Pupil influence on the quality of vision in rotationally asymmetric multifocal IOLs with surface-embedded near segment

Purpose To evaluate the influences of preoperative pupil parameters on the visual outcomes of the SBL-3, a rotationally asymmetric multifocal intraocular lens (IOL) with a surface-embedded near segment. Setting Cathedral Eye Clinic, Belfast, Northern Ireland, United Kingdom. Design Retrospective comparative case series. Methods Postoperatively, patients divided into 4 groups according to their pupil size as follows: Group A: 2.50 to 2.99 mm, Group B: 3.00 to 3.50 mm, Group C: 3.51 to 4.00 mm, and Group D: 4.01 to 4.50 mm. The uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuities, IOL centration and tilt, and quality of vision (QoV) questionnaires were compared between the 4 groups for 18 months postoperatively. Results The study comprised 90 patients (180 eyes). The mean preoperative pupil (photopic and mesopic) diameter was 4.3 mm ± 0.3 (SD) and 5.6 ± 1.4 mm, respectively, which decreased to 3.8 ± 0.7 mm and 4.9 ± 1.2 mm, respectively, at 18 months. Eighteen months postoperatively, both photopic and mesopic pupil groups had a statistically significant reduction in size from preoperative levels. No significant differences in UDVA, UIVA, and UNVA were found between the groups (P > .001). Significant differences in the QoV questionnaire day scores and night scores were found between the 4 groups (P Conclusions The rotationally asymmetric multifocal IOL provided excellent optical performance during 18-months follow-up. The preoperative photopic pupil is an important parameter for consideration of this type of IOL because smaller pupils have a significant negative subjective impact on QoV.