• Vol. 41, No. 4, 2025 e333
RESEARCH ARTICLE
In ecen yea s, he ield o oph halmology has seen
signi ican ad ancemen s in in aocula lens (IOL)
echnology. Mono ocal IOLs a e known o p o-
ide excellen a ision a e ca a ac su ge y, bu he
pa ien usually equi es spec acles o any o he dis-
ance. On he o he hand, mul i ocal designs, which
a e now mos ly based on di ac i e op ics, o e come
he spec acle dependence by p o iding wo o h ee
di e en ia ed peaks o ision bu a e associa ed wi h a
highe isk o gla e, halos, lowe con as sensi i i y,1
and al e a ions in spa io-ch oma ic ision.2
To add ess he e ol ing isual needs o he popula ion
a e lens su ge y, ex ended dep h o ocus (EDOF) ech-
nology ideally b idges he clinical sho comings be ween
ABSTRACT
PURPOSE: To cha ac e ize he op ical design and analyze he op-
ical quali y and halo induced by he new ex ended dep h o ocus
(EDOF) TECNIS Pu eSee in aocula lens (IOL) (Johnson & John-
son Su gical Vision) and o e alua e i s clinical pe o mance.
METHODS: The powe p o ile o he TECNIS Pu eSee was
measu ed wi h he NIMO TR1504 de ice (LAMBDA-X). The
h ough- ocus modula ion ans e unc ion a ea (TF-MTFa)
me ic om +2.00 o -4.00 diop e s (D) and he halo induced
by he IOL in he bes ocus plane o dis ance ision (0.00 D),
we e assessed o 2-, 3-, and 4.5-mm ape u e diame e s a
he IOL plane. The clinical e alua ion in a coho o pa ien s
included pos ope a i e e ac ion, isual acui ies, de ocus
cu e, and subjec i e symp oma ology.
RESULTS: The powe p o ile shows dis inc zones ha mee
ela i ely smoo hly. The la ges powe change occu s in he
cen al zone o he lens. The TF-MTFa cu es showed an in-
c ease in dep h o ocus o smalle pupils. La ge pupils e-
sul ed in smalle , lowe -in ensi y halos. Fo 2-, 3-, and 4.5-mm
pupils, halo sizes we e 18.64, 14.73, and 13.23 a cmin, espec-
i ely, and no malized ene gies we e 0.55, 0.46, and 0.42, e-
spec i ely. Clinical assessmen yielded excellen isual and
e ac i e ou comes, a dep h o ield om +1.00 o -2.00 D wi h
isual acui ies be e han 0.2 loga i hm o he minimum angle
o esolu ion, and wi h almos no dyspho opic symp oms.
CONCLUSIONS: The TECNIS Pu eSee IOL p o ided good dis-
ance op ical and isual quali y and an ex ended dep h o ield o
app oxima ely 2.00 D. The dep h o ocus inc eased o smalle
pupils. The halo induced by he lens was o low size and ene gy.
[J Re ac Su g. 2025;41(4):e333-e341.]
F om Fe nández-Vega Oph halmological Ins i u e, O iedo, Spain (BA-B, LF-V-C, JFA); Clinical and Expe imen al Eye Resea ch, Op ome y and
Vision Depa men , Facul y o Op ics and Op ome y, Uni e sidad Complu ense de Mad id, Mad id, Spain (IM-A); Applied Op ics and Image
P ocessing Resea ch G oup, Depa men o Op ics and Op ome y, Uni e si a Poli ècnica de Ca alunya Ba celonaTech, Te assa, Spain (FC,
FV, MSM); and Clinical and Expe imen al Eye Resea ch, Op ome y and Vision Depa men , Facul y o Op ics and Op ome y, Uni e sidad
Complu ense de Mad id, Mad id, Spain (DM-C).
© 2025 Al onso-Ba olozzi, Ma inez-Albe quilla, Fe nández-Vega-Cue o, e al; licensee SLACK Inco po a ed. This is an Open Access a icle
dis ibu ed unde he e ms o he C ea i e Commons A ibu ion-NonComme cial 4.0 In e na ional (h ps://c ea i ecommons.o g/licenses/
by-nc/4.0). This license allows use s o copy and dis ibu e, o emix, ans o m, and build upon he a icle non-comme cially, p o ided he
au ho is a ibu ed and he new wo k is non-comme cial.
Funding: Suppo ed by p ojec PID2020-114582RB-I00/AEI/10.13039/501100011033 (FC, FV, MSM) om he Spanish Agencia Es a al de
In es igación.
Disclosu e: The au ho s ha e disclosed no po en ial con lic s o in e es , inancial o o he wise.
Add ess co espondence o José F. Al onso, MD, PhD, Fe nández-Vega Oph halmological Ins i u e, A da. D es. Fe nández-Vega 114, 33012
O iedo, Spain; email: [email p o ec ed].
