Czech and Slovak Ophthalmology 356 10.31348/2025/10 Original article Presentation of a New Method for Quantitative Determination of Trifocal Intraocular Lens Decentration Moreno Juan José Galvis Virgilio https://orcid.org/0000-0003-4587-5364 Salazar Mariana Villamizar Sylvia Juliana https://orcid.org/0000-0002-7296-3522 Leal Nathaly Tello Alejandro https://orcid.org/0000-0001-5081-0720 13 2 2025 5 5

Aims: This pilot study aims to present a novel method for quantitatively assessing the decentration of a trifocal intraocular lens (IOL) (Acrysof IQ PanOptix®) relative to three ocular reference points: the visual axis (first Purkinje reflex), the photopic pupil center, and, for the first time, the corneal geometric center. Additionally, the study evaluates the influence of postoperative chord mu, chord alpha, and the distances of the IOL from these reference points on visual outcomes. Materials and Methods: This retrospective, observational study included 18 eyes from 12 patients who underwent cataract surgery with PanOptix® IOL implantation. Postoperative IOL positioning was assessed using OPD-Scan III images, applying a novel approach that combines diffuse frontal and retroillumination views. Distances between the IOL center and three ocular reference points, including the corneal geometric center, were measured, and postoperative patient satisfaction was evaluated using the Catquest-9SF survey. Statistical analyses were performed to assess correlations among reference distances, chord measurements, and visual performance. Results: The study found that in 72.2% of cases, the IOL center was closer to the visual axis than to the corneal geometric center. A greater distance between the IOL and the corneal geometric center was associated with an improved near-vision area under the visual acuity defocus curve. However, no significant correlations were found between chord mu or chord alpha and visual outcomes, patient symptoms, or satisfaction. Conclusion: This new approach to determining IOL centration proved practical, showing that the PanOptix® IOL tends to remain close to the visual axis over time, aligning with the surgeon’s initial placement. No clear associations were found between chord mu, chord alpha, or most IOL distances (except the distance to the corneal geometric center) and visual quality or patient satisfaction. Further studies are needed to confirm these findings and to refine selection criteria for multifocal IOLs to enhance patient satisfaction and visual outcomes.

 Trifocal intraocular lens IOL decentration corneal geometric center visual axis chord mu chord alpha References Galvis V, Escaf LC, Escaf LJ, et al. Visual and satisfaction results with implantation of the trifocal Acrysof IQ PanOptix® intraocular lens in cataract surgery. J Optom. 2022;15(3):219-227. Zhu Y, Zhong Y, Fu Y. The effects of premium intraocular lenses on presbyopia treatments. Adv Ophthalmol Pract Res. 2022;2(1):100042. Moshirfar M, Tuttle JJ, Stoakes IM, Hoopes PC. Refractive lens exchange: weighing the implications of early crystalline lens removal. J Cataract Refract Surg. 2023;49(10):1071-1072. Chang DH, Waring GO 4th. The subject-fixated coaxially sighted corneal light reflex: a clinical marker for centration of refractive treatments and devices. Am J Ophthalmol. 2014;158(5):863-874. Holladay JT. Apparent chord mu and actual chord mu and their clinical value. J Cataract Refract Surg. 2019;45(8):1198-1199. Wang L, Guimaraes de Souza R, Weikert MP, Koch DD. Evaluation of crystalline lens and intraocular lens tilt using a swept-source optical coherence tomography biometer. J Cataract Refract Surg. 2019;45(1):35-40. Prakash G, Prakash DR, Agarwal A, Kumar DA, Agarwal A, Jacob S. Predictive factor and kappa angle analysis for visual satisfaction in patients with multifocal IOL implantation. Eye (Lond). 2011;25(9):1187-1193. Holladay JT, Zhao H, Reisin CR. Negative dysphotopsia: the enigmatic penumbra. J Cataract Refract Surg. 2012;38(7):1251-1265. Holladay JT, Simpson MJ. Negative dysphotopsia: Causes and rationale for prevention and treatment. J Cataract Refract Surg. 2017;43(2):263-275. Qi Y, Lin J, Leng L, et al. Role of angle κ in visual quality in patients with a trifocal diffractive intraocular lens. J Cataract Refract Surg. 2018;44(8):949-954. Fu Y, Kou J, Chen D, et al. Influence of angle kappa and angle alpha on visual quality after implantation of multifocal intraocular lenses. J Cataract Refract Surg. 2019;45(9):1258-1264. Sandoval HP, Potvin R, Solomon KD. The Effects of Angle Kappa on Clinical Results and Patient-Reported Outcomes After Implantation of a Trifocal Intraocular Lens. Clin Ophthalmol. 2022;16:1321-1329. Garzón N, García-Montero M, López-Artero E, et al. Influence of angle κ on visual and refractive outcomes after implantation of a diffractive trifocal intraocular lens. J Cataract Refract Surg. 2020;46(5):721-727. Velasco-Barona C, Corredor-Ortega C, Mendez-Leon A, et al. Influence of Angle κ and higher-order aberrations on visual quality employing two diffractive trifocal IOLs. J Ophthalmol. 