Multifocal contact lenses for preoperative simulation of enhanced monofocal and extended depth of focus intraocular lenses using adaptive optics

Abstract

Purpose To evaluate whether multifocal contact lenses (CLs) can serve as preoperative simulators of postoperative vision with enhanced monofocal and extended depth of focus (EDOF) intraocular lenses (IOLs), using the SimVis Gekko™ adaptive-optics visual simulator. Methods Twenty-four presbyopic subjects (mean age 54.9 ± 5.0 years; range 46-63) underwent monocular simulation of two daily disposable multifocal CLs (1-Day Acuvue® Moist Multifocal, medium addition; and Biotrue® ONEday for Presbyopia, high addition) and two IOLs (Tecnis® Eyhance™, enhanced monofocal; and LuxSmart™, EDOF) using the SimVis Gekko™ under photopic conditions and a fixed 3 mm pupil aperture. Monocular defocus curves were obtained from -3.00 to +1.00 D in 0.50 D steps. Area under the curve (AUC), negative-defocus cutoff at the 0.2 logMAR threshold, and defocus slopes from linear mixed-effects models were compared across lens conditions for both raw and offset corrected datasets. Results Both CLs exhibited a systematic -0.50 D myopic offset relative to the IOL simulations, consistent with their center-near design. After applying a +0.50 D vergence correction, AUC values were comparable across all four designs (p = 0.18). At the 0.2 logMAR threshold, LuxSmart showed the widest functional range (cutoff -2.38 ± 0.66 D) and Biotrue the narrowest (-1.69 ± 0.53 D). Mixed-effects modeling indicated equivalent defocus slopes between 1-Day Acuvue Moist and Tecnis Eyhance after vergence alignment (p = 0.894), while LuxSmart showed greater defocus tolerance and Biotrue degraded significantly faster (p = 0.005). Conclusions Once the intrinsic -0.50 D myopic offset is compensated, the 1-Day Acuvue Moist Multifocal closely replicates the through-focus visual performance of the Tecnis Eyhance IOL, supporting its use as a practical preoperative simulator for patients being considered for enhanced monofocal implantation. Multifocal CLs combined with adaptive optics simulation may assist surgeons in tailoring IOL selection and improve shared decision-making before cataract surgery.