Submi ed: No embe 25, 2024. Accep ed: Feb ua y 21, 2025. Published online: Ap il 1, 2025.
doi: 10.3928/1081597X-20250221-02
Op ical and Visual Ou comes o a New
Re ac i e Ex ended Dep h o Focus
In aocula Lens
Belén Al onso-Ba olozzi, MD, PhD; I ene Ma inez-Albe quilla, PhD;
Luis Fe nández-Vega-Cue o, MD, PhD; Fá ima Cuella , MSc; Fidel Vega, PhD;
Ma ía S. Millán, PhD; Da id Mad id-Cos a, PhD; José F. Al onso, MD, PhD
e334
mono ocal and mul i ocal designs.3 EDOF IOLs aim o
inc ease he dep h o ield while minimally a ec ing dis-
ance ision4,5 and minimizing dyspho opic phenomena.
Di ac i e designs we e he pionee ing echnology wi hin
he EDOF IOL amily.6 Howe e , hey we e o en associ-
a ed wi h educed con as sensi i i y and he de elop-
men o dyspho opic symp oms in low-ligh condi ions.3
Since hen, mul iple echnologies ha e been de eloped o
p o ide his ex ended ange o ision, such as using he
pinhole p inciple o elonga e he ocus, modi ying he
sphe ical abe a ion, o using bianalogic designs.5
Wi hin his a ie y o op ions, new EDOF designs
a e being launched in o he ma ke , such as he TECNIS
Pu eSee IOL (DEN00V model; Johnson & Johnson Su -
gical Vision). Acco ding o he manu ac u e , his is a
pu ely e ac i e lens designed o deli e unin e up -
ed and high-quali y ision a di e en dis ances while
main aining low le els o dyspho opic phenomena
ypical o mono ocal IOLs. Howe e , o ully unde -
s and how hese design goals a e add essed, i would
be in e es ing o know he IOL powe p o ile ac oss he
lens ape u e, which, o da e, has no been disclosed
by he manu ac u e . In addi ion, he e a e so a ew
pee - e iewed publica ions epo ing on op ical and
isual esul s wi h he TECNIS Pu eSee IOL.7,8
The e o e, his s udy had h ee objec i es. Fi s ,
o cha ac e ize he op ical design o his new EDOF
TECNIS Pu eSee DEN00V IOL by expe imen ally de-
e mining he lens powe p o ile. Second, o analyze
in i o i s op ical quali y and halo o ma ion. Finally,
o e alua e he clinical pe o mance o his IOL in a
coho o pa ien s a e ca a ac su ge y.
PATIENTS AND METHODS
IOL
The TECNIS Pu eSee DEN00V IOL is de ined by he
manu ac u e as a pu ely e ac i e p esbyopic-co ec -
ing IOL wi h con inuous-powe echnology. I is a single-
piece asphe ic oldable lens manu ac u ed in hyd opho-
bic so ac ylic ma e ial wi h an Abbe numbe o 55 and
e ac i e index o 1.47 (35 °C) and designed o be placed
in he capsula bag. The IOL ea u es an an e io asphe ic
su ace in ended o compensa e o he a e age sphe ical
abe a ion o he co nea, whe eas i s pos e io e ac i e
su ace is enginee ed o p o ide a con inuous change
in powe , he eby ex ending he dep h o ocus. In his
s udy, he in i o measu emen s (powe p o ile, op ical
pe o mance, and halo induced) we e done wi h a lens o
nominal 20.00 diop e s (D) base powe .
POwe P O ILe MaPPIng and wa e On anaLysIs
The NIMO TR1504 de ice (LAMBDA-X) was used
o map he powe p o ile o he IOL. The wo king
p inciple o his de ice is based on a phase-shi ing
Schlie en echnique ha combined wi h a phase-
shi ing me hod allows he measu emen s o he
ligh de ia ions,9 which can be used o calcula e he
powe cha ac e is ics o he lens wi hin he op ical
zone.10-13
OP IcaL Pe O Mance
The es bench used o e alua e he op ical pe o -
mance o he TECNIS Pu eSee IOL has been p e iously
desc ibed by ou g oup.14,15 In b ie , he op ical bench,
which is Ame ican Na ional S anda ds Ins i u e (ANSI)
Z80.35-2018 complian ,16 is o med by an illumina ion
sys em, a model eye, and an image acquisi ion sys em.
Speci ically o his s udy, we employed a high-powe
b oadband g een LED (SOLIS 565C; Tho labs GmbH)
combined wi h a na ow bandpass in e e en ial il e
wi h ansmission peak a 550 nm and ull wid h a hal
maximum o 10 nm. The model eye has an a i icial co -
nea ha mimics he sphe ical abe a ion o he a e age
human co nea (Ze nike coe icien Z4
0 = +0.27 µm o a
5.15 mm pupil a he IOL plane).16 A mic oscope and a
cha ge coupled de ice came a we e used o acqui e he
image o med by he model eye wi h he IOL inse ed.
The bes ocus plane o dis ance (0.00 D de ocus)
was de e mined acco ding o he ANSI guidelines as
he posi ion o maximum modula ion ans e unc ion
(MTF) alue (a 50 cycles/mm) wi h he 3-mm ape u e.
