Journal Article

Effects of Pupil Size on Functional Outcomes of a Simultaneous Vision Intraocular Lens

Kohnen, Thomas, Hemkeppler, Eva, Kaiser, Klemens P., Böhm, Myriam, Davidova, Petra

2025

Overview

Purpose To evaluate the relationship between pupil size and subjective visual quality after implantation of a simultaneous vision intraocular lens (IOL). Methods Patients after bilateral implantation of a trifocal, diffractive IOL were prospectively included. Three months postoperatively, subjective refraction, UDVA, and axis deviation were measured. Pupil size was obtained with an infrared-based pupillometer (PupilX; Albomed) in scotopic, mesopic, and photopic conditions. Subjective impairment with optical phenomena was surveyed in different lighting conditions. Results Fifty-two patients (mean age: 68 years) were included; 54 eyes received non-toric IOLs and 50 eyes received toric IOLs. Preoperative spherical equivalent (SE) was −0.914 diopters (D) (range: −10.00 to +5.92 D) and SE and lens torus were 20.3 D (range: 9.00 to 32.00 D) and 1.65 D (range: 1.00 to 3.75 D), respectively. Three months postoperatively pupil size was 5.42 mm (range: 2.60 to 7.50 mm) in scotopic, 4.24 mm (range: 2.60 to 6.10 mm) in mesopic, and 3.38 mm (range: 1.20 to 5.60 mm) in photopic conditions, spherical manifest refractive error 0.14 D (range: −0.75 to 1.25 D), SE 0.034 D (range: −1.13 to +1.13 D), and UDVA 20/22.4 (range: 20/63 to 20/12.5). In low light conditions, halos correlated weakly with scotopic (r = 0.268, P = .006) and mesopic (r = 0.298, P = .002) pupil size and double-contour with scotopic pupil size (r = 0.234, P = .018). Glare, starbursts, and blurred vision were not influenced in any condition. Further significant influential factors were postoperative spherical manifest refractive error (P = .014), SE (P = .007) and lens torus (P = .029) for halos and preoperative SE (P = .019), postoperative UDVA (P = .035), and lens SE (P = .023) for double-contour. In multiple regression analysis, lens torus, mesopic pupil size, preoperative SE, and postoperative UDVA remained significant. Conclusions Pupil size did not play a major role in disturbance with optical phenomena after implantation of a trifocal diffractive IOL. [J Refract Surg. 2025;41(7):e645–e654.]

• Publisher: SLACK Incorporated,Slack, Inc,SLACK INCORPORATED
• Subject: Adult / Aged / Aged, 80 and over / Astigmatism / Cataracts / Clinical outcomes / Evaluation / Female / Humans / Influence / Intraocular lenses / Laboratories / Lasers / Lens Implantation, Intraocular / Lenses, Intraocular / Male / Measurement / Mesopic Vision - physiology / Middle Aged / Multifocal Intraocular Lenses / Patient outcomes / Patients / Phacoemulsification / Postoperative period / Prospective Studies / Pseudophakia - physiopathology / Pupil (Eye) / Pupil - physiology / Questionnaires / Refraction, Ocular - physiology / Regression analysis / Variance analysis / Visual acuity / Visual Acuity - physiology