tehran 1544914599, Iran, et al. 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Biomed Hub. 2023;8:25\u0026ndash;30. https://doi.org/10.1159/000529234.\u003c/li\u003e\n\u003cli\u003eMojzis P, Kukuckova L, Majerova K, Liehneova K, Pi\u0026ntilde;ero DP. Comparative analysis of the visual performance after cataract surgery with implantation of a bifocal or trifocal diffractive IOL. J Refract Surg. 2014;30:666\u0026ndash;72. https://doi.org/10.3928/1081597X-20140903-06.\u003c/li\u003e\n\u003cli\u003eAlfonso JF, Fern\u0026aacute;ndez-Vega L, Puchades C, Mont\u0026eacute;s-Mic\u0026oacute; R. Intermediate visual function with different multifocal intraocular lens models. J Cataract Refract Surg. 2010;36:733\u0026ndash;9. https://doi.org/10.1016/j.jcrs.2009.11.018.\u003c/li\u003e\n\u003cli\u003eHayashi K, Hayashi H, Nakao F, Hayashi F. Correlation between pupillary size and intraocular lens decentration and visual acuity of a zonal-progressive multifocal lens and a monofocal lens. Ophthalmology. 2001;108:2011\u0026ndash;7. https://doi.org/10.1016/s0161-6420(01)00756-4.\u003c/li\u003e\n\u003cli\u003eIOL Tilt and Decentration - Ophthalmology. https://www.aaojournal.org/article/S0161-6420(10)00397-0/fulltext. Accessed 8 June 2025.\u003c/li\u003e\n\u003cli\u003eRuiz-Alcocer J, Mart\u0026iacute;nez-Alberquilla I, Rementer\u0026iacute;a-Capelo LA, De Gracia P, Lorente-Vel\u0026aacute;zquez A. Changes in Optical Quality Induced by Tilt and Decentration of a Trifocal IOL and a Novel Extended Depth of Focus IOL in Eyes With Corneal Myopic Ablations. J Refract Surg. 2021;37:532\u0026ndash;7. https://doi.org/10.3928/1081597X-20210518-03.\u003c/li\u003e\n\u003cli\u003eYan W, Auffarth GU, Khoramnia R, Łabuz G. A Comparative Analysis of the Effects of Misaligning Different Trifocal Intraocular Lenses. JCM. 2024;14:187. https://doi.org/10.3390/jcm14010187.\u003c/li\u003e\n\u003cli\u003eVelasco-Barona C, Corredor-Ortega C, Mendez-Leon A, Casillas-Chavar\u0026iacute;n NL, Valdepe\u0026ntilde;a-L\u0026oacute;pez Velarde D, Cervantes-Coste G, et al. Influence of Angle \u0026kappa; and Higher-Order Aberrations on Visual Quality Employing Two Diffractive Trifocal IOLs. J Ophthalmol. 2019;2019:1\u0026ndash;8. https://doi.org/10.1155/2019/7018937.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cataract, Multifocal intraocular lenses (MIOLs), Optical performance, Modulation transfer function (MTF), Pentafocal Intraocular Lens","lastPublishedDoi":"10.21203/rs.3.rs-7489432/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7489432/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThis study aimed to evaluate the optical performance of a novel pentafocal intraocular lens (IOL) and compare it with established quadrifocal and trifocal designs under controlled experimental conditions.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThree diffractive IOLs\u0026mdash;pentafocal PMEA60, quadrifocal PanOptix, and trifocal AT LISA Tri 839MP\u0026mdash;were assessed using optical bench testing simulating the human eye. Through-focus modulation transfer function (TF-MTF) was measured at 50 lp/mm and as an average across 0‒100 lp/mm at 3.0 mm and 4.5 mm pupil apertures. Optical quality was evaluated under axial alignment, 0.5 mm decentration, and 5\u0026deg; tilt across distance, intermediate, and near focal points. Root mean square error (RMSE) was used to quantify MTF deviations under misalignment.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAt a 3.0 mm pupil diameter, PMEA60 demonstrated consistent TF-MTF across all focal ranges, with enhanced intermediate-focus performance (0.162\u0026thinsp;\u0026plusmn;\u0026thinsp;0.032) and stable MTF under decentration (0.154\u0026thinsp;\u0026plusmn;\u0026thinsp;0.037). In comparison, PanOptix presented a decrease in distance MTF from 0.322\u0026thinsp;\u0026plusmn;\u0026thinsp;0.041 to 0.277\u0026thinsp;\u0026plusmn;\u0026thinsp;0.069, and AT LISA Tri showed a reduction from 0.323\u0026thinsp;\u0026plusmn;\u0026thinsp;0.059 to 0.276\u0026thinsp;\u0026plusmn;\u0026thinsp;0.071 under tilt conditions. At a 4.5 mm pupil diameter, PMEA60 exhibited five distinct focal peaks and maintained MTF stability (RMSE\u0026thinsp;\u0026le;\u0026thinsp;0.087), whereas PanOptix and AT LISA Tri displayed notable MTF degradation under misalignment (RMSE\u0026thinsp;\u0026le;\u0026thinsp;0.137 and \u0026le;\u0026thinsp;0.215, respectively). Near-focus MTF values were comparable among all tested models.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe pentafocal PMEA60 IOL provides better optical continuity and positional stability compared to quadrifocal and trifocal counterparts. Its broad MTF profile and reduced sensitivity to misalignment indicate its suitability as a full-range vision solution. These findings support its potential for clinical application, informing intraocular lens selection and aiding in the prediction of postoperative visual outcomes.\u003c/p\u003e","manuscriptTitle":"Optical Quality Comparison of a Novel Pentafocal IOL with Quadrifocal and Trifocal IOLs Under Axial, Decentered, and Tilted Conditions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-17 07:19:02","doi":"10.21203/rs.3.rs-7489432/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"042fc17e-513f-44c9-a653-29b766afa291","owner":[],"postedDate":"October 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-26T03:53:50+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-17 07:19:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7489432","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7489432","identity":"rs-7489432","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}