The op ical pe o mance was e alua ed ia h ough- o-
cus MTF (TF-MTF) a 50 cycles/mm and TF-MTF a ea
(TF-MTFa), he la e calcula ed as desc ibed in ea lie
publica ions14,15,17 and summa ized he e o he sake o
comple eness. Fi s , he MTF was measu ed ac oss a
ange o ocal posi ions, om +2.50 o -5.00 D in 0.10-D
s eps. In each posi ion o his ange, he a ea unde
MTF was calcula ed by in eg a ing he co esponding
MTF cu e on he spa ial equencies ange om 0 o
50 cycles/mm. The TF-MTFa was ob ained o ape u e
diame e s o 2-, 3-, and 4.5-mm in he IOL plane co -
esponding o app oxima ely 2.3-, 3.5-, and 5.2-mm,
espec i ely, in he en ance pupil plane o a pa ien ’s
eye, he la e being he pa ame e measu ed in he clin-
ic. Unless o he wise speci ied, om now on he pupil
ape u es will be e e ed o as he IOL plane.
Finally, om he TF-MTFa measu emen s wi h a
3-mm pupil we calcula ed he simula ed isual acui y
in he +1.00 o -3.00 D de ocus ange using he o mula
ecommended in ANSI.16
HaLO assessMen
The halo induced by he TECNIS Pu eSee IOL was
measu ed as desc ibed elsewhe e14,18-20 employing he
same model eye used o he e alua ion o he op ical
• Vol. 41, No. 4, 2025 e335
pe o mance. The halo assessmen was pe o med wi h
a 200-µm pinhole as he es objec and a high-powe
LED wa m whi e ligh sou ce (SOLIS-2C; Tho labs
GmbH), combined wi h a bandpass il e (PE530-25.5;
MidOp .Inc) whose spec al ansmi ance simula es
he pho opic esponse o he human eye, o align wi h
ANSI ecommenda ions.16
The came a eco ded he image o he pinhole es
o med a he bes ocus plane o dis ance ision
(0.00 D) by he model eye wi h he TECNIS Pu eSee
IOL. Typically, he digi al image showed cen al co e
wi h a su ounding halo. The ene gy in each o hese
wo egions was compu ed and no malized o he o al
ene gy o he image. Addi ionally, and in acco dance
wi h ANSI guidelines, he images will be epo ed in
wo ways: as p in ed images using a gamma co ec ion
o 0.5 o clea ly show he halo and as a adial ligh
in ensi y g aph, wi h isual angle plo ed on he X-
axis and he loga i hmic alue o he ligh in ensi y on
he Y-axis. These halo measu emen s we e pe o med
o 2-, 3-, and 4.5-mm ape u e diame e s. Addi ion-
ally, halo measu emen s we e also aken o +0.50
and -0.50 D o de ocus o assess he e ec ha mild
pos ope a i e e ac i e e o s migh ha e on he halo
o ma ion. Such a de ocus was only induced o a 4.5-
mm ape u e (5.2 mm a he pa ien ’s en ance pupil),
ep esen a i e o nigh ision (mesopic condi ions).
cLInIcaL assessMen
The clinical s udy in ol ed pa ien s who unde -
wen bila e al ca a ac su ge y wi h implan a ion o he
TECNIS Pu eSee IOL a Fe nández-Vega Oph halmo-
logical Ins i u e (O iedo, Spain). This s udy con o med
o he p inciples o he Decla a ion o Helsinki and all
en olled pa icipan s signed he in o med consen . Pa-
ien s be ween 65 and 85 yea s wi h no p e ious ocula
su ge ies, i egula co neal as igma ism, ocula abno -
mali ies, o condi ions con aindica ed in IOL implan-
a ion we e included in he s udy. Exclusion c i e ia in-
cluded co neal as igma ism o g ea e han 1.50 D and
axial leng h ou side he ange o 22 o 25 mm. A com-
ple e oph halmological examina ion was pe o med
p io o s udy p ocedu es, including e ac ion, co neal
opog aphy, sli -lamp biomic oscopy, and onome y.
The Ba e Uni e sal II o mula was used o IOL pow-
e calcula ion, a ge ing emme opia.
All su ge ies we e pe o med by he same expe i-
enced su geon (JFA) ollowing he same p ocedu e as
p e iously desc ibed in o he in es iga ions.13 A em-
osecond lase (CATALYS P ecision Sys em; Johnson
& Johnson Su gical Vision) was used o ca y ou he
an e io capsulo omy and agmen a ion o he nucle-
us. A capsula ension ing (AC001102, 11/10 diam-
e e ; AJL Oph halmic) was implan ed in all cases, aim-
ing o p o ide capsula bag s abili y and acili a e he
IOL cen a ion.