2019;2019:7018937. Fernández J, Burguera N, Rocha-de-Lossada C, Rachwani-Anil R, Rodríguez-Vallejo M. Influence of a multifocal intraocular lens centration and eye angles on light distortion and ocular scatter index. Graefes Arch Clin Exp Ophthalmol. 2023;261(8):2291-2299. Wallerstein A, Ridgway C, Gatinel D, et al. Angle kappa influence on multifocal IOL outcomes. J Refract Surg. 2023;39(12):840–849. He W, Qiu X, Zhang S, et al. Comparison of long-term decentration and tilt in two types of multifocal intraocular lenses with OPD-Scan III aberrometer. Eye (Lond). 2018;32(7):1237-1243. Karhanová M, Pluháček F, Mlčák P, Vláčil O, Šín M, Marešová K. The importance of angle kappa evaluation for implantation of diffractive multifocal intra-ocular lenses using pseudophakic eye model. Acta Ophthalmol. 2015;93(2): e123-e128, doi: 10.1111/aos.1252110.1111/aos.12521 Wang R, Long T, Gu X, Ma T. Changes in angle kappa and angle alpha before and after cataract surgery. J Cataract Refract Surg. 2020;46(3):365-371. Umesh Y, Saolapurkar K, Joshi P, Singh D. Measurement of change in angle kappa and its correlation with ocular biometric parameters pre- and post-phacoemulsification. Indian J Ophthalmol. 2023;71(2):535-540. Woodward MA, Randleman JB, Stulting RD. Dissatisfaction after multifocal intraocular lens implantation. J Cataract Refract Surg. 2009;35:992-927. Leysen I, Bartholomeeusen E, Coeckelbergh T, Tassignon MJ. Surgical outcomes of intraocular lens exchange: five-year study. J Cataract Refract Surg. 2009;35:1013-1018. de Vries NE, Webers CA, Touwslager WR, et al. Dissatisfaction after implantation of multifocal intraocular lenses. J Cataract Refract Surg. 2011;37(5):859-865. Soda M, Yaguchi S. Effect of decentration on the optical performance in multifocal intraocular lenses. Ophthalmologica. 2012;227(4):197-204. Fuentes V, Galvis V, Tello A. Acrysoft ReSTOR esférico vs Acrysoft ResSTOR asférico: Centramiento y efecto sobre la calidad visual objetiva y subjetiva del paciente. Revista Sociedad Colombiana de Oftalmología. 2009;42(1):887-901. Karhanová M, Marešová K, Pluháček F, Mlčák P, Vláčil O, Šín M. Význam úhlu kappa pro centraci multifokálních nitroočních čoček. [The importance of angle kappa for centration of multifocal intraocular lenses]. Cesk Slov Oftalmol. 2013;69(2):64-68. Czech. Chen X, Gu X, Wang W, et al. Characteristics and factors associated with intraocular lens tilt and decentration after cataract surgery. J Cataract Refract Surg. 2020;46(8):1126-1131. Kimura S, Morizane Y, Shiode Y, et al. Assessment of tilt and decentration of crystalline lens and intraocular lens relative to the corneal topographic axis using anterior segment optical coherence tomography. PLoS One. 2017;12(9) de Castro A, Rosales P, Marcos S. Tilt and decentration of intraocular lenses in vivo from Purkinje and Scheimpflug imaging. Validation study. J Cataract Refract Surg. 2007;33(3):418-429. Wang X, Dong J, Wang X, Wu Q. IOL tilt and decentration estimation from 3-dimensional reconstruction of OCT image. PLoS One. 2013;8(3):e59109. Ashena Z, Maqsood S, Ahmed SN, Nanavaty MA. Effect of Intraocular Lens Tilt and Decentration on Visual Acuity, Dysphotopsia and Wavefront Aberrations. Vision (Basel). 2020;4(3):41. Meng J, He W, Rong X, Miao A, Lu Y, Zhu X. Decentration and tilt of plate-haptic multifocal intraocular lenses in myopic eyes. Eye Vis (Lond). 2020;7:17. Xu J, Zheng T, Lu Y. Effect of Decentration on the Optical Quality of Monofocal, Extended Depth of Focus, and Bifocal Intraocular Lenses. J Refract Surg. 2019;35(8):484-492. Rodríguez-Vallejo M, Llorens-Quintana C, Furlan WD, Monsoriu JA. Visual acuity and contrast sensitivity screening with a new iPad application. Displays. 2016; 44:15-20. Fernández J, Rodríguez-Vallejo M, Tauste A, Albarrán C, Basterra I, Piñero D. Fast measure of visual acuity and contrast sensitivity defocus curves with an iPad application. Open Ophthalmol. J. 2019;1:15-22. Fernández J, Ribeiro FJ, Rodríguez-Vallejo M, et al. Standard for collecting and reporting outcomes of IOL-based refractive surgery: update for enhanced monofocal, EDOF, and multifocal IOLs. J Cataract Refract Surg. 2022;48(11):1235-1241. Cervantes-Coste G, Tapia A, Corredor-Ortega C, et al. The Influence of Angle Alpha, Angle Kappa, and Optical Aberrations on Visual Outcomes after the Implantation of a High-Addition Trifocal IOL. J Clin Med. 2022;11(3):896. Qin M, Ji M, Zhou T, et al. Influence of angle alpha on visual quality after implantation of extended depth of focus intraocular lenses. BMC Ophthalmol. 2022;22(1):82. Fernández J, Rodríguez-Vallejo M, Martínez J, Tauste A, Piñero DP. Biometric Factors Associated with the Visual Performance of a High Addition Multifocal Intraocular Lens. Curr Eye Res. 2018;43(8):998-1005. Xu J, Lin P, Zhang S, Lu Y, Zheng T. Risk Factors Associated With Intraocular Lens Decentration After Cataract Surgery. Am J Ophthalmol. 2022;242:88-95. doi:10.1016/j.ajo.2022.05.00510.1016/j.ajo.2022.05.005 Polit F, Polit A, Polit J. Method to quantify the decentration of the multifocal intraocular lenses in relation to the visual axis in eyes following phacoemulsification. Vision Pan-America. 2018:17 (4):117-119.