Pos ope a i e isi s we e pe o med 1 day and 1 and
3 mon hs a e implan a ion. A 3 mon hs pos ope a i e-
ly, he s udy p o ocol o e alua e he clinical ou comes
consis ed o mani es e ac ion, monocula unco ec ed
(UDVA) and co ec ed (CDVA) dis ance isual acui ies
a 100% con as unde pho opic condi ions (85 cd/m2),
and monocula de ocus cu e ( he igh eye o each pa-
ien ) e alua ed om +2.00 o -5.00 D in 0.50-D s eps.
Finally, he p ac i ione showed all pa ien s images o
ep esen a i e halos and gla e, asking hem o indica e
whe he hey expe ienced such isual dis u bance and,
i so, he equency ( a e, some imes, mos o he ime,
always) and how bo he some i was (sligh , medium,
mode a e, se e e).
Da a analysis was pe o med using SPSS o Win-
dows so wa e, e sion 14.0 (SPSS, Inc). No mal-
i y was checked wi h he Kolmogo o -Smi no es .
Visual and e ac i e ou comes we e analyzed a he
3-mon h pos ope a i e isi . Means and s anda d de-
ia ions o pe cen ages we e used o epo pos ope a-
i e isual and e ac i e esul s.
RESULTS
POwe P O ILe MaPPIng
Figu e 1 shows he measu ed sagi al powe p o ile o
he 20.00 D TECNIS Pu eSee IOL. Gi en he adial sym-
me y o he measu ed powe map (see he inse o Fig-
u e 1), he powe p o ile is plo ed as IOL powe a ia-
ion e sus adial dis ance om he cen e o he lens.
The powe p o ile shows dis inc zones ha mee ela-
i ely smoo hly. The la ges powe change is e idenced
in he cen al zone o he lens, whe e powe a ies om
Figu e 1. Powe map and powe p o ile o he TECNIS Pu eSee IOL
(Johnson & Johnson Su gical Vision). Ve ical axis ep esen s he
a e age sagi al powe in diop e s, and ho izon al axis ep esen s
he adial dis ance in millime e s om he IOL cen e . Ho izon al line
ep esen s he nominal powe (20.00 diop e s [D]).
e336
app oxima ely 19.5 D a he cen e (0.0 mm) up o a
maximum o app oxima ely 23.4 D a he adial dis ance
o 0.90 mm. F om 1.1 o 1.4 mm, he measu ed powe
is p ac ically cons an and close o he nominal 20.00 D
base powe o he IOL. F om 1.4 mm ou wa d, he e is
a smoo h decay o he powe , eaching app oxima ely
19.00 D a 2.25 mm ( he maximum adial dis ance o
which eliable measu emen s we e s ill ob ained).
OP IcaL Pe O Mance
Figu e 2 shows he TF-MTF a 50 cycles/mm and
he TF-MTFa cu es o pupil ape u es o 2-, 3-, and
4.5-mm. The h ee TF-MTFa cu es (Figu e 2B) exhib-
i ed a single peak o maximum alue a he nominal
de ocus o 0.00 D. The TF-MTFa alues a his poin ,
ep esen ing he posi ion o op imal op ical quali y,
we e 28.2, 29.0, and 36.6 (a.u.) o he 2-, 3-, and 4.5-
mm pupils, espec i ely, demons a ing a consis en
posi i e associa ion wi h ape u e size. As de ocus in-
c eased, he MTFa cu es g adually declined, wi h dis-
inc a ia ions in luenced by pupil size. Wi h smalle
pupils he cu e b oadened, leading o a wide egion
o slow deg ada ion and sus ained image quali y.
Figu e 3 shows he simula ed isual acui y om +1.00
o -3.00 D o de ocus. The bes isual acui y o -0.07
logMAR was achie ed a 0.00 D de ocus and sligh ly de-
c eased o 0.09 logMAR a app oxima ely -0.75 D o de-
ocus, emaining cons an un il -1.75 D, whe e i begins
o decline. The ange o e gences om 0.00 D (dis ance
ocus) o nega i e e gences (in e media e and nea dis-
ances) whe e isual acui y was equal o o be e han
0.20 logMAR was -2.13 D. The simula ed isual acui y
be ween -0.50 and +0.50 D (ie, a si ua ion ha accoun s
o possible mild hype opic o myopic e ac i e e o s
pos ope a i ely) emained be e han 0.1 logMAR, which
indica es ha he TECNIS Pu eSee may ha e a good ole -
ance o hese e o s (± 0.50 D om a ge ed emme opia).
HaLO assessMen
Halo induced by he TECNIS Pu eSee IOL is ep e-
sen ed in Figu e 4 o h ee pupils o 2-, 3-, and 4.5-
mm diame e . In e es ingly and somehow unexpec ed,
smalle ape u es esul ed in bo h la ge and mo e in-
ense halos. Thus, no malized halo ene gies o 0.55 ±
0.01, 0.46 ± 0.01, and 0.42 ± 0.01 wi h halo sizes o 18.6
± 0.2, 14.7 ± 0.2, and 13.2 ± 0.2 a cmin we e de e mined
wi h pupils o 2-, 3-, and 4.5-mm, espec i ely.
Addi ionally, Figu e 5 shows he e ec o de ocus
on he halo wi h a 4.5-mm ape u e. Posi i e de ocus
(equi alen o myopic de ocus) c ea ed a wide and
mo e in ense halo ou o he co e.
cLInIcaL Ou cOMes
This clinical s udy in ol ed 30 eyes o 15 pa ien s
(5 men and 10 women) wi h a mean age o 75.9 ± 4.9
Figu e 2. (A) Th ough- ocus modula ion ans e unc ion (TF-MTF) a
50 cycles/mm and (B) TF-MTF a ea (TF-MTFa) cu es ob ained wi h
he TECNIS Pu eSee IOL (Johnson & Johnson Su gical Vision) o a 2-,
3-, and 4.5-mm ape u e. D = diop e s
Figu e 3. Simula ed h ough ocus isual acui y wi h he TECNIS Pu eSee
IOL (Johnson & Johnson Su gical Vision) calcula ed om op ical bench
measu emen s (Figu e 2B) ob ained in an eye model o a 3-mm pupil.
D = diop e s
• Vol. 41, No. 4, 2025 e337
Figu e 4. Bes ocus images o he pinhole objec es ( op) and hei in ensi y p o iles (bo om) o med by he eye model wi h a TECNIS Pu eSee IOL
(Johnson & Johnson Su gical Vision) o a (A) 2-, (B) 3-, and (C) 4.5-mm pupil. A gamma co ec ion o 0.5 is applied o he op images o acili a e
he isualiza ion o he halo. P o iles depic he in ensi y in loga i hmic scale.
Figu e 5. Pinhole objec es ( op) and i s in ensi y p o ile (bo om) o med by he eye model wi h a TECNIS Pu eSee IOL (Johnson & Johnson
Su gical Vision) wi h a 4.5-mm pupil a (A) -0.50, (B) 0.00, and (C) +0.50 diop e s (D) o de ocus. A gamma co ec ion o 0.5 is applied o he op
images o acili a e he isualiza ion o he halo. P o iles depic he in ensi y in loga i hmic scale.
e338
yea s. P eope a i e demog aphic da a o he pa ien s
a e summa ized in Table 1. The mean IOL powe was
22.40 ± 2.50 D ( ange: 19.00 o 26.00 D).
The mean pos ope a i e monocula UDVA and
CDVA a e 3 mon hs we e 0.10 ± 0.15 and 0.05 ±
0.09 logMAR, espec i ely. The mean pos ope a i e
sphe e and mean cylinde we e -0.07 ± 0.23 and -0.42
± 0.48 D, espec i ely, wi h 100% o pa ien s ha ing
e ac i e sphe es be ween +0.50 and -0.50 D.
Figu e 6 shows he pos ope a i e monocula de ocus
cu e 3 mon hs a e TECNIS Pu eSee IOL implan a ion.
The cu e yields one peak o maximum isual acui y a
0.00 D de ocus (dis ance ision). As nega i e de ocus in-
c eases (in e media e-nea dis ances), he isual acui y
exhibi s a p og essi e and smoo h decay. As a esul , he
isual acui y was 0.2 logMAR (app oxima ely 20/32) o be -
e ac oss he e gence ange om 0.00 D o -2.00 D (equi -
alen o 50 cm om he eye). A he e gence o -2.50 D
(40 cm om he eye) he isual acui y was 0.25 ± 0.15
logMAR. Fu he mo e, he analysis o he isual acui y on
he posi i e ange o e gences showed a good ole ance o
myopic de ocus, wi h alues be e han 0.1 logMAR (ap-
p oxima ely 20/25) o e gences up o +1.00 D.
Rega ding isual dis u bances symp oma ology, no
pa ien s complained abou gla e, and 14 o 15 pa ien s
did no epo halo. The only pa ien who expe ienced
such isual dis u bance epo ed i as sligh ly bo he -
some and wi h a a e equency o occu ence.
DISCUSSION
The op ical quali y and clinical pe o mance o
EDOF IOLs ha e ga ne ed signi ican esea ch in e es
because o hei po en ial ad an ages o pa ien s wi h
p esbyopia o ca a ac s. New EDOF designs a e being
in oduced o he ma ke , such as he TECNIS Pu eSee
IOL, which acco ding o he company is a pu ely e ac-
i e lens designed o p o ide unin e up ed, high-quali-
y ision along wi h a dyspho opsia p o ile compa able
o a mono ocal design. The aim o his s udy was o
ca y ou a comp ehensi e manu ac u e -independen
cha ac e iza ion o he op ical design and an e alua ion
o he op ical and isual pe o mance o his new EDOF
IOL, he TECNIS Pu eSee. Fo his pu pose, he powe
p o ile o he lens was i s measu ed, ollowed by ana-
lyzing i s op ical quali y and halo o ma ion when in-
se ed in a model eye. Finally, he isual pe o mance
was assessed in a clinical se ing.
As shown in Figu e 1, he powe p o ile o he
TECNIS Pu eSee IOL p esen ed di e en ia ed zones
ac oss he op ical diame e ha mee ela i ely
smoo hly. The cen al zone o he lens shows a com-
plex design a ea, wi h a con inuous change in powe
om 19.50 D (ie, sligh ly below he 20.00 D nominal
powe o he IOL) a he cen e o he lens, up o a
peak powe o 23.5 D a he adial dis ance o 0.9 mm.
Then, wi hin his cen al zone ha ex ends o a adial
dis ance o 1.1 mm, he design o he lens combines
a a /nea scheme. F om a adial dis ance o 1.4 mm
owa d he pe iphe y o he op ical zone o he TEC-
NIS Pu eSee IOL, he powe smoo hly dec eases ol-
lowing a simila end o ha p e iously epo ed in
o he TECNIS asphe ic lenses13,21 o main ain he same
sphe ical abe a ion co ec ion (-0.27 µm o a 5.15-
mm ape u e in he IOL plane).7
The ea u es o he powe p o ile shown in Figu e 1
a e simila o se e al exempla y designs disclosed by
TABLE 1
P eope a i e Pa ien Da a
Cha ac e is ic Mean ± SD (Range)
Age (yea s) 75.9 ± 4.9 (65 o 85)
Re ac i e sphe e (D) +0.30 ± 1.96 (-3.00 o +4.00)
Re ac i e cylinde (D) -0.89 ± 0.62 (-1.50 o 0.00)
Topog aphic cylinde (D) 0.70 ± 0.41 (-1.50 o 0.00)
Monocula CDVA (logMAR) 0.20 ± 0.17 (0.00 o 0.52)
Minimum ke a ome y (D) 43.71 ± 1.58 (41.50 o 46.50)
Maximum ke a ome y (D) 44.40 ± 1.45 (41.75 o 46.75)
ACD (mm) 2.64 ± 0.49 (1.64 o 3.49)
ATA dis ance (mm) 11.69 ± 0.54 (10.98 o 12.80)
Pho opic pupil diame e (mm) 3.11 ± 0.87 (2.14 o 5.05)
Mesopic pupil diame e (mm) 4.51 ± 0.80 (3.06 o 6.00)
Axial leng h (mm) 23.26 ± 0.80 (22.24 o 24.75)
ACD = an e io chambe dep h; ATA = angle- o-angle; CDVA = co ec ed dis-
ance isual acui y; D = diop e s; logMAR = loga i hm o he minimum angle
o esolu ion; SD = s anda d de ia ion
Figu e 6. Mean pos ope a i e monocula isual acui y (loga i hm o
he minimum angle o esolu ion [logMAR]) wi h bes co ec ion o
dis ance as a unc ion o he cha e gence. E o ba s ep esen he
± s anda d de ia ion o he measu emen s. D = diop e s
• Vol. 41, No. 4, 2025 e339
Fa ia-Ribei o e al,22 which we e based on op ical
powe s ha a y as cosine unc ions o he adial posi-
ion inside di e en zones o ob ain EDOF IOLs. In ad-
di ion, he powe p o ile epo ed in his s udy closely
aligns wi h he esul o Schmid and Bo kens ein,23
who de i ed he powe p o ile o he TECNIS Pu e-
See (model ZEN00V) om he measu ed wa e on o
he IOL. On he o he hand, i is ema kable he di e -
ences wi h he enhanced mono ocal IOL o he same
company (TECNIS Eyhance IOL), whose powe p o ile
showed a mono onous (ie, wi hou powe peaks) and
apid decay om he cen e o he pe iphe y o he
lens.13,21 Recen ly, Ga zon e al10 epo ed he powe
p o ile o a non-di ac i e wa e on -shaping EDOF
IOL (Ac yso IQ Vi i y). Al hough bo h lenses (Ac yso
IQ Vi i y and TECNIS Pu eSee) p esen ed he la ges
powe a ia ion in he cen al zone, he di e ence be-
ween hei powe pa e ns should be no ed.
O he EDOF and enhanced mono ocal IOL designs
p o ide an inc ease o he e ec i e IOL powe (myopic
shi ) o smalle pupils.18,24 The ini ial analysis o he
TECNIS Pu eSee IOL’s powe p o ile migh also sugges
such myopic shi o smalle pupils. Howe e , as ex-
plained below, his IOL does no exhibi his beha io .
This di e ence p obably comes om he p ope design
o he cen al zone, dedica ing he mos cen al zone o
he base powe , which allows he IOL o wo k some-
how as a bi ocal lens o smalle pupils (2.5 o 3.5 mm).
Once he powe p o ile was measu ed and in e -
p e ed, he op ical pe o mance was assessed by TF-
MTF analysis (Figu e 2). This me ic was e alua ed o
2-, 3-, and 4.5-mm ape u es in he IOL plane, which
would co espond o an eye en ance pupil o 2.3-, 3.5-
and 5.2-mm and migh be a good ep esen a ion o he
pa ien ’s pupil size om pho opic o mesopic condi-
ions. The cu es o TF-MTFa (Figu e 2B) e ealed an
associa ion be ween he pupil size and he maximum
op ical quali y and cu e shape. The la ge he pupil,
he highe he MTFa peak and hus he op ical quali y
a 0.00 D ocus, bu wi h a na owe mono ocal-like
cu e shape. As he pupil dec eases, he MTFa cu e
becomes wide , he e o e inc easing he dep h o o-
cus. These co ela ions we e also ound by Schmid
and Bo kens ein23 o he TECNIS Pu eSee (ZEN00V,
he h ee-piece IOL model) IOL. Fu he mo e, he
widening o he MTFa cu e, and hence, he inc ease
o he dep h o ocus as he pupil becomes smalle ,
ha e been also ound wi h o he non-di ac i e EDOF
designs (Len is Com o ,24 MiniWell,24 LuxSma ,24,25
and Ac yso IQ Vi i y18,19,24).
In addi ion o he dependence o op ical qual-
i y on he pupil shown abo e, se e al EDOF and en-
hanced mono ocal IOL designs also exhibi ed pupil
dependence in e ms o i s e ec i e powe , he la e
ypically in ol ing a myopic shi wi h smalle ape -
u es.13,18,19,24,25 Al hough his e ec may be posi i e
o help ocusing objec s a close dis ances whe e pu-
pilla y miosis occu s na u ally, i would be coun e -
p oduc i e when looking a dis ance wi h a ela i ely
small pupil (eg, a he beach on a b igh sunny day).
In con as , ou op ical-bench esul s wi h he TECNIS
Pu eSee IOL show ha o he pupil ange conside ed
(2 o 4.5 mm a he IOL plane), he bes ocus consis-
en ly co espond o he lens’s base powe (ie, dis ance
ision). The e o e, his analysis sugges s ha he e -
ec i e powe o he TECNIS Pu eSee lens is no pupil
dependen , which may ha e a posi i e impac on he
pa ien ’s sa is ac ion because hei pupil ape u e will
change depending on he illumina ion condi ions.
The simula ed isual acui y om +1.00 o -3.00 D
o de ocus (Figu e 3) yielded a smoo h simula ed de-
ocus cu e wi h a sligh d op a he in e media e i-
sion, eaching alues be e han 0.2 logMAR up o
2.00 D (equi alen o 50 cm), and showing a dec ease
o highe de ocus alues. These esul s can be com-
pa ed o hose ob ained by Ala con e al7 using he
same EDOF IOL design, he la e showing a sligh ly
be e in e media e ision. O no e, he simula ed
isual acui y calcula ions we e aken binocula ly,
whe eas ou s udy was calcula ed monocula ly, and
i does no ake in o accoun he a o able con ibu-
ion o bo h eyes o isual acui y. These indings sug-
ges (and i was con i med subsequen ly in ou clini-
cal s udy discussed below) ha he TECNIS Pu eSee
IOL could mee he s anda d o EDOF IOL acco ding o
he Ame ican Academy o Oph halmology Task Fo ce
Consensus o EDOF lenses.26
The las a m o he in i o e alua ion was he assess-
men o he halo induced by he TECNIS Pu eSee IOL.
In e es ingly and in con as wi h di ac i e mul i o-
cal IOLs whe e he highe halos we e c ea ed o highe
pupil sizes,27 he halo ea u es wi h TECNIS Pu eSee,
in e ms o bo h size and ene gy, we e smalle o la ge
ape u es (Figu e 4). Fo he ape u e size o 4.5 mm, he
halo size was small (13.2 ± 0.2 a cmin) and, he e o e,
less ene gy (0.42 ± 0.01) was was ed in he halo. This as-
socia ion be ween la ge pupils and small halos was also
epo ed wi h ano he nondi ac i e EDOF IOL design
bu only wi h monoch oma ic g een ligh .18,19 Consid-
e ing ha he halo has i s peak o discom o in nigh
and dim condi ions, when he pupil size is la ge , he
in ensi y o he halo o med by an eye wi h he TECNIS
Pu eSee IOL will be low. Thus, i should be expec ed
ha his IOL design p o okes educed le els o pho ic
phenomena in pa ien s, as has been subsequen ly con-
i med in he clinical s udy.
e340
Mo eo e , conside ing ha pos ope a i e e ac i e
e o s can occu a e IOL implan a ion, i is c ucial o
assess he e ec o de ocus on he halo o med a he
bes image plane. Hype opic and myopic de ocus we e
s udied o a 4.5-mm IOL ape u e (5.2-mm eye’s en-
ance pupil, ep esen a i e o nigh ision). Al hough
he halo ea u es we e no signi ican ly in luenced by
he de ocus (Figu e 5), he posi i e de ocus (pos op-
e a i e esidual myopia) inc eased he ela i e ene gy
o he halo, inducing a sligh inc ease o halo in en-
si y. These esul s ag ee wi h wo p e ious s udies7,28
ha e ealed ha he p esence o a sligh amoun o
de ocus inc eased he halo induced by he TECNIS
Pu eSee IOL bu in a simila way o he halo o a
mono ocal IOL (Tecnis One, ZCB00). Mo eo e , he
EDOF TECNIS Pu eSee IOL showed a dyspho opsia
p o ile compa able o he mono ocal IOL, e en in he
p esence o mild e ac i e e o , and lowe le els o
dyspho opsia han a di ac i e EDOF design (Tecnis
Sym ony ZXR00). These esul s sugges ha pos op-
e a i e e ac i e e o , mainly myopic, could ha e an
impac on pho ic phenomena, al hough isual acui y
would be essen ially p ese ed.
Once he op ical quali y o he TECNIS Pu eSee IOL
was assessed, i was c ucial o alida e hese indings in
a clinical se ing o de e mine i s isual pe o mance.
Ou esul s a 3 mon hs yielded excellen isual and
e ac i e ou comes. The monocula UDVA and CDVA
we e 0.10 ± 0.15 and 0.05 ± 0.09 logMAR, espec i ely,
and all eyes had a e ac i e sphe e wi hin ±0.50 D.
The monocula de ocus cu e ob ained wi h he
TECNIS Pu eSee IOL showed a peak o maximum i-
sion a 0.00 D de ocus, ollowed by a smoo h decay
o bo h hype opic and myopic e gences. The cu e
showed a good ole ance o posi i e de ocus (pos ope -
a i e myopic de ocus), wi h a isual acui y close o 0.0
logMAR o +0.50 D and 0.1 logMAR o +1.00 D. Fo
nega i e de ocus (in e media e and nea ision) he i-
sual acui y was be e han 0.2 logMAR (20/32) up o
a e gence o -2.00 D (equi alen o 50 cm), and 0.25
± 0.15 logMAR a he e gence -2.50 D (equi alen o
40 cm). These esul s showed ha his new EDOF IOL
p o ides good dis ance isual acui y, op imal o unc-
ional, up o a dis ance be ween 50 and 40 cm om he
eye. Co be e al8 also epo ed mean monocula de-
ocus cu es o he TECNIS Pu eSee IOL (ZEN00V).
The monocula nega i e de ocus ange whe e isual
acui y o 0.2 logMAR o be e was achie ed ex ended
o -1.60 D, sligh ly lowe han ou s udy (-2.00 D).
A ecen a icle29 de eloped a unc ional classi ica-
ion o simul aneous ision IOL seeking a global con-
sensus, whe e IOLs could be classi ied depending on
he shape o he de ocus cu e. Acco ding o his, he
TECNIS Pu eSee IOL analyzed in ou s udy could be
classi ied as an “ex ended” design.
Finally, his s udy has some limi a ions ha need
o be acknowledged. We did no e alua e he pa ien ’s
subjec i e pe cep ion wi h a alida ed ques ionnai e.
Howe e , all pa ien s we e asked i hey pe cei ed
dis u bing halos and gla e and how equen and
bo he some hese isual dis u bances we e; only one
pa ien epo ed expe iencing gla e occasionally and
wi h sligh in ensi y. Simila indings we e epo ed
by Co be e al,8 showing high pe cen ages o pa ien s
who did no expe ience, we e no bo he ed by, o we e
sligh ly bo he ed by isual symp oms. Addi ionally,
ano he limi a ion is he numbe o pa ien s included
and he sho pos ope a i e ollow-up pe iod. These
ac o s should be aken in o conside a ion in u u e
esea ch o p o ide a mo e comp ehensi e and ep e-
sen a i e e alua ion o he clinical pe o mance o he
TECNIS Pu eSee IOL.
CONCLUSION
The TECNIS Pu eSee IOL p o ided good dis ance
op ical and isual quali y, and a clinically de e mined
ex ended dep h o ield o app oxima ely 2.00 D. The
op ical pe o mance was pupil dependen in e ms o
maximum quali y MTFa peak (achie ed o 0.00 D)
and MTFa cu e wid h, inc easing he dep h o ocus
o smalle pupils. Howe e , he lens design does no
exhibi he myopic powe shi commonly ound wi h
small ape u es in o he EDOF IOLs a ailable in he
ma ke .
The halo induced by he lens in mesopic condi ion
was o low size and ene gy. A small amoun o e ac-
i e e o could be well ole a ed bu could also sligh -
ly inc ease he halo.
AUTHOR CONTRIBUTIONS
S udy concep and design (BA-B, IM-A, LF-V-C, FV,
MSM, DM-C, JFA); da a collec ion (BA-B, IM-A, FC);
analysis and in e p e a ion o da a (BA-B, IM-A, LF-V-C,
FC, FV, MSM, DM-C, JFA); w i ing he manusc ip (BA-B,
IM-A); c i ical e ision o he manusc ip (LF-V-C, FC,
FV, MSM, DM-C, JFA); supe ision (DM-C, JFA)
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